Tissue Engineering with Recombinant Human Bone Morphogenetic Protein‐2 for Alveolar Augmentation and Oral Implant Osseointegration: Experimental Observations and Clinical Perspectives*

Abstract

Surgical placement of oral implants is governed by the prosthetic design and by the morphology and quality of the alveolar bone. Nevertheless implant placement often appears difficult, if at all possible, due to aberrations of the alveolar ridge. Hence prosthetically dictated implant positioning often entails augmentation of the alveolar ridge and adjoining structures. In this review we discuss recent observations of the biologic potential, clinical relevance, and perspectives of application of recombinant human bone morphogenetic protein-2 (rhBMP-2) technologies for alveolar bone augmentation and oral implant osseointegration. Using discriminating critical-size supraalveolar defects and clinical modeling in dogs, we show that rhBMP-2 has a substantial potential for augmenting alveolar bone and supporting osseointegration of titanium oral implants. Moreover, using clinical modeling, we demonstrate re-osseointegration in advanced periimplantitis defects and long-term functional loading of titanium oral implants placed into rhBMP-2-induced bone. Our studies suggest that inclusion of rhBMP-2 for alveolar bone augmentation and oral implant fixation will not only enhance the predictability of existing clinical protocol but also allow new approaches to these procedures.

Craniofacial Tissue Engineering by Stem Cells

“…BMPs have been shown to induce bone regeneration in peri-implant and maxillary sinus-floor augmentation procedures (Boyne, 1996;Boyne et al, 1997;Hanisch et al, 1997), extraction socket defects (Howell et al, 1997a;Cochran et al, 2000;Fiorellini et al, 2005), and mandibular discontinuity defects (Boyne et al, 1999;Warnke et al, 2004). The use of BMPs for oral and craniofacial reconstruction has recently been reviewed (Nakashima and Reddi, 2003;Wikesjö et al, 2005).…”

Localized delivery of growth factors for periodontal tissue regeneration: Role, strategies, and perspectives

“…87 In laboratory-based investigations, a resorbable collagen sponge (RCS) carrier is the most commonly reported delivery vehicle fabricated from collagen-based biomaterials. 28,[30][31][32] For example, surgical implantation of rhBMP-2 in the RCS has been demonstrated to significantly enhance bone regeneration in intrabony periodontal defects in the baboon; 28 and collagen scaffolds loaded with BMP-2 and/or -7 also have been successfully used in applications to induce bone formation, which has led to the development of FDA-approved collagen-BMP products for the treatment of such bone defects. 87 The However, the lack of space provision by ACS may be one of the major factors responsible for its failure to maintain sufficient quantities of bone in most implant-based studies.…”

“…12,14 However, only a few of these growth factors (PDGF-BB, BMP-2, BMP-7, and IGF-1) have been reported to enhance regeneration in animals with periodontal defects or inducedexperimental periodontitis and also in human clinical applications (Table I). 32,[38][39][40] It is now well established that the utilization of multiple growth factors and cytokines forms an integral part of the processes involved in wound healing, initiated when an injury occurs and continues until the wound is completely healed and act in a concentration-and timedependent manner during the wound healing process. 9,16,21,22 While the positive effects of growth factors on osteogenesis (osteoblasts) are well established, less is known about the way in which growth factors effect cementogenesis, PDL fibroblasts, and their role in the formation of a new functionized PDL.…”

Bone augmentation of the atrophic anterior maxilla for dental implants using rhBMP-2 and titanium mesh: histological and tomographic analysis

“…3 Relevant bone formation for various skeletal defects, including those of the craniofacial complex, has been observed in the presence of rhBMP-2 in clinical studies. 2,4 However, only a few reports have evaluated the use of rhBMP-2 or other BMP family members in conjunction with dental implants in the aesthetic zone. 4,5 Therefore, the objective of this prospective case series study was to evaluate the clinical and histological effects of rhBMP-2 alveolar bone augmentation in the rehabilitation of the severely resorbed anterior maxilla with osseointegration implants.…”

“…In particular, recombinant human BMP-2 (rhBMP-2) has been shown to stimulate adult mesenchymal stem cells to induce clinically relevant bone formation. 2 Since 2002, the US Food and Drug Administration (FDA) has approved the use of absorbable collagen sponge (ACS) as a carrier for rhBMP-2 in lumbar fusion and long bone fracture repairs. In 2007, rhBMP-2 was used for alveolar ridge and maxillary sinus augmentation.…”