Is rhBMP-2/Demineralized Bone Matrix Comparable to Iliac Crest Bone Grafting in Alveolar Cleft Reconstruction?

Abstract

After conventional primary closure of a cleft lip there is inevitable scar tissue, oral nasal fistula, inadequate support for the ala of the nose and absence of bone in the region of the future permanent lateral incisor and canine. Secondary bone grafting is hence required during mixed dentition to provide necessary bone support and attached gingiva for teeth adjacent to the cleft, closure of any remaining oronasal fistula, and improvement in support of the alar base. Many bone sources for bone grafting of the alveolar cleft have been utilized, including calvarium, mandibular symphysis, rib, tibia, allogeneic bone, and rhBMP-2, but anterior iliac crest bone graft (AICBG) remains the gold standard. Despite that, many complications are reported after iliac crest bone graft, including hematoma, seroma, false aneurysm, nerve and arterial injuries, gait disturbances, fracture of the iliac wing, visceral and ureteral injuries, peritoneal perforation, infection, sacroiliac instability, and pain.1 rhBMP-2 with demineralized bone matrix has become an alternative in reconstruction and provides a treatment option to avoid the need of a donor site and related morbidity.