A Demineralized Cortical Bone Sheet is a specialty allograft that is produced by a demineralization process which removes the mineral phase from the bone tissue surface, creating a more biologically active matrix. Demineralization preserves collagen while increasing the bio‑availability of bone‑morphogenetic protein‑2 (BMP‑2), making the matrix more osteoinductive. 1,2
In dentistry, there are new grafts which process these 100% demineralized allografts into thin sheets which become flexible after hydration. They are sold under various brand names, like Allosheet from Salvin Dental and the DALI Flex Graft from DDSGadget. Below we have compiled and update the most frequently asked questions about De-Mineralized Cortical Bone Sheets so you get everything you need to know about the cortical sheets in one place! For pricing and purchasing, please visit: DALI Flex Graft
What are the benefits of the Demineralized Cortical Sheet ?
- When hydrated the sheet becomes pliable and adapts easily to graft sites
- The DALI Cortical Sheet is packaged in sterile saline to allow for faster hydration!
- Because of it’s flexible nature it is the perfect solution for the augmentation of a buccal ridge deficiency.
- Can be sutured in place or fixated with screws or tacks
- Sterilized using low-dose gamma irradiation
- Sourced and Processed by a leading AATB-accredited tissue bank.
What are the sizes of the Demineralized Cortical Sheet ?
The DALI Cortical Sheet is offered in a 10mm x 10mm x 1mm size. Some other brands also offer a 10mm X 18mm x 1mm size, though we have found the 10x10 size to be much more suitable for the primary use case of this the cortical sheets.
Do you have cases demonstrating the effectiveness of the Demineralized Cortical Sheet ?
Yes. With regards to ridge augmentation, please see the The use of demineralized laminar bone sheets in guided bone regeneration procedures: report of three cases. , where Demineralized sheets were utilized for guided bone regeneration around five implants. "In all cases, significant regeneration of hard tissues occurred, and no complications were encountered. "3
Furthermore, we have an excellent case with a 2-year follow up utilizing the DALI Flex Graft, which you can read about at Grafting’s Best Kept Secret: DALI Flex Cortical Bone Sheet and at Effectively Addressing Defects around Implants with a Cortical Bone Sheet. In this case, the cortical sheets was used to help simplify contour augmentation around an implant to address a ridge deficiency. At 2 year follow up, the ridge contour and the tissue profile were ideal and the DALI Flex Graft integrated well into the surrounding bone.
What is the recommended method for hydrating the DALI Flex Graft Demineralized Cortical Bone Sheet and how long should it be hydrated for?
The DALI Flex Graft can be hydrated using the patient’s blood or with saline solution. To accelerate graft reconstitution, DALI Flex Graft is packaged in sterile saline, as such hydrating it after opening should be quick, with graft pliability in under 10 minutes.
Can the Demineralized Cortical Sheet be placed over particulate graft material?
Yes, the Cortical Sheet can be placed over particulate graft.
What is the the Demineralized Cortical Sheet material made from? Is there any collagen in it?
The Cortical Sheet is 100% Bone that has been demineralized, which is a special process that removes the mineral phase from the bone tissue surface. Demineralization preserves collagen while increasing the bio‑availability of bone‑morphogenetic protein‑2 (BMP‑2).
Can the Demineralized Cortical Sheet be used without a membrane?
In general, the use of a dental membrane is to prevent the soft tissue cell from entering the graft site prior to bone forming, and to help contain granular graft materials in place (if they are used). This is the natural role for periosteum – the separation of hard and soft tissue. As such, if there is primary closure of an intact periosteum, than this is sufficient, and there should be no need for a membrane when using the Cortical Sheet. However, without primary closure, and if the periosteum is damaged, torn or cut for vertical release, it becomes less effective as a barrier and a membrane should be used.
Can the Demineralized Cortical Sheet be cut and folded to increase millimeter height?
Yes, you may cut the Cortical Sheet and fold one piece on top of the other to increase thickness.
References
- Glowacki J. Demineralized Bone and BMPs: Basic Science and Clinical Utility. J Oral Maxillofac Surg. 2015 Dec;73(12 Suppl):S126-31.
- Salmeron S, Freire MO, Dos Santos CF, de Oliveira RC, Lisboa-Filho PN, Arruda LB, Trino LD, Sant’Ana ACP, Zadeh HH, de Rezende MLR. Demineralization Promotes Changes on the Bone Surface That Improve Osteoblast Growth. Int J Oral Maxillofac Implants. 2026 Jun 12;41(3):410-418.
- Fugazzotto PA. The use of demineralized laminar bone sheets in guided bone regeneration procedures: report of three cases. Int J Oral Maxillofac Implants. 1996 Mar-Apr;11(2):239-44.