A Histological and Clinical Evaluation of Long-Term Outcomes of Bovine Bone-Derived Xenografts in Oral Surgery: A Systematic Review

Background: Bovine bone-derived xenografts are widely used in regenerative dental procedures due to their osteoconductive properties and volumetric stability. However, their long-term behavior and biological integration remain a subject of debate. This systematic review aims to critically assess the histological and clinical outcomes associated with bovine xenografts over extended follow-up periods. Methods: An electronic search was performed in PubMed, Scopus, and Web of Science, including studies published in the English language from 2005 to 2025 for a total of 217 records, which were initially identified from PubMed, Scopus, and Wos. Results: After duplicate removal, following title/abstract screening and full-text evaluation, 11 studies met the inclusion criteria. These studies reported on the use of bovine-derived xenografts in clinical contexts, assessing parameters such as graft integration, histological remodeling, complication incidence (e.g., chronic inflammation or foreign body reactions), and implant success rates over time. Conclusions: The current evidence suggests that bovine-derived xenografts, particularly Bio-Oss®, are associated with favorable long-term outcomes in bone regenerative procedures, demonstrating satisfactory graft integration and implant survival rates. However, variations in study design, follow-up duration, and outcome measures warrant further high-quality, long-term randomized clinical trials to confirm these findings and guide clinical decision-making.