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Poster Board Number: 39: Alveolar Ridge Reconstruction Using Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2)
Scientific Poster Session with rigid fixation support but at times with inadequate bone volume and donor site morbidity. The FDA has approved 100% non-crystalline amorphous Poly-DL-Lactic Acid mesh (PDLLA) for maintaining relative position of bone fragments or bone grafts (autograft or allograft) in reconstruction of the craniofacial or mandibular areas. Poly-DL-Lactic Acid mesh completely hydrolyzes in 12 to 15 months and loses structural strength in approximately 10 to 12 weeks. Benefits include minimal to no soft tissue reaction and the lack of impediment to implant placement at 4 to 6 months utilization. This method with rhBMP-2 and allogeneic or autogenous stem cell source provides a predictable three dimensional reconstruction with adequate volume. References: Carter TG, Brar PS, Tolas A, Beirne OR: Off-label use of recombinant human bone morphogenetic protein-2 (rhBMP-2) for reconstruction of mandibular bone defects in humans. J Oral Maxillofac Surg 66:1417, 2008. Herford AS, Boyne PJ, et al: Reconstruction of mandibular continuity defects with bone morphogenetic protein-2 (rhBMP-2). J Oral Maxillofac Surg 66:616, 2008.
POSTER BOARD NUMBER: 39 Alveolar Ridge Reconstruction Using Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2) N. Park: Kings County Hospital, Y. Yusupov, D. Vasquez, D. Hoffman, S. Lazow, J. Berger Statement of the Problem: Many options exist for the reconstruction of alveolar ridge defects. Autogenous and alloplastic grafts have been used. The autograft bone has the disadvantage of resorption and donor site morbidity. Alloplastic materials do not readily allow placement of implants. In the search for the ideal bone graft material, the use of growth factor, recombinant human bone morphogenetic protein-2 (rhBMP-2) is currently becoming a popular alternative. Its clinical application is already FDA approved for lumbar spinal fusion and tibia fracture, ridge preservation of extraction socket, and maxillary sinus augmentations. The use of rhBMP-2 on an absorbable collagen sponge (ACS) as an alveolar onlay graft has potential limitations. The rhBMP-2/ACS has limited capacity to resist compression; sufficient space is not provided or maintained in which bone may form. The objective of this study was to evaluate the effect of rhBMP-2/ACS as an alveolar onlay graft when used in conjunction with space protective titanium mesh. Materials and Methods: A retrospective review of eight patients with class III alveolar ridge defects (Lekholm and Zarb classification) who underwent alveolar ridge augmentations was performed. All patients had pre-augmentation CT scans from which stereolithic modAAOMS • 2010
els were generated. These models were used to preshape titanium mesh into an ideal ridge dimension adequate in height and width for future implant placement. Augmentations were performed with 0.8mg/ml rhBMP-2 soaked on an ACS. A total of 4.0mg rhBMP-2 was used per defect. 2 ml of demineralized bone matrix (DBM) putty was then placed on the rhBMP-2/ACS and the resulting construct formed into a roll and placed over the defect. Titanium mesh was secured over the ”roll” with 1.5mm titanium screws. Methods of Data Analysis: This study was assessed clinically and radiographically via CT scans prior to, immediately after, and 6 months post alveolar augmentation. CT guided measurements of the width and height of alveolar bone were taken at each proposed implant site. The horizontal and vertical net gains were compared to the dimension of titanium mesh. Results of Investigation: All proposed implant sites demonstrated radiographic evidence of vertical and horizontal bone formation approximating the titanium mesh dimension. Vertical bone gain averaged 84% and horizontal bone gain averaged 94% of height and width of titanium mesh, respectively. Implants were successfully placed in 32 of 32 proposed sites 6 month post ridge augmentation. No additional grafting procedures were needed prior to implant placement. Conclusion: The study showed that rhBMP-2/ACS/ DBM is an effective onlay source to augment alveolar bone height and width prior to implant placement. References: Boyne P: Application of bone morphogenetic proteins in the treatment of clinical oral and maxillofacial osseous defects. J Bone Joint Surg Am 83-A: S146-S150, 2001 Lekholm U, Zarb GA: Patient selection and preparation. In Branemark P-I, Zarb GA, Albrektsson T (eds): Tissue-Integrated Prosthesis: Osseointegration in Clinical Dentistry. Chicago, Quintessence, 1985, pp199-209
POSTER BOARD NUMBER: 40 Mandibular Reconstruction With a NonVascularized Iliac Crest Bone Graft Utilizing Computer-Aided Design and Computer-Aided Manufacturing for the Fabrication of a Custom Surgical Resection Guide and Reconstruction Plate B.D. Foley: Vanderbilt University, S. Press Statement of the Problem: Nonvascularized iliac crest bone grafts (ICBG) are the gold standard for small (⬍4 to 6cm) mandibular reconstructions resulting from odontogenic cysts and tumors, osteomyelitis, and comminuted or avulsive mandibular injuries. The goal of mandibular reconstruction is to create an orthognathie-83
POSTER BOARD NUMBER: 39 Alveolar Ridge Reconstruction Using Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2) N. Park: Kings County Hospital, Y. Yusupov, D. Vasquez, D. Hoffman, S. Lazow, J. Berger Statement of the Problem: Many options exist for the reconstruction of alveolar ridge defects. Autogenous and alloplastic grafts have been used. The autograft bone has the disadvantage of resorption and donor site morbidity. Alloplastic materials do not readily allow placement of implants. In the search for the ideal bone graft material, the use of growth factor, recombinant human bone morphogenetic protein-2 (rhBMP-2) is currently becoming a popular alternative. Its clinical application is already FDA approved for lumbar spinal fusion and tibia fracture, ridge preservation of extraction socket, and maxillary sinus augmentations. The use of rhBMP-2 on an absorbable collagen sponge (ACS) as an alveolar onlay graft has potential limitations. The rhBMP-2/ACS has limited capacity to resist compression; sufficient space is not provided or maintained in which bone may form. The objective of this study was to evaluate the effect of rhBMP-2/ACS as an alveolar onlay graft when used in conjunction with space protective titanium mesh. Materials and Methods: A retrospective review of eight patients with class III alveolar ridge defects (Lekholm and Zarb classification) who underwent alveolar ridge augmentations was performed. All patients had pre-augmentation CT scans from which stereolithic modAAOMS • 2010
els were generated. These models were used to preshape titanium mesh into an ideal ridge dimension adequate in height and width for future implant placement. Augmentations were performed with 0.8mg/ml rhBMP-2 soaked on an ACS. A total of 4.0mg rhBMP-2 was used per defect. 2 ml of demineralized bone matrix (DBM) putty was then placed on the rhBMP-2/ACS and the resulting construct formed into a roll and placed over the defect. Titanium mesh was secured over the ”roll” with 1.5mm titanium screws. Methods of Data Analysis: This study was assessed clinically and radiographically via CT scans prior to, immediately after, and 6 months post alveolar augmentation. CT guided measurements of the width and height of alveolar bone were taken at each proposed implant site. The horizontal and vertical net gains were compared to the dimension of titanium mesh. Results of Investigation: All proposed implant sites demonstrated radiographic evidence of vertical and horizontal bone formation approximating the titanium mesh dimension. Vertical bone gain averaged 84% and horizontal bone gain averaged 94% of height and width of titanium mesh, respectively. Implants were successfully placed in 32 of 32 proposed sites 6 month post ridge augmentation. No additional grafting procedures were needed prior to implant placement. Conclusion: The study showed that rhBMP-2/ACS/ DBM is an effective onlay source to augment alveolar bone height and width prior to implant placement. References: Boyne P: Application of bone morphogenetic proteins in the treatment of clinical oral and maxillofacial osseous defects. J Bone Joint Surg Am 83-A: S146-S150, 2001 Lekholm U, Zarb GA: Patient selection and preparation. In Branemark P-I, Zarb GA, Albrektsson T (eds): Tissue-Integrated Prosthesis: Osseointegration in Clinical Dentistry. Chicago, Quintessence, 1985, pp199-209
POSTER BOARD NUMBER: 40 Mandibular Reconstruction With a NonVascularized Iliac Crest Bone Graft Utilizing Computer-Aided Design and Computer-Aided Manufacturing for the Fabrication of a Custom Surgical Resection Guide and Reconstruction Plate B.D. Foley: Vanderbilt University, S. Press Statement of the Problem: Nonvascularized iliac crest bone grafts (ICBG) are the gold standard for small (⬍4 to 6cm) mandibular reconstructions resulting from odontogenic cysts and tumors, osteomyelitis, and comminuted or avulsive mandibular injuries. The goal of mandibular reconstruction is to create an orthognathie-83