Abstract
Recombinant human bone morphogenetic protein-2 (rhBMP-2) is an osteoinductive growth factor used in oral and maxillofacial surgery. It offers a feasible alternative for various regenerative procedures, including reconstruction of mandibular defects. In this study, we report a case of a large Pindborg tumor involving the left mandible. The treatment consisted of surgical resection, followed by off-label use of rhBMP-2 in addition to bone marrow aspirate concentrate, together with an allograft in a titanium mesh. The patient was rehabilitated with dental implants, and a good clinical outcome was achieved. We found no evidence of bone resorption or complications in both clinical and radiographic evaluations during the one-year follow-up period. In conclusion, we have demonstrated the efficacy of using rhBMP-2 combined with bone marrow aspirate concentrate, and an allograft with a titanium mesh, for the reconstruction of long mandibular bone defects. Not only is this combination feasible, but it also has the advantages of lower morbidity and cost.
Highlights
The reconstruction of mandibular defects poses a significant challenge in oral and maxillofacial surgery, in cases with bone continuity defects [1]
One of the alternatives to traditional bone grafting is the use of recombinant human bone morphogenetic protein-2, which is a potent osteoinductive growth factor that attracts mesenchymal stem cells, and stimulates them to proliferate and differentiate into osteoblasts [8, 9]. rhBMP-2 can be used alone or in combination with different types of grafts, such as allografts and autografts
Autogenous bone grafts are still considered the gold standard for the reconstruction of osseous defects since they incorporate all the properties necessary for bone regeneration, i.e. osteogenesis, osteoinduction, and osteoconduction
Summary
The reconstruction of mandibular defects poses a significant challenge in oral and maxillofacial surgery, in cases with bone continuity defects [1]. Autogenous bone grafts are considered the gold standard for surgical repair of most osseous defects [4, 5]; there are major drawbacks to this treatment modality, including donor site morbidity and the limited amount of bone that can be harvested [6, 7]. With recent breakthroughs in tissue engineering, many new graft materials and treatment modalities for the reconstruction of mandibular defects have been developed. Allografts are osteoconductive materials, which maintain space for bone ingrowth, whereas bone marrow aspirate concentrate (BMAC) increases the supply of stem cells and cytokines, increasing the osteogenic potential of the graft [10]. We sought to evaluate the results of using rhBMP-2 combined with BMAC, and an allograft with a titanium mesh, for the reconstruction of segmental bone defects
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