# Contamination in Bone Substitute Materials: A Systematic Review
## 4 Discussion  
During bone augmentation procedures, due to significant bone loss, the lack of contamination of the surgical field is crucial to the success of the procedure [42; 43]. Aseptic and anti-iseptic techniques help reduce the number of contaminants transferred to the surgical field by the operator's tools and hands. However, all these efforts to increase the success of treatment may be in vain when using bone substitute material containing contaminants. This systematic review included 22 papers that evaluated various contaminants in bone substitute materials. These contaminants can be of organic origin, chemical compounds, or crystalline phases that hinder or prevent new bone formation. The findings indicate significant gaps \begin{table}
\begin{tabular}{c c c c c c c c} \hline \hline \multirow{2}{*}{**Study**} & **Physiochemical** & **Quantitative** & **Presence** & **Detailed Description** & & & \\  & **and/or Micro-discreparation** & **Assessment of** & **Assessment of** & **of a** & **of Material** & **Sample Size** & **Biological** & **Total** \\  & **Evaluated** & **In Alloplastic** & **Control** & **Propation/** & **Calculation** & **Assessment** & **pls.** & **Risk of Bias** \\  & **Alloplastic** & **Material** & **Group** & **Decontamination** & & & \\ \hline [PERSON] et al. [22] & 1 & 0 & 1 & 1 & 0 & 0 & 3 & Moderate \\ \hline [PERSON] et al. [30] & 1 & 0 & 1 & 1 & 0 & 1 & 4 & Moderate \\ \hline [PERSON] et al. [9] & 1 & 0 & 1 & 1 & 0 & 1 & 4 & Moderate \\ \hline [PERSON] et al. [24] & 1 & 1 & 1 & 1 & 0 & 1 & 5 & Low \\ \hline [PERSON] et al. [25] & 1 & 1 & 0 & 1 & 0 & 0 & 3 & Moderate \\ \hline [PERSON] et al. [26] & 1 & 1 & 0 & 1 & 0 & 0 & 3 & Moderate \\ \hline [PERSON] et al. [31] & 0 & 0 & 1 & 1 & 0 & 0 & 2 & Moderate \\ \hline [PERSON] et al. [32] & 1 & 1 & 1 & 1 & 0 & 1 & 5 & Low \\ \hline [PERSON] et al. [37] & 1 & 1 & 1 & 1 & 0 & 1 & 5 & Low \\ \hline [PERSON] et al. [38] & 1 & 0 & 0 & 1 & 0 & 0 & 2 & Moderate \\ \hline [PERSON] et al. [40] & 1 & 0 & 1 & 1 & 0 & 1 & 4 & Moderate \\ \hline [PERSON] et al. [33] & 1 & 0 & 0 & 0 & 0 & 1 & 2 & Moderate \\ \hline [PERSON] et al. [11] & 1 & 1 & 1 & 1 & 0 & 1 & 5 & Low \\ \hline [PERSON] et al. [27] & 1 & 1 & 0 & 1 & 0 & 0 & 3 & Moderate \\ \hline [PERSON] et al. [36] & 1 & 0 & 1 & 1 & 0 & 1 & 4 & Moderate \\ \hline [PERSON] et al. [41] & 1 & 1 & 1 & 1 & 0 & 0 & 4 & Moderate \\ \hline [PERSON] et al. [28] & 1 & 1 & 1 & 1 & 0 & 0 & 4 & Moderate \\ \hline [PERSON] et al. [34] & 1 & 0 & 0 & 1 & 0 & 1 & 3 & Moderate \\ \hline [PERSON] et al. [35] & 1 & 1 & 1 & 1 & 0 & 1 & 5 & Low \\ \hline [PERSON] et al. [29] & 1 & 1 & 1 & 1 & 0 & 1 & 5 & Low \\ \hline [PERSON] et al. [39] & 0 & 0 & 1 & 1 & 0 & 1 & 3 & Moderate \\ \hline [PERSON] et al. [23] & 1 & 1 & 1 & 1 & 0 & 0 & 4 & Moderate \\ \hline \hline \end{tabular}
\end{table} 
Table 3: Quality assessment. in research on the contamination of bone substitute materials. Among the studies included in the review, thirteen focused on synthetic materials [9; 11; 23; 24; 26; 27; 29; 32; 35; 36; 37; 40; 41], four studies dealt with animal materials [22; 25; 28; 38], and two investigated human materials [34; 39]. Additionally, two studies analyzed both human and animal materials [30; 31], and one study compared human, animal, and synthetic materials [33]. Tests of allogeneic and xenogeneic bone substitute materials have shown that some materials contain contaminants, although manufacturers ensure the purity of their materials. Research by [PERSON] et al. [31] based on the analysis of allogenic bone blocks available on the market showed that three out of five materials available on the market were contaminated. Manufacturers ensured the purity of the materials, but contaminants such as organic and cellular residues were found. Histological analysis of the Maxgraft material by [PERSON] et al. [38] showed cellular debris, intertrabecular fat, connective tissue, and collagen. The work of [PERSON] et al.