Volumetric Cleft Changes in Treatment With Bone Morphogenic Protein/β-Tricalcium Phosphate Versus Grafts From the Iliac Crest or Symphysis

Abstract

To compare the volumetric changes in successfully treated clefts with secondary alveolar grafting using recombinant human bone morphogenic protein-2 (rhBMP-2) delivered in β-tricalcium phosphate (βTCP) scaffold versus autogenous grafts obtained from the iliac crest and mandibular symphysis. We performed a retrospective cohort study of cone-beam computed tomography scans of 25 subjects with unilateral or bilateral clefts. Of the 25 patients, 7 received an iliac crest bone graft, 9 received a mandibular symphyseal bone graft, and 9 subjects received the rhBMP-2/βTCP bone substitute. Volumetric rendering software was used to calculate the amount of new bone formation and residual bone defect present in the cleft area. The data were analyzed using Wilcoxon and Kruskal-Wallis tests and Pearson's correlation coefficient. The mean percentage of new bone formation for the iliac crest, symphysis, and rhBMP-2/βTCP was 85.47, 80.56, and 81.22%, respectively (P=.0854). The initial cleft volume had a weak positive correlation with the percentage of new bone formation (r=0.18), but the postoperative residual cleft volume had a strong negative correlation (r=0.71). rhBMP2 delivered in a βTCP scaffold in alveolar cleft patients can be a viable alternative to autogenous iliac crest and symphysis grafts, eliminating donor site morbidity.