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The Journal of Periodontology and Misinformation

The one check on the publication of false information are letters to the editor, and unlike other journals, the Journal of Periodontology does not allow letters to the editor.

Letters to the editor in scientific journals serve several purposes:

  1. Communication: Letters to the editor provide a platform for researchers and experts to communicate with the journal’s readership and the scientific community at large. They allow authors to share their thoughts, opinions, and insights on recently published articles or scientific issues of interest.
  2. Corrections and Critiques: Letters to the editor often serve as a means to point out errors, omissions, or shortcomings in published articles. They offer an avenue for researchers to provide corrections, clarifications, or additional information to enhance the scientific record.
  3. Discussion and Debate: Letters to the editor foster scientific discourse and open dialogue by allowing researchers to engage in discussions or debates about a particular topic or study. They can present alternative interpretations, challenge existing findings, or propose new hypotheses, sparking further research and exploration.

Presently, the Journal of Periodontology continues to publish false statements about various bone grafts in the articles it publishes. The biggest area of potential abuse is when the authors are also on the board of the journal. When this occurs, it is unlikely anyone is going to challenge a publication by another board member, especially when similar biases are shared. Without letters to the editor to hold the journal in check, the journal no longer is restrained from printing misinformation. One area of obvious abuse is the false statements that are permitted to be made in Journal of Periodontology in articles about cadaver bone grafts.

Recent articles have been allowed to claim that allografts are osteoinductive and stimulate osteogenesis in humans. There are no studies that show allografts are osteoinductive or stimulate osteogenesis in humans, but there are many articles that conclude that allografts are not osteoinductive and do not stimulate osteogenesis. It is not possible for all of the members of the board be so ignorant of the literature that these statements are permitted. Recent articles in the Journal of Periodontology state that Bio-Oss is deproteinized. Bio-Oss is full of proteins and it is not possible for members of the board to know so little about the bone grafts they study and use to not know this fact. This level of ignorance is not possible for those that claim to be our most learned.

Allograft Osteoinductivity

A case in point is the publication of articles by Dr. Mealey involving allografts. Dr. Mealey has continued to state that allografts are osteoinductive as if to give the material some positive physiologic properties. A personal email was sent to Dr. Mealey over a decade ago asking if he would share what scientific basis he has for making these statements in his publications. His reply:

“As you know, induction studies are generally done in animal models, as such studies are not do-able in humans. I know of no such human studies, which is why our discussion of this issue was more theoretical than evidence-based.”
– Dr. Brian Mealey

Dr. Mealey has been claiming allografts are osteoinductive his entire career, yet he admits he has no scientific basis for his claims. In response, I sent him human studies that conclusively determined that allografts are not osteoinductive in humans, and of course he did not respond. The following articles were sent to Dr. Mealey over a decade ago that clearly establish that allografts are not osteoinductive in humans. There are no published articles that find that allografts are osteoinductive in humans as he continues to claim.

  • Mineralization processes in demineralized bone matrix grafts in human maxillary sinus floor elevations.
    • Groeneveld EH, van den Bergh JP, Holzmann P, ten Bruggenkate CM, Tuinzing DB, Burger EH
  • Comparison of bone regeneration with the use of mineralized and demineralized freeze-dried bone allografts: a histological and histochemical study in man.
    • Piattelli A, Scarano A, Corigliano M, Piattelli M.
  • Clinical and histologic observations of sites implanted with intraoral autologous bone grafts or allografts. 15 human case reports.
    • Becker W, Urist M, Becker BE, Jackson W, Parry DA, Bartold M, Vincenzzi G, De Georges D, Niederwanger M
  • The osteoinductive potential of demineralized freeze-dried bone allograft in human non-orthotopic sites: a pilot study.
    • Paul BF, Horning GM, Hellstein JW, Schafer DR

Animal studies also state allografts are not osteoinductive in animals:

  • Variations in bone regeneration adjacent to implants augmented with barrier membranes alone or with demineralized freeze-dried bone or autologous grafts: a study in dogs.
    • Becker W, Schenk R, Higuchi K, Lekholm U, Becker BE
  • A comparative analysis of bone formation induced by human demineralized freeze-dried bone and enamel matrix derivative in rat calvaria critical-size bone defects.
    • Intini G, Andreana S, Buhite RJ, Bobek L

The literature is clear that allografts are not osteoinductive in humans.

Dr. Mealey has continued to publish papers on allografts and continues to state the grafts are osteoinductive without any indications that his statements are theoretical. This deception is just an effort to fool the profession into thinking there is something beneficial to these bone grafts. Dr. Mealey does not state that allografts stimulate osteogenesis because the literature is overwhelming in concluding that cadaver bone grafts inhibit bone formation. Even if allografts were osteoinductive, what benefit is there to stimulating a precursor cell to become an osteoblast if that osteoblast is inhibited from producing bone?

Allograft Resorption

Another area of continued misinformation promoted by Dr. Mealey is the implication that allografts are eventually resorbed and become normal bone. He cites studies where demineralized freeze-dried bone allograft have produced histology with no retained graft particles. The only problem is that demineralized freeze-dried bone allograft is not bone. Bone is a mineralized tissue and when you take away the mineralization, you have particles that are 90% collagen and 10% proteins. For actual bone to be resorbed, this requires an osteoclast and osteoclasts have never been found on a mineralized allograft particle after it has been covered with mineralization. The collagen that results from demineralization is not resorbed by osteoclasts because it is not bone, but it can be resorbed by the body’s immune response. Dr. Mealey knows that mineralized bone allograft are not resorbed over time and he has proven that in one of his very own publications:

However, in a recent publication, Dr. Mealey states:

“It is also not clear the amount of time needed for the particulate bone allograft to be entirely replaced with new vital bone.”

Dr. Mealey knows that once covered with mineralizaton, mineralized freeze-dried bone allograft is never resorbed over time, and he knows that demineralized freeze-dried bone will be slowly resorbed over time because it is just collagen. He also knows that studies have found that mineralized freeze-dried bone allograft have approximately 30% retained particles at all time points. He put together a study combining 70% mineralized freeze dried bone allograft and 30% demineralized freeze dried bone allograft, followed it for a year, and found 18% retained graft particles. He uses this to try to convince the reader that if they had just waited longer, all the graft would be resorbed and turn into vital bone. Do the math. If 100% mineralized freeze-dried bone allograft results in 30% retained graft particles that never resorb, but you mix in 30% demineralized freeze-dried bone allograft which will be totally cleared by the immune response, that will give you the 18% and it is all mineralized freeze dried bone allograft that is never going to be resorbed.

Bone Type and Quality

Apparently, Dr. Mealey does not know that for a mineralized particulate bone graft to be resorbed and remodeled, it requires a basic multicellular unit (described in the short course video linked below) and the remodeling process converts the particulate graft into lamellar bone — never woven bone. However, after one year, he states that the vital bone is woven bone, not lamellar bone. We suggest that Dr. Mealey take our short course on bone biology because he would then know that resorption and remodeling only produces lamellar bone and never woven bone. Dr. Mealey claimed the histology was all woven bone after one year, which proves that no resorption or remodeling of the mineralized graft particles have occurred and never will occur. Irrespective if the allograft is demineralized or not, the bone produced is never normal and always sclerotic, and unfortunately Dr. Mealey cannot tell the difference between woven bone and sclerotic bone.

In this article Dr. Mealey also provides his definition of bone quality:

“Bone quality can be evaluated histologically by determining the amount of vital bone formation…”

According to this assessment, the sclerotic bone in your knee that needs to be cut out and replaced is the best bone in your body. Sclerotic bone is vital bone with a high percentage of vital mineralized tissue, but it also is pathologic, never becomes healthy lamellar bone, and eventually fails whether it is supporting your body or your dental implant.

The article ends with the statement:

“The amount of time required for a particulate bone allograft to be entirely replaced by new host bone remains unclear.”

Dr. Mealey has no scientific support for his claims of allograft osteoinduction in humans, but he continually states the opposite because he needs to convince the reader that there is some positive physiologic property of the material. He has no scientific support for misleading the reader into thinking that what they are doing to their patients will ever produce normal bone.

Many in our profession have promoted cadaver bone grafts for their entire career and now that these materials are being questioned, some are desperate to protect their legacy and many are willing to promote false information to keep the profession under their control. We are interested in educating the profession so that each clinician can recognize false information. We have produced a 2-hour video that educates the professional and gives you the knowledge to identify misinformation when you see it:

Free Short Course on Bone Science

Here is an article you will never see published in the Journal of Periodontology:

Many thought leaders in the periodontal profession have protected themselves from scientific scrutiny by not allowing letters to the editor in their primary journal. Debate is stifled because the false statements that are continually allowed to be published in Journal of Periodontology cannot be challenged. If the reader believes what is published in the Journal of Periodontology, it is our contention that they are intentionally being kept ignorant.

If Dr. Mealey would like to respond to this article, we will ensure his rebuttal is available to read for all who subscribe to our newsletter. Any response to this article is welcomed and will be shared with our community for debate. If any reader would like to develop a better understanding of bone and bone graft biology so they can better understand the concepts discussed in this post, we urge you to watch the short course on bone science linked above.

MEMBER:

American Society for Bone and Mineral Research (ASBMR)

Tissue Engineering and Regenerative Medicine International Society (TERMIS)

American Academy of Implant Dentistry (AAID)

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