Volumetric cleft changes in treatment with bone morphogenic protein/beta-tricalcium phosphate versus grafts from the iliac crest or symphysis

Publication date: Available online 21 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Robert L. Trujillo, Onur Kadioglu, G. Fräns Currier, Kevin S. Smith, Enver Yetkiner
PurposeTo compare the volumetric changes in successfully treated clefts with secondary alveolar grafting using recombinant human bone morphogenic protein-2 delivered in ß-tricalcium phosphate scaffold versus autogenous grafts obtained from the iliac crest and the mandibular symphysis.Materials and MethodsA retrospective cohort study comprising cone-beam computed tomography scans of 25 subjects with unilateral or bilateral clefts was implemented. Seven subjects received iliac crest bone graft, nine subjects received mandibular symphyseal bone graft, and nine subjects received rhBMP-2/ßTP bone substitute. Volumetric rendering software was used to calculate the amount of new bone formation and residual bone defect in the cleft area. Data were analyzed using Wilcoxon and Kruskal-Wallis tests and Pearson's correlation coefficient.ResultsMean percent new bone formation for iliac crest, symphysis and rhBMP-2/ßTP were 85.47, 80.56, and 81.22 %, respectively (p-value = 0.0854). Initial cleft volume had a weak positive correlation with the percentage of new bone formation (r=0.18), but the post-surgical residual cleft volume had a strong negative correlation (r=0.71).ConclusionRh-BMP-2 delivered in ßTP scaffold in alveolar cleft patients can be a viable alternative for autogenous iliac crest and symphysis grafts, eliminating donor site morbidity.



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