Volume 1, Issue 2

 

New Development in Bone Regeneration Use of rhBMP-2 in Oral Maxillofacial Surgery

August 2, 2010

Background:

INFUSE Bone Graft is indicated as an alternative to autogenous bone graft .Bone Morphogenetic Proteins (BMP) are cytokines that belong to a family of TGF-beta superproteins. There are 15 BMPs identified  BMP2 is the product used).

BMP functions include: the induction of bone and cartilage maturation of osteocytes, chondroblasts, osteoblasts.  The BMP is reconstituted in normal saline and placed on a specially developed collagen carrier sponge.  The benefit of infuse is that it avoids the necessity of harvesting a graft from a secondary site.  In OMFS the most common sites are the iliac crest, tibia, lateral ramus, and anterior chin.

 Objectives:

Evaluate the success of infuse bone graft in bony defects and time of usable bone formation in reconstruction.  To evaluate the off label use in 4 cases where infuse was placed for increased bone thickness, and for closure of alveolar cleft.

 

 

Methods:

12 patients received infuse bone graft in varying quantities depending on the size of the defect and bone necessary.  In certain cases titanium mesh was placed to prevent compression of the graft.  Preoperative imaging was obtained prior to graft placement.  Prior to reconstruction with titanium implants a post infuse CT scan or panoramic radiograph was taken.

 

 

 

Results:

In all 8 of the twelve patients production of viable bone was successful.  The other 4 patients do not have enough time passed as yet to evaluate bone formation.    5 of the patients received implants and the quality of bone was extremely dense upon clinical evaluation as compared to the surrounding bone.

 

Discussion:

The formation of de novo bone takes 6 months after placement of infuse bone graft.  Autogenous bone grafting techniques are highly predictable and reliable.  However, there are disadvantages with autogenous bone grafts,  postoperative morbidities from harvesting process  include bowel perforation, gait disturbances, paresthesias, hematoma, increased operating time and pain.

Infuse has reliably grown bone in all patients where bone formation was assessable via radiograph.  As of now infuse is FDA approved only for sinus augmentation and tooth extraction socket preservation in Oral Maxillofacial use.  In the 4 off label use of infuse, significant bone formation was evident after 6 months.

References:

1)Todd G. Carter, “Off-Label Use of Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2) for Reconstruction of Mandibular Bone Defects in Humans,” Journal of Oral and Maxillofacial Surgery July 2008 (Vol. 66, Issue 7, Pages 1417-1425)

2) Alan S. Herford, Philip J. Boyne, “Reconstruction of Mandibular Continuity Defects With Bone Morphogenetic Protein-2 (rhBMP-2),” Journal of Oral and Maxillofacial Surgery April 2008 (Vol. 66, Issue 4, Pages 616-624)

3) Alan S. Herford, “Recombinant Human Bone Morphogenetic Protein-2 (Rh BMP-2),” Journal of Oral and Maxillofacial Surgery August 2005 (Vol. 63, Issue 8, Supplement, Pages 14-15)

4) Epub 2009 Sep 26. “A trial of alveolar cleft bone regeneration by controlled release of bone morphogenetic protein: an experimental study in rabbits,” Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Dec;108(6):812-20.