Application of Recombinant Human BMP-2 with Bone Marrow Aspirate Concentrate and Platelet-Rich Fibrin in Titanium Mesh for Vertical Maxillary Defect Reconstruction prior to Implant Placement

Abstract

Recombinant human bone morphogenetic protein 2 (rhBMP-2) is an alternative bone substitute for extensive maxillary bone defects which avoids the disadvantages associated with other grafting materials. This report details a case of a 32-year-old female with a severe vertical and horizontal maxillary bony defect that developed after tumor removal. She underwent two unsuccessful regenerative surgeries with an iliac bone graft. Reconstruction of the maxillary defect was planned by offlabel use of rhBMP-2/absorbable collagen sponge (ACS) combined with a bone marrow aspirate concentrate (BMAC) and allograft in a titanium mesh covered in platelet-rich fibrin (PRF). Clinical and radiographic evaluations showed good quality and quantity of bone formation, and she was rehabilitated with dental implants and prosthodontic treatment. Based on this case, the use of rhBMP-2 as a graft material appears encouraging with a satisfying outcome. The present case is aimed at reporting the clinical and radiographic effectiveness of rhBMP-2/ACS in combination with PRF and a titanium mesh for severe maxillary bone defects. Future investigations will be required to ascertain the long-term survival of implants in areas grafted with rhBMP-2.

Bench-to-bedside: Feasibility of nano-engineered and drug-delivery biomaterials for bone-anchored implants and periodontal applications

“…Additionally, the measurement of drug release in situ was not possible to be performed [ 73 ]. Biomaterials for bone regeneration with incorporated molecules such as BMP-2 were applied in patients with successful results; however, there was no analysis of the drug release rates after clinical application [ 74 , 75 ]. These reports show a lack of scientific description of the characterization of drug release biomaterials and few studies support methodologies to understand BDDSs when applied in a clinical environment, indicating the necessity of novel methods to analyze drug release after biomaterial application in humans.…”

A perspective: Regeneration of soft and hard tissues in the oral cavity, from research to clinical practice

“…Martha Somerman DDS, PhD Field Chief Editor, Frontiers in Dental Medicine derived growth factor-BB (rhPDGF) (7); enamel matrix derivative (EMD) (8); and bone morphogenetic proteins (rhBMP2/BMPs) (9), although the latter is more commonly used by oral and maxillofacial surgeons for larger defects (10). Further, it was mentioned that BMPs are expensive and thus cost-benefit needs to be considered in the decision-making process (11).…”

Angiogenic and Osteogenic Properties of Fibrin in Bone Tissue Engineering

“…Recently, various composites of platelet-rich fibrin (PRF) with other biomaterials have been developed in making new regenerative bone materials (66)(67)(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78)(79). Folded PRF with human cortical bone matrix gelatin has shown better resistance against proteolytic digestion which is important in reducing the degradation rate of the bone matrices (66).…”

“…Another interesting approach is the combination of PRF with alloy materials such as Magnesium (Mg) and Titanium that has enhanced the in vitro bone mineralization (68,69). By combining with recombinant human bone morphogenetic protein 2 (rhBMP-2), PRF in Titanium mesh has improved the quality and quantity of bone formation in humans with vertical maxillary defects (70). The integration of fibrin with alloy materials that have shown good osteogenic differentiation properties will be beneficial to the development of functional bone implants in bone regeneration (68)(69)(70)(71).…”