3D Cone Beam Computed Tomography Volumetric Outcomes of rhBMP-2 with a Demineralized Bone Matrix Scaffold versus Autologous Iliac Crest Bone Graft for Alveolar Cleft Reconstruction
Fan Liang, MD1, Stephen Yen, DMD, PhD2, Luke Sanborn, BS2, Leia Yen, BS2, Ellynore Florendo, BS2, Mark Urata, MD DMD1, Jeffrey Hammoudeh, MD DMD2.
1Keck School of Medicine of USC, Los Angeles, CA, USA, 2Childrens Hospital Los Angeles, Los Angeles, CA, USA.
Recent studies indicate that recombinant human bone morphogenic protein-2 encased in a demineralized bone matrix scaffold (rhBMP/MS) is a comparable alternative to iliac crest bone grafting in secondary alveolar cleft reconstruction. In this study, we utilize Cone Beam Computed Tomography (CBCT) to provide the first clinical evaluation of volumetric differences in bony reconstitution between rhBMP/MS vs. iliac crest bone graft.
A prospective study was performed for 55 patients who underwent secondary alveolar cleft reconstruction over a 2 year period. 38 patients received rhBMP/MS and 17 patients underwent iliac bone grafting. Postoperatively, occlusal radiographs were obtained at 3 months and CBCT images at 6-9 months. Bone stock was evaluated on occlusal radiographs using the Bergland rating scale whereas specialized software was used to obtain volumetric data on CBCT images.
At 3 months, occlusal radiographs demonstrate that 67% of patients receiving rhBMP/MS had complete bone fill vs 56% of patients with iliac bone graft. Volumetric analysis using CBCT images showed rhBMP/MS patients had 40% bone fill compared with 20% in the iliac graft population. Further analysis revealed preferential bone fill in the anteroposterior and vertical vs the transverse dimensions.
These data demonstrate comparable if not better bony regrowth in alveolar cleft defects using rhBMP/MS vs. iliac bone graft on both occlusal and CBCT imaging. CBCT is shown to provide a nuanced spatial understanding of bony reconstitution that can be extended to understanding the temporal sequence of events in future studies.
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