Reduced morbidity and improved healing with bone morphogenic protein-2 in older patients with alveolar cleft defects.
BACKGROUND
In older cleft patients, alveolar bone grafting may be associated with poor wound healing, graft exposure, recurrent fistula, and failure of tooth eruption. A new procedure using a resorbable collagen matrix with bone morphogenetic protein (BMP)-2 was compared with traditional iliac crest bone graft to close alveolar defects in older patients.


METHODS
Skeletally mature patients with an alveolar cleft defect undergoing alveolar cleft repair were divided into either group 1 (BMP-2, experimental) or group 2 (traditional iliac graft, control) (n = 21). Bone healing was assessed with intraoral examination and NewTom scans (three-dimensional, Panorex, periapical films). Donor-site morbidity was determined with pain surveys. Overall cost and length of hospital stay were used to examine economic differences.


RESULTS
Preoperative and follow-up (1 year) intraoral examinations revealed fewer complications (11 percent versus 50 percent) and better estimated bone graft take in group 1 compared with group 2. Panorex and three-dimensional computed tomographic scans showed enhanced mineralization in group 1 compared with group 2. Volumetric analysis showed group 1 had a larger percentage alveolar defect filled with new bone (95 percent) compared with group 2 (63 percent). Donor-site pain intensity and frequency were significant in group 2 but not group 1. The mean length of stay was greater for group 2 compared with group 1. In addition, the mean overall cost of the procedure was greater in group 2 ($21,800) compared with group 1 ($11,100).


CONCLUSIONS
For this select group of late-presenting alveolar cleft patients, the BMP-2 procedure resulted in improved bone healing and reduced morbidity compared with traditional iliac bone grafting.
Dickinson
Brian P
BP
Los Angeles, Calif. From the Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine, University of California, Los Angeles.
Ashley
Rebekah K
RK
Wasson
Kristy L
KL
O'Hara
Catherine
C
Gabbay
Joubin
J
Heller
Justin B
JB
Bradley
James P
JP
D000287:Administration, Topical; D000293:Adolescent; D000539:Alveolar Process / Q000187:drug effects* / Q000601:surgery; D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins / Q000008:administration & dosage*; D016025:Bone Transplantation; D002972:Cleft Palate / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D017102:Fracture Healing / Q000187:drug effects; D006801:Humans; D007085:Ilium / Q000601:surgery; D036341:Intercellular Signaling Peptides and Proteins / Q000008:administration & dosage*; D008297:Male; D016212:Transforming Growth Factor beta / Q000008:administration & dosage*; D014945:Wound Healing / Q000187:drug effects; D014947:Wounds and Injuries / Q000188:drug therapy*
C525718:BMP2 protein, human; D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins; D036341:Intercellular Signaling Peptides and Proteins; D016212:Transforming Growth Factor beta