transforming-growth-factor-beta and Jaw--Edentulous--Partially

To compare the effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) in an absorbable collagen sponge carrier (ACS) with autogenous bone graft for augmentation of the edentulous atrophic anterior maxilla.. Twenty-four subjects were enrolled in a randomized, controlled, parallel-group, open-label clinical trial. Subjects either received rhBMP-2/ACS (1.5 mg/ml) or particulated autogenous bone harvested from the mandibular retromolar region. A titanium-mesh was used to provide space and wound stability. A guide was used to standardize clinical recordings using an analogue caliper. Alveolar ridge width was also assessed using cone-beam computed tomography.. rhBMP-2/ACS yielded significantly greater radiographic horizontal bone gain compared with autogenous bone graft at immediate subcrestal levels (1.5 ± 0.7 versus 0.5 ± 0.9 mm; p = 0.01); non-significant differences were observed at mid- (2.9 ± 0.8 versus 2.9 ± 0.9 mm; p = 0.98) and apical (1.7 ± 0.9 versus 1.8 ± 1.1 mm; p = 0.85) crestal levels. No significant differences in clinical horizontal bone gain were observed at 6 months between rhBMP-2/ACS and autogenous bone graft (3.2 ± 0.9 mm versus 3.7 ± 1.4 mm; p = 0.31). Sixty-two implants were placed after 6 month of healing with no significant differences between groups for number of implants, implant size, primary stability and survival.. rhBMP-2/ACS appears a realistic alternative for augmentation of the edentulous atrophic anterior maxilla.

Topics: Absorbable Implants; Adult; Alveolar Process; Alveolar Ridge Augmentation; Atrophy; Autografts; Biocompatible Materials; Bone Morphogenetic Protein 2; Bone Transplantation; Collagen; Cone-Beam Computed Tomography; Dental Implantation, Endosseous; Dental Implants; Drug Carriers; Female; Follow-Up Studies; Humans; Jaw, Edentulous, Partially; Male; Maxilla; Middle Aged; Osteogenesis; Recombinant Proteins; Surgical Mesh; Titanium; Transforming Growth Factor beta

This pilot study was designed to determine the clinical bone formation ability of a human recombinant DNA bone morphogenetic protein-7, also referred to as Osteogenic Protein-1 [OP-1] combined with a collagen carrier, implanted in the maxillary sinus of 3 patients. The results were compared with a group of 3 patients treated with sinus floor elevation and autogenous bone grafts.. 6 consecutive patients, 4 female and 2 male, between 48 and 57 years of age were treated by means of sinus floor elevation for insufficient bone height in the posterior maxilla for implant surgery. 3 patients, 2 female and 1 male, were treated with OP-1 attached to a collagen device. In these patients, 4 maxillary sinus grafting procedures according to Tatum's method were carried out. 1 g of collagen carrier containing 2.5 mg rhOP-1 mixed with 3 ml of saline was placed between the bony floor and the elevated mucosal lining of the most caudal part of the maxillary sinus, in order to increase the vertical bone dimension to place dental implants of a sufficient length. The 3 other patients, also 2 female and 1 male, with a total of 5 sinus sites, were treated with sinus floor elevation and autogenous iliac crest bone grafts. After 6 months, during dental implant preparation, bone cores were taken for histology. Thus, clinical, radiological and histological results of the 2 groups of 3 patients were compared.. 6 months after sinus grafting with OP-1, in 1 male, well-vascularized bone-like tissue of good quality was observed clinically. This could be confirmed by histology. In the second, female, patient no bone formation was observed at all. A cyst-like granular tissue mass, without purulent content, was removed. In the 3rd, female, patient, who received bilateral sinus grafts, some bone-like formation was seen, however it showed flexible tissue which led to the decision that at 6 months after the sinus grafting, the implant placement had to be postponed. In all 5 autogenous grafted sinuses a bone appearance similar to normal maxillary bone was observed clinically as well as histologically and dental implants could be placed six months after sinus floor elevation surgery.. These findings indicate that the OP-1 device has the potential for initiating bone formation in the human maxillary sinus within 6 months after a sinus floor elevation operation. However, the various findings in these 3 patients indicate that the behaviour of the material is at this moment insufficiently predictable, in this indication area. Further investigation is indicated before OP-1 can be successfully used instead of the "gold standard" autogenous bone graft.

Topics: Biopsy; Bone Morphogenetic Protein 7; Bone Morphogenetic Proteins; Bone Transplantation; Dental Implantation, Endosseous; Female; Humans; Jaw, Edentulous, Partially; Male; Maxilla; Maxillary Sinus; Middle Aged; Pilot Projects; Prospective Studies; Radiography; Recombinant Proteins; Transforming Growth Factor beta; Transplantation, Autologous

Cases of severely atrophic edentulous maxilla require reconstruction techniques employing bone grafts to promote adequate bone dimension for the successful placement of dental implants for prosthetic rehabilitation that reestablishes the patient's function and aesthetics. This study aims to present a severely atrophic edentulous maxilla reconstruction with the off-label use of recombinant human bone morphogenetic protein type 2 (rhBMP-2) associated with lyophilized particulate bovine bone xenograft for the prosthetic rehabilitation with osseointegrable dental implants. The paper describes a case of severely atrophic edentulous maxilla in a 42-year-old woman referred to the dental school with complaint of failure in adaptating to the dentures. The patient reported 27 years of maxilla edentulism and consecutive treatment failures, so the proposed therapy was the reconstruction of the maxilla with an association of rhBMP-2 and lyophilized bovine bone xenograft for increasing bone volume and further prosthetic rehabilitation with osseointegrated dental implants. The present report illustrates a case of atrophic edentulous maxilla in which the off-label use of rhBMP-2 was successful and the patient's prosthetic rehabilitation could be concluded. The 8 dental implants received prosthetic functional load during 1 year of follow-up with no complications. Based on the case presented, the association between rhBMP-2 and a bovine bone xenograft could be considered a viable option for the reconstruction of atrophic edentulous maxilla. After a year of functional prosthetic load follow-up, the patient is asymptomatic and satisfactorily adaptated to the prosthesis, which restored her functional and aesthetic demands.

Topics: Adult; Animals; Atrophy; Bone Morphogenetic Protein 2; Bone Transplantation; Cattle; Dental Implantation, Endosseous; Dental Prosthesis, Implant-Supported; Esthetics, Dental; Female; Freeze Drying; Humans; Jaw, Edentulous, Partially; Maxilla; Recombinant Proteins; Transforming Growth Factor beta

The loss of multiple teeth or trauma to the anterior maxilla often results in a deficient ridge width for prosthetic tooth rehabilitation. This study evaluated the use of titanium mesh and recombinant human bone morphogenetic protein 2 (rhBMP-2) for the repair of major bone defects in the alveolar bone. Five patients were enrolled in the study; these patients required implant replacements for two contiguous missing teeth in the anterior maxilla, which lacked sufficient bone. Residual ridges were augmented with rhBMP-2 and titanium mesh to direct the geometry of the newly formed bone. Seven months later, a bone biopsy specimen was removed from the implantation site before osteotomy and insertion of dental implants. Cone beam computed tomography (CBCT) scans were obtained preoperatively, postoperatively (baseline), and 48 months after implantation to evaluate implant healing. All dental implants were placed in the grafted sites without the need for further bone augmentation. The most frequent adverse effects were facial oedema and oral erythema. Biopsy specimens were used to evaluate bone quality. CBCT scans provided a prediction of alveolar restoration and long-term success. The combination of rhBMP-2 and titanium mesh provided effective augmentation of the atrophic anterior maxilla prior to implant placement.

Topics: Alveolar Ridge Augmentation; Atrophy; Biopsy; Bone Morphogenetic Protein 2; Cone-Beam Computed Tomography; Dental Implantation, Endosseous; Dental Implants; Female; Humans; Jaw, Edentulous, Partially; Male; Maxilla; Middle Aged; Osteotomy; Prospective Studies; Recombinant Proteins; Surgical Flaps; Surgical Mesh; Titanium; Transforming Growth Factor beta; Treatment Outcome

To test the hypothesis that a synthetic hydroxyapatite/β-tricalcium phosphate (HA/TCP) construct combined with polyethylene glycol (PEG) hydrogel including recombinant human bone morphogenetic proteins-2 (rhBMP-2) enhances new bone formation compared with bone morphogenetic proteins-2 (BMP-2) delivered using the HA/TCP construct alone.. Bilateral mandibular partial thickness 20 × 8 × 8 mm (L × W × H) alveolar defects were surgically created in the edentulated posterior mandible in 18 female minipigs. Randomized into two groups of nine animals each, the alveolar defects either received HA/TCP or HA/TCP/PEG with or without BMP-2 (105 μg/defect) in contra-lateral sites using a split-mouth design. Primary outcome, bone density (%) within four regions of interest, was evaluated following a 4-week healing interval when the animals were killed for histometric analysis.. Bone morphogenetic proteins-2 loaded onto HA/TCP constructs significantly enhanced new bone formation compared with HA/TCP controls. Adding PEG apparently obstructed BMP-2 induced bone formation.. Polyethylene glycol compromises the osteogenic effect of BMP-2.

Topics: Alveolar Bone Loss; Alveolar Process; Animals; Biocompatible Materials; Bone Density; Bone Morphogenetic Protein 2; Bone Substitutes; Calcium Phosphates; Drug Carriers; Female; Hydrogel, Polyethylene Glycol Dimethacrylate; Jaw, Edentulous, Partially; Mandible; Mandibular Diseases; Mandibular Reconstruction; Osteogenesis; Random Allocation; Recombinant Proteins; Swine; Swine, Miniature; Transforming Growth Factor beta