Maxillary Alveolar Clefts Reconstruction Using Recombinant Human Bone Morphogenetic Protein-2 (rh BMP-2) and Absorbable Collagen Sponge Carrier (ACS)

Oral Abstract Session 4 sence of neuropathic pain at 3, 6, and 12 months after surgery. Methods of Data Analysis: A four-fold table was used to obtain sensitivity, specificity, positive predictive values, and negative predictive values for neuropathic pain after surgery. A chi square was used to determine the level of statistical significance, and a logistic regression analysis was used to evaluate the association between neuropathic pain and secondary endpoints. Results: Forty-one patient records were reviewed; the average age at time of injury was 36.6 years (range 15.3-59.5 years); gender ratio male/female 12/29; the mean duration of injury before repair was 10.9 months (range 0.5-84.5 mos); class of injury distribution was: Class III - 21.7%, Class IV - 34.8%, Class V - 43.5%; there were 27 lingual and 14 inferior alveolar nerve repairs; etiology of nerve injury: 3rd molar surgery was the predominant cause of injury (73.9%), 8.7% periodontic surgery and others included implant placement, osteotomy, endodontic; 11 patients had neuropathic pain before surgery and 30 did not. The presence of neuropathic pain prior to nerve surgery was the significant risk factor associated with the presence of neuropathic pain following trigeminal nerve surgery. Pain prior to surgery had the following: sensitivity 72.7% (pain present before surgery would be present after surgery), specificity 100% (no pain before surgery, no pain after surgery), positive predictive value 100% (pain before surgery was predictor of pain after surgery), and negative predictive value 91% (some who had pain before surgery would not have pain after [9%]). In 100% of patients, if there was no neuropathic pain prior to surgery there was none after surgery. Conclusion: The presence of neuropathic pain prior to trigeminal nerve repair is the major risk factor for developing postoperative neuropathic pain following nerve surgery. These findings also suggest that trigeminal nerve surgery is not a risk factor for postoperative trigeminal neuropathic pain in the absence of neuropathic pain before surgery.

Presented by: Nader N. Elbokle, DDS, MS, PhD, Giza, Egypt Statement of the Problem: The alveolar bone graft is an essential step in the overall management of a patient with cleft lip and palate. Secondary alveolar bone graft procedure has been established as the “gold standard” for alveolar cleft reconstruction and has provided a foundational support in current cleft management. Many sources, both autogenous and alloplasts, have been studied and compared in the search for the ideal bone graft material. The regeneration of bone defects using rh BMP-2 holds promise as a future treatment for reconstructive surgery and implant dentistry. Materials and Methods: Six consecutive patients with unilateral maxillary alveolar clefts were randomly selected from the outpatient clinic of the Oral & Maxillofacial Surgery Department, Cairo University, Egypt. These alveolar clefts were grafted with rh BMP-2 in an absorbable collagen sponge carrier. The patients were chosen with the following criteria: Age of the patients ranging from 7 to 11 years, free from any systemic disease with no local pathosis of the maxilla that may interfere with surgery. Methods of Data Analysis: This study was assessed clinically and radiographically via CT scans prior to alveolar cleft grafting and 6 months after grafting. Volumetric analysis was performed to evaluate the volume of the alveolar cleft grafted, also densitometric analysis was performed to evaluate the bone density achieved and compare it with native bone. Results: Preliminary results showed clinical success of alveolar cleft grafting using rh-BMP-2 and ACS carrier. Radiographic assessement at 6 months post alveolar grafting showed adequate filling of bone in the alveolar defect and significant increase in bone density of the rh-BMP-2 alveolar graft. Conclusion: This study showed that rh-BMP-2/ACS may provide an acceptable alternative to autogenous bone grafts and bone substitutes for maxillary alveolar cleft reconstruction in humans.

References Rath EM. Peripheral neurotrauma-induced sensory neuropathy. Oral and Maxillofacial Surgery Clinics of North America. 13:223, 2001 Gregg, JM. Studies of traumatic neuralgia in the maxillofacial region: symptom complexes and response to microsurgery. J Oral Maxillofac Surg 48:135, 1990

References Marukawa E, Asahina I, Oda M, Seto I, Alam MI, Enomoto S. Bone regeneration using recombinant human bone morphogenetic protein-2 (rhBMP-2) in alveolar defects of primate mandibles. Bri. J. of Oral and Maxillofac. Surg. 39: 452– 459, 2001 Hibi H, Yamada Y, Ueda M, Endo Y: Alveolar cleft osteoplasty using tissue engineered osteogenic material. Int. J. Oral Maxillofac. Surg. 35: 551–555, 2006

Maxillary Alveolar Clefts Reconstruction Using Recombinant Human Bone Morphogenetic Protein-2 (rh BMP-2) and Absorbable Collagen Sponge Carrier (ACS)

OsteoMark: A Novel Surgical Navigation System for Minimally Invasive Oral and Maxillofacial Surgery

Mohamed El-Faramawey, BDS, MS, Giza, Egypt (Elbokle N; Allam K)

Carl Bouchard, DMD, MSc, FRCD(C), Quebec City, Quebec, Canada (Magill J; Kaban LB; Troulis MJ)

AAOMS • 2009

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