![[ Visit Client Website ]](images/banner.gif)
Recent studies suggest that recombinant human bone morphogenic protein (rhBMP)-2 encased in a demineralized bone matrix scaffold (MS) is a comparable alternative to iliac crest bone grafting for secondary alveolar cleft repair. Post reconstruction occlusal radiographs are used to measure bone reconstitution but cannot evaluate bony growth in three dimensions. In this study, we use Cone Beam Computed Tomography (CBCT) to provide the first volumetric comparison of bone fill between rhBMP-2/MS and iliac crest grafts.
Methods/Materials
A prospective study was performed to include 55 patients undergoing secondary alveolar cleft repair over a 2 year period. 38 patients received rhBMP-2/MS and 17 patients underwent iliac bone grafting. Postoperatively, occlusal radiographs were obtained at 3 months and CBCT at 6-9 months. Bone stock was evaluated on occlusal radiographs using the Bergland rating scale and AMIRA® software was used to obtain volumetric data on CBCT images.
Results
At 3 months, post-operative occlusal radiographs demonstrate that 67% of patients receiving rhBMP-2/MS had complete bone fill vs 56% of patients in the iliac bone graft group. In contrast, 3D volumetric analysis using CBCT data at 6 to 9 months showed that patients in the rhBMP-2/MS group had on average 31.6% (95% CI: 24.2- 38.5%) bone fill compared with 32.5% (95% CI: 22.1-42.9%) in the iliac bone population.
Conclusions
These data demonstrate comparable bony regrowth in alveolar cleft defects using rhBMP-2/MS vs. iliac bone graft. This study, which is the first to perform 3D volumetric analysis of alveolar cleft repair between two treatment modalities, demonstrates that complete fill on occlusal radiographs does not indicate full bony reconstitution as seen on CBCT images. We believe that CBCT will provide a more nuanced understanding of temporal and spatial events in bone regeneration in alveolar cleft repair as well as in other geometrically complex problems in craniofacial reconstruction.