Min Song-Hee, Kang No-Eul, Song Seung-Il, Lee Jeong-Keun
Department of Oral and Maxillofacial Surgery, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Korea.
J Korean Assoc Oral Maxillofac Surg. 2020 Jun 30;46(3):191-196. doi: 10.5125/jkaoms.2020.46.3.191.
Beyond the original application approved by the U.S. Food and Drug Administration, recombinant human bone morphogenetic protein-2 (rhBMP-2) is used for medication-related osteonecrosis of the jaw (MRONJ) treatment because of its bone remodeling enhancement properties. The purpose of the study was to investigate the bone formation effect of rhBMP-2/absorbable collagen sponge (ACS) in patients with MRONJ.
In this retrospective cohort study, 26 female patients diagnosed with MRONJ and who underwent mandibular sequestrectomy at Ajou University Dental Hospital from 2010 to 2018 were included. The experimental group was composed of 18 patients who received rhBMP-2/ACS after sequestrectomy, while the control group was composed of 8 patients who did not receive rhBMP-2/ACS after sequestrectomy. A total dose of 0.5 mg of rhBMP-2 was used in the experimental group at a concentration of 0.5 mg/mL. Follow-up panoramic X-rays were taken immediately after the surgery and more than 6 months after the surgery. Using those X-rays, a radiographic index of bone defect area was calculated using the modified Ihan Hren method, which measures radiographic density of the normal bone and the defect site.
This study suggests that rhBMP-2 contributes to new bone formation. The mean radiographic index immediately after surgery and more than 6 months after the surgery for the experimental group was 68.4% and 79.8%, respectively. The mean radiographic index immediately after surgery and more than 6 months after the surgery for the control group was 73.4% and 76.7%, respectively (Wilcoxon signed rank test, >0.05). The mean radiographic index increased 11.4% in the experimental group and 3.27% in the control group (Mann-Whitney U-test, <0.05).
Based on the results, use of rhBMP-2/ACS on bone defect sites after sequestrectomy could be a successful strategy for treatment of MRONJ patients.
除了美国食品药品监督管理局批准的原始应用外，重组人骨形态发生蛋白-2（rhBMP-2）因其增强骨重塑的特性，还被用于治疗药物相关性颌骨坏死（MRONJ）。本研究的目的是调查rhBMP-2/可吸收胶原海绵（ACS）对MRONJ患者的骨形成效果。
在这项回顾性队列研究中，纳入了2010年至2018年在阿朱大学牙科医院被诊断为MRONJ并接受下颌骨死骨切除术的26例女性患者。实验组由18例在死骨切除术后接受rhBMP-2/ACS的患者组成，而对照组由8例在死骨切除术后未接受rhBMP-2/ACS的患者组成。实验组使用的rhBMP-2总剂量为0.5mg，浓度为0.5mg/mL。术后立即及术后6个月以上拍摄随访全景X线片。利用这些X线片，采用改良的伊汉·赫伦方法计算骨缺损面积的影像学指数，该方法测量正常骨和缺损部位的影像学密度。
本研究表明rhBMP-2有助于新骨形成。实验组术后立即及术后6个月以上的平均影像学指数分别为68.4%和79.8%。对照组术后立即及术后6个月以上的平均影像学指数分别为73.4%和76.7%（Wilcoxon符号秩检验，>0.05）。实验组的平均影像学指数增加了11.4%，对照组增加了3.27%（Mann-Whitney U检验，<0.05）。
基于这些结果，在死骨切除术后的骨缺损部位使用rhBMP-2/ACS可能是治疗MRONJ患者的一种成功策略。
