Reconstruction of alveolar defects using titanium-reinforced porous polyethylene as a containment device for recombinant human bone morphogenetic protein 2.
OBJECTIVE
The use of recombinant human bone morphogenetic protein 2 (rhBMP-2) in a collagen carrier is a proven alternative to autogenous bone grafting for certain cases. One of the principle limitations of rhBMP-2 at present, however, is the lack of a reliable rigid containment system to prevent soft tissue collapse of the collagen carrier sponge. The present case series describes the use of titanium-reinforced porous polyethylene as a containment device for rhBMP-2-grafted alveolar defects.


METHODS
A case review was performed of 8 patients who had undergone rhBMP-2 bone grafting using porous polyethylene as the containment device. Eight maxillary and two mandibular alveolar defects were grafted using rhBMP-2 and titanium-reinforced porous polyethylene as a soft tissue barrier. One patient received autologous ramus bone in addition to the rhBMP-2. All patients were followed up by clinical examination and periodic radiographic studies for 6 months to 2 years. Implant-borne prostheses were fabricated on all successful grafts.


RESULTS
Of the 10 grafted alveolar defects, 2 (20%) resulted in early exposure of the containment devices, were removed, and resulted in no bone formation. One of the 10 defects (10%) became exposed 3 months postoperatively and resulted in only moderate bone formation. In the 7 nonexposed cases (70%), bone formation was excellent, and implants were successfully placed.


CONCLUSIONS
Titanium-reinforced porous polyethylene might be a useful alternative containment device for rhBMP-2-grafted alveolar defects. The exposure rate of 30% in the present case series is comparable to that for titanium alone. Modifications to the shape and thickness of the material might improve its use in alveolar reconstruction and further reduce the incidence of exposure. Further studies are needed; however, titanium-reinforced porous polyethylene could become a new addition to the armamentarium of clinicians grafting alveolar defects.
Castle Rock Oral and Maxillofacial Surgery, Castle Rock, CO, USA. kristopherhart@yahoo.com
Kristopher L
KL
Hart
Dylan
D
Bowles
D000328:Adult; D016301:Alveolar Bone Loss / Q000601:surgery; D000540:Alveolar Ridge Augmentation / Q000379:methods*; D001672:Biocompatible Materials / Q000737:chemistry; D055396:Bone Morphogenetic Protein 2 / Q000008:administration & dosage / Q000627:therapeutic use*; D016025:Bone Transplantation; D015921:Dental Implants; D004337:Drug Carriers; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery; D008437:Maxilla / Q000293:injuries / Q000601:surgery; D008875:Middle Aged; D010012:Osteogenesis / Q000187:drug effects; D020959:Polyethylene / Q000737:chemistry; D016062:Porosity; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D019651:Plastic Surgery Procedures / Q000379:methods*; D059546:Sinus Floor Augmentation / Q000379:methods; D013529:Surgical Wound Dehiscence / Q000209:etiology; D014025:Titanium / Q000737:chemistry; D016212:Transforming Growth Factor beta / Q000008:administration & dosage / Q000627:therapeutic use*; D014182:Transplantation, Autologous; D014948:Wounds, Gunshot / Q000601:surgery
D001672:Biocompatible Materials; D055396:Bone Morphogenetic Protein 2; D015921:Dental Implants; D004337:Drug Carriers; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta; C499469:recombinant human bone morphogenetic protein-2; D020959:Polyethylene; D014025:Titanium