Bone morphogenetic proteins for periodontal and alveolar indications; biological observations - clinical implications.
Surgical placement of endosseous oral implants is governed by the prosthetic design and by the morphology and quality of the alveolar bone. Nevertheless, often implant placement may be complexed, if at all possible, by alveolar ridge irregularities resulting from periodontal disease, and chronic and acute trauma. In consequence, implant positioning commonly necessitates bone augmentation procedures. One objective of our laboratory is to evaluate the biologic potential of bone morphogenetic proteins (BMP) and other candidate biologics, bone biomaterials, and devices for alveolar ridge augmentation and implant fixation using discriminating large animal models. This focused review illustrates the unique biologic potential, the clinical relevance and perspectives of recombinant human BMP-2 (rhBMP-2) using a variety of carrier technologies to induce local bone formation and implant osseointegration for inlay and onlay indications. Our studies demonstrate a clinically relevant potential of a purpose-designed titanium porous oxide implant surface as stand-alone technology to deliver rhBMP-2 for alveolar augmentation. In perspective, merits and shortcomings of current treatment protocol including bone biomaterials and guided bone regeneration are addressed and explained. We demonstrate that rhBMP-2 has unparalleled potential to augment alveolar bone, and support implant osseointegration and long-term functional loading. Inclusion of rhBMP-2 for alveolar augmentation and osseointegration will not only enhance predictability of existing clinical protocol but also radically change current treatment paradigms.
Wikesjö
U M E
UM
Laboratory for Applied Periodontal & Craniofacial Regeneration, Department of Periodontics, Medical College of Georgia School of Dentistry, Augusta, GA 30912, USA. uwikesjo@mcg.edu
Qahash
M
M
Huang
Y-H
YH
Xiropaidis
A
A
Polimeni
G
G
Susin
C
C
D000540:Alveolar Ridge Augmentation / Q000379:methods*; D000818:Animals; D001672:Biocompatible Materials / Q000627:therapeutic use; D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins / Q000627:therapeutic use*; D018786:Bone Substitutes / Q000627:therapeutic use; D003758:Dental Implantation, Endosseous / Q000379:methods; D015921:Dental Implants; D017267:Dental Prosthesis Design; D004195:Disease Models, Animal; D004337:Drug Carriers; D048091:Guided Tissue Regeneration / Q000379:methods; D006801:Humans; D016348:Osseointegration / Q000187:drug effects; D010012:Osteogenesis / Q000187:drug effects; D010510:Periodontal Diseases / Q000601:surgery*; D011994:Recombinant Proteins / Q000627:therapeutic use*; D016212:Transforming Growth Factor beta / Q000627:therapeutic use*
D001672:Biocompatible Materials; D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins; D018786:Bone Substitutes; D015921:Dental Implants; D004337:Drug Carriers; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta; C499469:recombinant human bone morphogenetic protein-2