Risk of Prion Disease Transmission through Bovine-Derived Bone Substitutes: 
A Systematic Review
Yeoungsug Kim DDS1, Hessam Nowzari DDS; PhD2,*, Sandra K. Rich MPH, 
PhD3
Article first published online: 15 DEC 2011
DOI: 10.1111/j.1708-8208.2011.00407.x
© 2011 Wiley Periodicals, Inc. 
Issue 
Clinical Implant Dentistry and Related Research 
Clinical Implant Dentistry and Related Research 
Volume 15, Issue 5, pages 645–653, October 2013 
Additional Information(Hide All)
How to CiteAuthor InformationPublication History 
 How to Cite
Kim, Y., Nowzari, H. and Rich, S. K. (2013), Risk of Prion Disease 
Transmission through Bovine-Derived Bone Substitutes: A Systematic Review. 
Clinical Implant Dentistry and Related Research, 15: 645–653. doi: 
10.1111/j.1708-8208.2011.00407.x 
Author Information 1 Resident, Advanced Education in Periodontics Program, 
Herman Ostrow School of Dentistry, University of Southern California, Los 
Angeles, CA, USA
2 professor, Clinical Dentistry and director, Advanced Education in 
Periodontics Program, Herman Ostrow School of Dentistry, University of Southern 
California, Los Angeles, CA, USA
3 associate professor, Advanced Education in Periodontics Program, Herman 
Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, 
USA 
*Dr. Hessam Nowzari, Herman Ostrow School of Dentistry, University of 
Southern California, Norris Dental Science Center-DEN, 925W. 34th Street, Room 
119, Los Angeles, CA 90089-0641, USA; e-mail: nowzari@usc.edu 
Publication History Issue published online: 7 OCT 2013 Article first 
published online: 15 DEC 2011 
Keywords:
anorganic bovine bone substitutes; BSE diagnostic test; BSE prion 
inactivation; BSE prion infectivity; protein; PrP(27-30); PrPSc 
ABSTRACT 
Background: Despite the causal association between variant Creutzfeldt – 
Jakob disease and bovine spongiform encephalopathy (BSE), bovine origin graft 
materials are widely used during dental surgical procedures. The aim of this 
study was to assess the risk of BSE transmission through anorganic bovine bone 
substitutes. 
Methods: Electronic database of MEDLINE was searched to identify relevant 
studies regarding our focused questions, presence of BSE prion infectivity in 
raw bovine bone, BSE prion inactivation by bone substitute manufacturing 
process, protein contents in anorganic bovine bone substitutes, and validity of 
current BSE diagnostic methods. Search terms yielded 1,704 titles. After 
title/abstract screening and duplicates removal, 36 full-text articles were 
screened for inclusion. 
Results: A total of 16 studies were included in the final analysis. No 
eligible studies were identified regarding the efficacy of BSE prion 
inactivation by the treatments used for anorganic bovine bone manufacturing. BSE 
infectivity and PrPSc, pathological prion, were detected in bovine bone marrow 
and serum samples. Proteins were detected in Tutoplast® (bovine), Bio-Oss®, and 
tibia samples treated at the similar condition for Bio-Oss deproteinization. 
Inconsistent results of different BSE diagnostic tests were not unusual findings 
(Iwata et al. 2006; Arnold et al. 2007; Murayama et al. 2010), and a study by 
Balkema-Buschmann and colleagues showed an apparent discrepancy between BSE 
infectivity and detection of PrP(27-30), the current surrogate marker for prion 
disease infectivity. 
Conclusion: This review indicates that bovine-derived graft biomaterials 
may carry a risk of prion transmission to patients. 
Thursday, January 17, 2013
TSE guidance, surgical, dental, blood risk factors, Part 4 Infection control of CJD, vCJD and other human prion diseases in healthcare and community settings (updated January 2013)
http://transmissiblespongiformencephalopathy.blogspot.com/2013/01/tse-guidance-surgical-dental-blood-risk.html
Tuesday, October 29, 2013 
VARIANT CJD PRESENTS DIFFERENTLY IN OLDER PATIENTS 
Monday, October 14, 2013 
Researchers estimate one in 2,000 people in the UK carry variant CJD proteins
http://creutzfeldt-jakob-disease.blogspot.com/2013/10/researchers-estimate-one-in-2000-people.html
 
Researchers estimate one in 2,000 people in the UK carry variant CJD proteins
http://creutzfeldt-jakob-disease.blogspot.com/2013/10/researchers-estimate-one-in-2000-people.html
WHAT about the sporadic CJD TSE proteins 
?
WE now know that some cases of sporadic CJD are linked to atypical BSE 
and atypical Scrapie, so why are not MORE concerned about the sporadic CJD, and 
all it’s sub-types $$$ 
Sunday, August 11, 2013 
Creutzfeldt-Jakob Disease CJD cases rising North America updated report August 2013
Creutzfeldt-Jakob Disease CJD cases rising North America with Canada seeing an extreme increase of 48% between 2008 and 2010
http://creutzfeldt-jakob-disease.blogspot.com/2013/08/creutzfeldt-jakob-disease-cjd-cases.html
Creutzfeldt-Jakob Disease CJD cases rising North America updated report August 2013
Creutzfeldt-Jakob Disease CJD cases rising North America with Canada seeing an extreme increase of 48% between 2008 and 2010
http://creutzfeldt-jakob-disease.blogspot.com/2013/08/creutzfeldt-jakob-disease-cjd-cases.html
Sunday, October 13, 2013 
CJD TSE Prion Disease Cases in Texas by Year, 2003-2012
http://creutzfeldt-jakob-disease.blogspot.com/2013/10/cjd-tse-prion-disease-cases-in-texas-by.html
CJD TSE Prion Disease Cases in Texas by Year, 2003-2012
http://creutzfeldt-jakob-disease.blogspot.com/2013/10/cjd-tse-prion-disease-cases-in-texas-by.html
Wednesday, September 25, 2013
Cleaning, disinfection and sterilization of surface prion contamination
http://creutzfeldt-jakob-disease.blogspot.com/2013/09/cleaning-disinfection-and-sterilization.html

 
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