Liang Fan, Yen Stephen L-K, Imahiyerobo Thomas, Sanborn Luke, Yen Leia, Yen Daniel, Nazarian Sheila, Jedrzejewski Breanna, Urata Mark, Hammoudeh Jeffrey
Los Angeles, Calif.; and Providence, R.I.
From the Keck School of Medicine and the School of Dentistry, University of Southern California; the Children's Hospital Los Angeles; and the Warren Alpert Medical School, Brown University.
Plast Reconstr Surg. 2017 Oct;140(4):767-774. doi: 10.1097/PRS.0000000000003686.
Recent studies indicate that recombinant human bone morphogenetic protein-2 (rhBMP-2) in a demineralized bone matrix scaffold is a comparable alternative to iliac bone autograft in the setting of secondary alveolar cleft repair. Postreconstruction occlusal radiographs demonstrate improved bone stock when rhBMP-2/demineralized bone matrix (DBM) scaffold is used but lack the capacity to evaluate bone growth in three dimensions. This study uses cone beam computed tomography to provide the first clinical evaluation of volumetric and density comparisons between these two treatment modalities.
A prospective study was conducted with 31 patients and 36 repairs of the alveolar cleft over a 2-year period. Twenty-one repairs used rhBMP-2/DBM scaffold and 14 repairs used iliac bone grafting. Postoperatively, occlusal radiographs were obtained at 3 months to evaluate bone fill; cone beam computed tomographic images were obtained at 6 to 9 months to compare volumetric and density data.
At 3 months, postoperative occlusal radiographs demonstrated that 67 percent of patients receiving rhBMP-2/DBM scaffold had complete bone fill of the alveolus, versus 56 percent of patients in the autologous group. In contrast, cone beam computed tomographic data showed 31.6 percent (95 percent CI, 24.2 to 38.5 percent) fill in the rhBMP-2 group compared with 32.5 percent (95 percent CI, 22.1 to 42.9 percent) in the autologous population. Density analysis demonstrated identical average values between the groups (1.38 g/cc).
These data demonstrate comparable bone regrowth and density values following secondary alveolar cleft repair using rhBMP-2/DBM scaffold versus autologous iliac bone graft. Cone beam computed tomography provides a more nuanced understanding of true bone regeneration within the alveolar cleft that may contribute to the information provided by occlusal radiographs alone.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
近期研究表明，在二期牙槽嵴裂修复中，脱矿骨基质支架中的重组人骨形态发生蛋白-2（rhBMP-2）是髂骨自体移植的一种可替代方法。重建后的咬合位X线片显示，使用rhBMP-2/脱矿骨基质（DBM）支架时骨量有所改善，但缺乏三维评估骨生长的能力。本研究采用锥形束计算机断层扫描，首次对这两种治疗方式进行体积和密度比较的临床评估。
进行了一项前瞻性研究，在2年期间纳入31例患者，对36处牙槽嵴裂进行修复。21处修复使用rhBMP-2/DBM支架，14处修复使用髂骨移植。术后3个月拍摄咬合位X线片以评估骨填充情况；术后6至9个月获取锥形束计算机断层扫描图像，以比较体积和密度数据。
3个月时，术后咬合位X线片显示，接受rhBMP-2/DBM支架治疗的患者中有67%牙槽完全骨填充，而自体骨组为56%。相比之下，锥形束计算机断层扫描数据显示，rhBMP-2组填充率为31.6%（95%CI，24.2%至38.5%），自体骨组为32.5%（95%CI，22.1%至42.9%）。密度分析显示两组平均密度值相同（1.38 g/cc）。
这些数据表明，使用rhBMP-2/DBM支架与自体髂骨移植修复二期牙槽嵴裂后，骨再生和密度值相当。锥形束计算机断层扫描能更细致地了解牙槽嵴内真正的骨再生情况，这可能有助于补充仅通过咬合位X线片提供的信息。
临床问题/证据水平：治疗性，II级。
