Purpose: Alveolar ridge augmentation is essential for success in implant therapy and depends on the biological performance of bone graft materials. This literature review aims to comprehensively explain the clinically relevant capabilities and limitations of currently available bone substitutes for bone augmentation in light of biomaterial science. Study selection: The biological performance of calcium phosphate-based bone substitutes was categorized according to space-making capability, biocompatibility, bioabsorption, and volume maintenance over time. Each category was reviewed based on clinical studies, preclinical animal studies, and in vitro studies. Results: Currently available bone substitutes provide only osteoconduction as a scaffold but not osteoinduction. Particle size, sensitivity to enzymatic or chemical dissolution, and mechanical properties affect the space-making capability of bone substitutes. The nature of collagen fibers, particulate size, and release of calcium ions influence the biocompatibility of bone substitutes. Bioabsorption of bone substitutes is determined by water solubility (chemical composition) and acid resistance (integrity of apatite structure). Bioabsorption of remnant bone substitute material and volume maintenance of the augmented bone are inversely related. Conclusion: It is necessary to improve the biocompatibility of currently available bone substitutes and to strike an appropriate balance between bioabsorption and volume maintenance to achieve ideal bone remodeling.
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