Received: 22 March 2023 Revised: 26 April 2023 Accepted: 26 April 2023
DOI: 10.1111/cid.13215
LETTER TO THE EDITOR
How the use of xenogeneic grafts can impact the relationship
with some social groups and blood donor patients
Dear Editor,
A projection of more than two million graft procedures for alveolar
bone reconstruction will be performed each year, worldwide (more
than 500 000 in the United States alone), and there is an expected
1–3
increase in this number. Bone substitute biomaterials and different
collagen membranes related to surgical protocols are used, to the det-
riment of the use of autogenous bone grafts. These products, defined
as synthetic or biological biomaterials, can be used in bone defects
2,4,5
with different magnitudes of treatment. In this context, the most
used biomaterials to bone regeneration are xenogeneic, of different
animal origins: bovine, swine, and equine. These biomaterials are
widely used for alveolar bone reconstruction procedures, with
predictable results, and longitudinal follow-up associated with implant
rehabilitation and periodontal treatment.6–12
However, the demand for these biomaterials impact in a situation,
according to different International Health Organizations, that regu-
late blood donations and transfusions—Food and Drug Administration
(FDA—United States), European Commission Public Health (ECPH—
Europe), and World Health Organization (WHO). Perhaps the knowl-
edge about the WHO, FDA, and ECPH regulations many times pre-
sents different points of view, these organizations are unanimous in
relation to the use of xenogeneic biomaterial, that the blood and deri-
vate donation from patients who received xenografts for alveolar
reconstructions are categorized as definitively ineligible for this dona-
13–17
tion. The WHO further suggested that transplant and/or graft of
allogenic origin since 1980, and grafts of xenogeneic origin performed
on the human body, are categorized as definitively ineligible too.13
These regulations are based on the fact that products of allogenic
or xenogeneic origin can lead to the development of prion diseases
such as Creutzfeldt Jakob Disease, and Mad Cow Disease or Spongiform
Encephalopathy in humans (in the case of bovine grafts).13
Current knowledge shows there are no reported events in den-
tistry related to cases of human contamination with development of
prion diseases after xenograft biomaterials were used for alveolar
bone regeneration procedures. However, despite this regulation by
the different health agencies cited above, the companies that market
these types of biomaterials guarantee that their preparation (treat-
ments aimed at removing organic material, calcination at different
temperatures, and/or treatment with sodium hydroxide) follows inter-
national standards, and that the use of these biomaterials is safe. But
it's important to stress that manufacturer cannot prove that inorganic
xenografts are totally absent of prions.18–20
Clin Implant Dent Relat Res. 2023;1–2. wileyonlinelibrary.com/journal/cid
In this context, this situation must be publicized in the dental
journals and professional media. Dental surgeons must clarify the con-
stitution and the origin of the biomaterials that will be used as grafts
for all the patients, blood donors, or not. It should be remembered
that different social groups of patients, such as followers of the vegan
lifestyle, as well as those belonging to certain religious groups, pro-
hibit practitioners from receiving products from animals or certain
species. These restrictive situations could have legal implications to
be imputed to dentistry professionals, who must be aware of patients
before using treatments with xenogeneic grafts.
AUTHOR CONTRIBU TIONS

bio: Concept/design; data analysis/interpreta-
Elton Gonçalves Zeno
tion; critical revision of article and approval of article. Dayane Ferreira
Resende: Data collection; data analysis/interpretation; drafting article

ria Netto de Albuquerque: Data collec-
and approval of article. Vito
tion; data analysis/interpretation; drafting article and approval of arti-
cle. Polianne Alves Mendes: Data collection; data analysis/
interpretation; drafting article and approval of article. Fernando
Antônio Mauad de Abreu: Concept/design; data analysis/interpreta-
tion; critical revision of article and approval of article. Maurício Greco
Côsso: Concept/design; data analysis/interpretation; critical revision
of article and approval of article. All authors actively participated in
the discussion of the manuscript's findings, and have revised and
approved the final version of the manuscript.
ACKNOWLEDG MENTS
The study was financed in part by the Coordenação de Aperfeiçoa-
mento Pessoal de Nível Superior—Brazil (CAPES).
FUNDING INF ORMATI ON
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
CONFLIC T OF INTER E ST STATEMENT
The authors declare no conflict ofinterest.

bio PhD
Elton Gonçalves Zeno
Dayane Ferreira Resende

ria Netto de Albuquerque
Vito
Polianne Alves Mendes
Fernando Antônio Mauad de Abreu PhD
Maurício Greco Côsso PhD
© 2023 Wiley Periodicals LLC. 1
2 LETTER TO THE EDITOR
Department of Dentistry, Pontifical Catholic University of Minas Gerais,
Belo Horizonte, Minas Gerais, Brazil
Correspondence

bio, Department of Dentistry, Pontifical
Elton Gonçalves Zeno
Catholic University of Minas Gerais, Dom José Gaspar
Av. 500, Coração Eucarístico, Belo Horizonte, MG 30535-901, Brazil.
Email: zenobio@pucminas.br
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