Bone grafting is one of the cornerstones of orthopaedic surgery. In cases like trauma, tumors, fusions and skeletal reconstruction there are often spaces and gaps that need to be filled in with bone. This is where bone grafting comes into play, and there are many options. The best bet is to use bone harvested from the patient, such as iliac crest bone graft from the pelvis. This is termed autograft and contains bone-producing stem-cells, growth factors and a structural scaffold to provide mechanical stability. In cases where a surgeon would like to avoid the pain and risk associated with harvesting bone, there are less invasive options. You can use bone obtained from organ donors, termed allograft (also less appropriately dubbed “croutons”). Allograft, however, carries the risk of infection and other transplant associated problems. Then there are bone graft substitutes/extenders, synthetic bioactive materials that provide a scaffold for healing bone to grow into. These usually are the least effective, however they can be combined with various modalities such as bone marrow aspirate to be a safe and effective (although more expensive) alternative to traditional bone grafting.
So in related news, ISTO just announced that their InQu Bone Graft extender/substitute material just received CE Mark approval (it received 510(k) clearance in the US in 2007). The product is somewhat unique, in that it combines polylactide-co-glycolide (PLGA) and unmodified hyaluronicacid (HyA), which are materials not commonly found in most commercially available bone graft substitutes. There is little research available regarding the effectiveness of this combination in skeletal surgery in the extremities, but it sounds promising. The PLGA is meant to provide an osteoconductive scaffold while the HyA improves handling, cell attachment and supports vascular ingrowth. It is designed for use in non-structural areas of bone, such as small voids from benign tumor excisions or hardware removals. The material is available as granules, a paste, putty and 3-dimensional structures.
Orthopedic and maxillofacial surgeons sometimes prepare for surgery by creating physical models of 3D scans of bones that they need to work on. Such models are also useful in educating med school students, doctors, and patients. However, these models tend to be very expensive, usually seen only in well-funded research projects or used by expensive medical professionals. Oftentimes, because the cost of the model is so high, a compromise must be made, so the resulting models end up being truncated or less than actual size.
Bone grafting is the use of either native, cadaveric, or artifical bone pieces to fill a void where you would like new bone to grow. Often at first, bone grafts have poor structural qualities and need hardware to protect them, the bone around and to keep them in place. In Oral-Maxillofacial surgery bone loss is often caused by infection, trauma, tumors and other conditions. 
Perhaps someday, the bi-annual trip to the dentist may become much less intimidating, thanks to researchers at Leeds University in the UK who have developed a completely pain-free way to fill cavities.
NovaBone Products has introduced a new line of biologically active bone-graft substitutes that are designed to enhance the body’s natural healing process by facilitating rapid vascularization and mineralization. Suspended in a rapidly-absorbable binder, the moldable material contains a calcium phosphosilicate with a continuous macroporous structure. Known as MacroPor-Si+, the product can be used to repair osseous defects throughout the skeletal system.
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