Reconstruction of Mandibular Defects Using Bone Morphogenic Protein: Can Growth Factors Replace the Need for Autologous Bone Grafts? A Systematic Review of the Literature

Alan S Herford,Rahul Tandon,Enrico Stoffella

doi:10.1155/2011/165824

Abstract

Autogenous bone is still considered the “gold standard” of regenerative and reconstructive procedures involving mandibular defects. However, harvesting of this material can lead to many complications like increasing morbidity, expanding of the surgical time, and incomplete healing of the donor site. In the last few years many authors looked for the development of effective reconstruction procedures using osteoinductive factors without the need for conventional bone grafting. The first-in-human study involving the use of Bone Morphongenic Proteins (rhBMP) for mandibular reconstruction was performed in 2001 by Moghadam. Only few articles have been reported in the literature since then. The purpose of this study was to search and analyze the literature involving the use of rhBMP for reconstruction of mandibular defects. In all the studies reported, authors agree that the use of grown factors may represent the future of regenerative procedures with more research necessary for confirmation.

Highlights

Tissue engineering holds great promise for revolutionizing many grafting procedures
The purpose of this study is to evaluate the different study present in the literature concerning the use of growth factors for the reconstruction of mandibular defects, comparing the method and the finals results
In all the other cases the carrier used was an absorbable collagen sponge (ACS), except for the first case reported in the literature, in which Moghadam et al used a poloxamer-based gel to create the bioimplant

Summary

Introduction

Tissue engineering holds great promise for revolutionizing many grafting procedures. Continuity defects of the mandible frequently result from tumor removal or significant trauma, and reconstruction of these defects can be challenging. The development of bone morphogenic proteins (BMPs) has offered an alternative to traditional bone grafting, which has been the gold standard for oral and maxillofacial reconstruction [2]. There have been few studies addressing the use of BMP in reconstructing critical-size defects of the mandible. Various bone grafting and bone manipulation techniques are available for restoring large mandibular bony defects. An ideal osseous grafting treatment should involve use of a bone inductive material that would be reliable, biocompatible, long-lasting, and capable of restoring mandibular continuity with minimal morbidity. The development of effective reconstruction procedures using osteoinductive factors, such as growth factors (GFs), without the need for conventional bone grafting has allowed the possibility to decrease surgical morbidity [7,8,9]. The risk of morbidity is a concern [11, 12] and has led to the great appeal of protein guided bone regeneration

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Conclusion