EFFECTS OF RECOMBINED HUMAN BONE MORPHOGENETIC PROTEIN-2 AS ALVEOLAR RIDGE PRESERVATION ON PAIN REDUCTION AND SOFT TISSUE HEALING PROCESS: A SPLIT MOUTH DESIGNED PILOT STUDY

Abstract

Background: The alveolar ridge undergoes physiological bone resorption following tooth extraction. Several alveolar ridge preservation (ARP) techniques have been researched and developed in an effort to reduce this process and maintain a favorable volume and morphology of the alveolar ridge for appropriate implant placement. Bone morphogenetic proteins (BMPs) are proteins derived from a subgroup of the transforming growth factor  family that accelerates ossification by controlling essential factors of the bone induction cascade, resulting in the proliferation of osteoblasts from mesenchymal stem cells and the biosynthesis of bone matrices. One of these BMPs is recombinant human bone morphogenetic protein-2 (rhBMP-2) that has been authorized to be used for ARP. Objective: This study aims to evaluate the effect of rhBMP-2 on the healing process and the level of pain following dental extraction. Methods: In this split-mouth pilot study, 11 patients underwent extractions of a minimum of two teeth, and randomly, one of the alveolar sockets was filled with a hemostatic sponge while the other was filled with a hemostatic sponge embedded with rhBMP-2. Both sockets were sutured using the X technique. Wound healing measurements were done on days 3, 7, and 14, and each participant was requested to document his pain experience using the Numerical Rating Scale (NRS). Results: In accordance with clinical evidence, it was observed that the mean pain score was at its peak on day 0 and progressively diminished in the subsequent days. Notably, this decline was more pronounced in the rhBMP-2 group compared to the control group. Importantly, a statistically significant reduction in pain level was detected on day 3 within the rhBMP-2 group, in contrast to the control group (P-value < 0.05). This indicated that the application of rhBMP-2 led to a noteworthy and meaningful alleviation of pain on the third day after treatment, surpassing the impact observed in the control group. For the wound healing changes, it uncovered statistically significant mean differences across various time intervals: day 0 and day 3, day 0 and day 7, day 0 and day 14, day 3 and day 7, and day 7 and day 14 (P-value < 0.0001). These significant differences strongly suggest dynamic changes in wound closure rates over time. Furthermore, the observed differences were more pronounced in the rhBMP-2-treated group compared to the control group. This augmentation of differences indicates that the utilization of rhBMP-2 for ARP within a fresh socket site resulted in a heightened acceleration of the wound healing process. Conclusion: Our results suggest that rhBMP-2 can decrease post-operative pain after tooth extraction and accelerate the soft tissue healing process.