SA2 - Assessing the Efficacy of Autologous Iliac Crest Bone Graft With Recombinant Human Bone Morphogenetic Protein for Alveolar Crest Reconstruction

Oral Abstract Presenter(s)

• 

  Kalvyn Ngo, DDS

  Oral and Maxillofacial Surgery Resident
  LA General Medical Center
  Los Angeles, California

Co-Author(s)

• 

  Idean Roohani, BS

  Research Fellow
  Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
  Los Angeles, California

Co-Author(s)

• 

  Marah Jolibois, MS (she/her/hers)

  Research Fellow
  Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
  Los Angeles, California
• 

  Sasha Lasky, BS

  Research Fellow
  Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
  South Pasadena, California
• 

  Tayla Moshal

  Research Fellow
  Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
  Los Angeles, California
• MU

  Mark M. Urata, DDS, MD

  Plastic Surgeon Attending
  Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles
  Los Angeles, California
• WM

  William P. Magee, III, DDS, MD

  Plastic Surgeon Attending
  Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles
  Los Angeles, California
• 

  Jeffrey A. Hammoudeh, DDS, MD

  Plastic Surgeon Attending
  Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles
  Los Angeles, California

Abstract:

Background: Recombinant human bone morphogenetic protein (rhBMP-2) with demineralized bone matrix (DBM) has served as a viable synthetic alternative to iliac crest bone graft (ICBG) in alveolar bone grafting (ABG). Despite significant advancements in ABG, the reported graft success rates vary widely for both ICBG and rhBMP-2/DBM.[1-2] Future dental rehabilitation requires adequate bone within the repaired alveolar cleft. This study compares graft success rates among rhBMP-2/DBM versus ICBG versus ICBG+rhBMP-2 for ABG.

Methods: A retrospective cohort study was conducted for patients undergoing ABG from 2017-2023. Clinical graft success was defined as no indication for revision ABG. Successful bony bridge formation and their respective bridge thickness were assessed based on CBCT imaging taken at least six months postoperatively (average 17.8±14.2 months). Bridge thickness was calculated based on the height of the graft site from the cementoenamel junction to the cleft-adjacent tooth root apex while ensuring the Hounsfield units measured in grafted areas were consistent with mineralized bone.

Results: Among 432 patients included, 284 rhBMP-2/DBM, 196 ICBG, and 47 ICBG+rhBMP-2 index procedures were reported. The mean age at bone grafting was 10.7±3.6 years for ICBG+rhBMP-2 patients, 10.2±3.2 years for ICBG patients, and 9.3±2.9 years for rhBMP-2/DBM patients, The clinical graft success rate across the 527 procedures was 95.9%, with comparable success rates across all three cohorts (rhBMP-2/DBM: 95.1% vs. ICBG: 95.4% vs. ICBG+rhBMP-2: 97.9%; p=0.694). Based on CBCT imaging, 88.9% of the ICBG+rhBMP-2 cohort had demonstrated successful bony formation, which was significantly higher compared to ICBG (89.4% vs. 65.3%; p=0.031) and rhBMP-2/DBM (88.9% vs. 61.5%; p=0.023). The average bridge thickness was higher in the ICBG+rhBMP-2 cohort compared to ICBG (7.4±2.6mm vs.4.7±1.9mm; p < 0.001) and rhBMP-2/DBM (7.4±2.6mm vs. 4.4±1.2mm; p < 0.001).

Conclusion: Our preliminary findings demonstrate that the use of ICBG with rhBMP-2 appears to result in more bony bridge formation and greater bridge thickness. With a higher rate of bony bridge formation and bridge thickness, dental rehabilitation of the repaired alveolar cleft space with implants or orthodontic movement of existing teeth may be more feasible.REFERENCES[1] Hammoudeh JA, Fahradyan A, Gould DJ, et al. A Comparative Analysis of Recombinant Human Bone Morphogenetic Protein-2 with a Demineralized Bone Matrix versus Iliac Crest Bone Graft for Secondary Alveolar Bone Grafts in Patients with Cleft Lip and Palate: Review of 501 Cases. Plastic and Reconstructive Surgery. 2017;140(2):318e - 325e. doi:10.1097/prs.0000000000003519[2] Lee KC, Costandi JJ, Carrao V, Eisig SB, Perrino MA. Autogenous Iliac Crest Versus rhBMP-2 for Alveolar Cleft Grafting: A 14-Year Single-Institution Experience. J Oral Maxillofac Surg. 2021;79(2):431-440. doi:10.1016/j.joms.2020.10.025

Table 1. Baseline Characteristics and Outcomes
Figure 1. Preoperative and Postoperative Cone-Beam Computed Tomography Scans for Patients who Underwent Alveolar Bone Grafting with ICBG (top row), rhBMP-2/DBM (middle row), and ICBG+rhBMP-2 (bottom row)