Hussein Khaled A, Zakhary Ibrahim E, Hailat Dana, Elrefai Rami, Sharawy Mohamed, Elsalanty Mohammed E
Oral and Dental Research Division, Department of Surgery and Medicine, National Research Center, Cairo, Egypt.
J Oral Maxillofac Surg. 2013 Jun;71(6):1107-18. doi: 10.1016/j.joms.2012.12.018. Epub 2013 Mar 7.
To compare the efficiency of recombinant human bone morphogenetic protein 2 (rhBMP2)/absorbable collagen sponge (ACS) in the delayed versus immediate reconstruction of mandibular segmental defects in a canine model.
We randomized 11 dogs into 2 groups: immediate reconstruction (group 1, n = 6) and delayed reconstruction (group 2, n = 5). A 35-mm osteoperiosteal segmental defect was created on the left side of the mandible. Reconstruction with rhBMP2/ACS was carried out in the same setting in group 1 or at 4 weeks postoperatively in group 2. The contralateral side acted as an internal control. Animals were monitored both clinically and radiographically throughout the experiment. Twelve weeks after the application of rhBMP2/ACS, the quantity of bone formation was evaluated using regenerate mapping and histomorphometric analysis. Qualitative evaluation was performed based on bone mineral density and Vickers microhardness (μHV) testing.
Postoperative seromas were observed in 83.3% of group 1 dogs only. Group 1 showed significantly larger physical dimensions than group 2 in most regenerate zones. Successful regeneration was achieved in 83.3% of group 1 dogs (discontinuity defect was seen in 1 of 6 dogs in group 1). Meanwhile, none of the 5 dogs in group 2 could be considered to have undergone successful regeneration (3 dogs had discontinuity defects, bony union occurred only in the basal third in the fourth dog, and the last dog showed union with only a shell of bone). The percent bone area and percent defect filling were significantly higher in group 1 than in group 2 (percent bone area, 52.4% ± 5.6% in group 1 and 36.6% ± 11.2% in group 2 [P = .02]; percent defect filling, 56.3% ± 5.5% in group 1 and 38.5% ± 10.8% in group 2 [P = .01]). Group 1 showed higher bone mineral density (0.7 ± 0.3 mg/cm(3) in group 1 and 0.4 ± 0.1 mg/cm(3) in group 2, P = .1). Finally, μHV was significantly higher in group 1 (20.3 ± 2.6 μHV) than in group 2 (13.2 ± 2.4 μHV) (P = .01).
Delaying the application of rhBMP2/ACS for 4 weeks attenuated the quantity and quality of regenerated bone in mandibular segmental defects.
在犬模型中比较重组人骨形态发生蛋白2（rhBMP2）/可吸收胶原海绵（ACS）用于下颌骨节段性缺损即刻重建与延迟重建的效率。
将11只犬随机分为2组：即刻重建组（第1组，n = 6）和延迟重建组（第2组，n = 5）。在下颌骨左侧制造一个35毫米的骨膜骨节段性缺损。第1组在相同条件下用rhBMP2/ACS进行重建，第2组在术后4周进行重建。对侧作为内部对照。在整个实验过程中对动物进行临床和影像学监测。在应用rhBMP2/ACS 12周后，使用再生图谱和组织形态计量分析评估骨形成量。基于骨密度和维氏显微硬度（μHV）测试进行定性评估。
仅在第1组83.3%的犬中观察到术后血清肿。在大多数再生区域，第1组的物理尺寸明显大于第2组。第1组83.3%的犬实现了成功再生（第1组6只犬中有1只出现间断性缺损）。同时，第2组的5只犬中没有一只被认为实现了成功再生（3只犬出现间断性缺损，第4只犬仅在基底部三分之一处发生骨愈合，最后一只犬仅见有一层骨壳的愈合）。第1组的骨面积百分比和缺损填充百分比显著高于第2组（骨面积百分比，第1组为52.4%±5.6%，第2组为36.6%±11.2%[P = .02]；缺损填充百分比，第1组为56.3%±5.5%，第2组为38.5%±10.8%[P = .01]）。第1组的骨密度更高（第1组为0.7±0.3毫克/立方厘米，第2组为0.4±0.1毫克/立方厘米，P = .1）。最后，第1组的μHV显著高于第2组（第1组为20.3±2.6 μHV，第2组为13.2±2.4 μHV）（P = .01）。
将rhBMP2/ACS的应用延迟4周会减弱下颌骨节段性缺损再生骨的数量和质量。
