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Francoisse CA, Sescleifer AM, Okeke RI, Tyson CV, Plikaitis C. Efficacy of Demineralized Bone Matrix for Revision Alveolar Bone Grafting in Patients Previously Treated with Bone Morphogenetic Protein 2 (BMP-2). Cleft Palate Craniofac J 2024; 61:1179-1185. [PMID: 36850061 DOI: 10.1177/10556656231159259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE This study investigates the effectiveness of demineralized bone matrix (DBX) to close alveolar clefts in patients previously treated with bone morphogenic protein-2 (BMP-2) who remained with bone nonunion. DESIGN This is an IRB-approved retrospective, single-center study. SETTING This study was conducted at a tertiary academic center. PATIENTS/PARTICIPANTS We searched for all surgical encounters with the Current Procedural Terminology (CPT) code 42210 from the years 2013-2019. Included patients were diagnosed with cleft alveolus, previous BMP-2 exposure and required revision bone grafting during mixed dentition for persistent alveolar defects. INTERVENTIONS 17 patients underwent revision alveolar bone grafting (ABG) with either DBX (n = 10) or autograft (n = 7) to repair persistent bony cleft. MAIN OUTCOME MEASURE(S) The primary study outcome measured was alveolar bone graft revision failure described as continued alveolar nonunion. RESULTS The median age at revision ABG was 13.1 ± 3.3 years, with a mean follow-up time of 4.9 years (1.1-9.2 years). Patients were 53% male, 47% had a unilateral cleft lip and alveolus. 58.8% of patients were treated with DBX in the cleft, 41.2% treated with autograft from iliac crest. Overall, 11.8% (n = 2) of all revisions failed, requiring a second revision. The average time to reoperation was 2.06 years, and both were re-grafted with autograft. There was no statistically significant difference between the type of bone graft source used and the failure rate obtained (P = .1544). CONCLUSIONS DBX and autologous iliac crest bone grafts achieve similar alveolar union rates during revision ABG in patients treated with previous BMP-2 to the alveolar cleft.
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Affiliation(s)
- Caitlin A Francoisse
- Division of Plastic Surgery, Saint Louis University, School of Medicine, St. Louis, MO, USA
| | - Anne M Sescleifer
- Department of General Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Raymond I Okeke
- Division of General Surgery, Saint Louis University, School of Medicine, St. Louis, MO, USA
| | - Cody V Tyson
- Division of Plastic Surgery, The University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL, USA
| | - Christina Plikaitis
- Division of Plastic Surgery, Saint Louis University, School of Medicine, St. Louis, MO, USA
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Ren J, Li Z, Liu W, Fan Y, Qi L, Li S, Kong C, Zou H, Liu Z. Demineralized bone matrix for repair and regeneration of maxillofacial defects: A narrative review. J Dent 2024; 143:104899. [PMID: 38428719 DOI: 10.1016/j.jdent.2024.104899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/14/2024] [Accepted: 02/23/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVES Demineralized bone matrix (DBM) is a well-established bone graft material widely accepted by dentists and the public for its favorable osteoconductivity and osteoinductive potential. This article aimed to provide a narrative review of the current therapeutic applications and limitations of DBM in maxillofacial bone defects. STUDY SELECTION, DATA, AND SOURCES Randomized controlled trials, prospective or retrospective clinical studies, case series and reports, and systematic reviews. MEDLINE, PubMed, and Google Scholar were searched using keywords. CONCLUSIONS Some evidence supported the therapeutic application of DBM in periodontal intrabony defects, maxillary sinus lifts, ridge preservation, ridge augmentation, alveolar cleft repair, orthognathic surgery, and other regional maxillofacial bone defects. However, the limitations of DBM should be considered when using it, including potential low immunogenicity, instability of osteoinductive potential, handling of the graft material, and patient acceptance. CLINICAL SIGNIFICANCE With the increasing demand for the treatment of maxillofacial bone defects, DBM is likely to play a greater role as a promising bone graft material. Safe and effective combination treatment strategies and how to maintain a stable osteoinductive potential will be the future challenges of DBM research.
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Affiliation(s)
- Jiwei Ren
- Hospital of Stomatology, Jilin University, China
| | - Zhiwei Li
- Hospital of Stomatology, Jilin University, China
| | - Wantong Liu
- Hospital of Stomatology, Jilin University, China
| | - Yixin Fan
- Hospital of Stomatology, Jilin University, China
| | - Le Qi
- Hospital of Stomatology, Jilin University, China
| | - Sining Li
- Hospital of Stomatology, Jilin University, China
| | - Chen Kong
- Hospital of Stomatology, Jilin University, China
| | - He Zou
- Hospital of Stomatology, Jilin University, China
| | - Zhihui Liu
- Hospital of Stomatology, Jilin University, China.
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Marquez JL, Sudduth J, DeMay H, Kuo K, Battistini A, Yamashiro DK, Siddiqi FA, Gociman B. Early Results on the Efficacy of Demineralized Bone Matrix, Bone Morphogenic Protein, and Freeze-dried Bone Chips in Alveolar Cleft Repair. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5600. [PMID: 38322815 PMCID: PMC10846763 DOI: 10.1097/gox.0000000000005600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/15/2023] [Indexed: 02/08/2024]
Abstract
Background Conventional treatment for alveolar cleft repair is done using autologous iliac crest alveolar bone graft (ABG). However, this method may not be ideal in all patients. Analysis of the efficacy of a mixture of demineralized bone matrix (DBX), bone morphogenic protein (rhBMP-2), and freeze-dried bone chips (FDBC) as an alternative for alveolar cleft repair was performed. Methods Consecutive patients from August 2019 to June 2022 undergoing early alveolar cleft repair, concomitant hard palate and alveolar cleft repair, secondary alveolar cleft repair, and regrafting from a previously failed ABG were analyzed. Computed tomography scans were performed to evaluate graft take at least 6 months postoperatively. Images were reviewed and scored. Alveolar graft height and graft thickness were recorded. A standardized scoring system was developed, with a score of 0 representing no graft take and 3 representing best possible graft take. Results Fifty-five consecutive alveolar clefts (43 patients) were identified as having undergone ABG and satisfied all the other inclusion criteria. Of these, 29 underwent first time ABG and 26 underwent redo ABG. The mean graft height and graft thickness recorded for all clefts was 2.2 and 2.0, respectively. Conclusions Early results evaluating the efficacy of ABG using DBX, rhBMP-2, and FDBC show feasibility in regard to both graft height and thickness when using a maxillary computed tomography scan to measure the bone graft take. These results suggest that DBX, rhBMP-2, and FDBC may act as a versatile bone graft material in cleft care, although further studies are needed to determine long-term outcomes.
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Affiliation(s)
- Jessica L. Marquez
- From Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jack Sudduth
- From Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Henning DeMay
- From Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Keith Kuo
- From Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Andrea Battistini
- From Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Duane K. Yamashiro
- From Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Faizi A. Siddiqi
- From Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Barbu Gociman
- From Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
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Motamedian SR, Mohaghegh S, Lakmazaheri E, Ahmadi N, Kouhestani F. Efficacy of regenerative medicine for alveolar cleft reconstruction: A systematic review and meta-analysis. Curr Stem Cell Res Ther 2022; 17:446-465. [DOI: 10.2174/1574888x17666220204145347] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/05/2021] [Accepted: 12/02/2021] [Indexed: 11/22/2022]
Abstract
Objective:
Objective: To analyze the efficacy and complications of regenerative medicine compared to autogenous bone graft for alveolar cleft reconstruction.
Method:
Method: Electronic search was done in PubMed, Scopus, Embase and Cochrane database for studies published until May 2021. No limitations were considered for the type of the included studies. The risk of bias (ROB) of the studies was assessed using the Cochrane Collaborations and NIH quality assessment tool. Meta-analyses were performed to assess the difference in the amount of bone formation and rate of complications. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for analyzing the level of the evidence.
Results:
Results: Among a total of 42 included studies, 21 studies used growth factors, 16 studies delivered cells, and five studies used biomaterials for bone regeneration of the alveolar cleft. Results showed no significant difference in the amount of bone formation between bone morphogenic protein-2 and iliac graft treated patients after six months (P=0.44) and 12 months (P=0.17) follow-up. Besides, higher swelling (OR=9.46,P<0.01) and less infection (OR=0.19,P=0.01) observed in BMP treated patients. Using stem cells can reduce the post-treatment pain (OR=0.04,P=0.01) but it has no significant impact on other complications (P>0.05). Using tissue engineering methods reduced the operation time (SD=1.06,P<0.01). GRADE assessment showed that results regarding the amount of bone formation volume after six and 12 months have low level of evidence.
Conclusion:
Conclusion: Tissue engineering methods can provide a comparable amount of bone formation as of the autogenous graft and reduce some of the complications, operation time and hospitalization duration.
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Affiliation(s)
| | - Sadra Mohaghegh
- Shahid Beheshti University of Medical Sciences, Tehran 1983963113, Iran
| | - Ehsan Lakmazaheri
- Shahid Beheshti University of Medical Sciences, Tehran 1983963113, Iran
| | - Nima Ahmadi
- University of Medical Sciences, Tehran 1983963113, Iran
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Abstract
The goals of alveolar cleft repair include (1) stabilization of the maxilla, (2) permitting tooth eruption, (3) eliminating the oronasal fistula, (4) improving aesthetics, and (5) improving speech. Alveolar cleft repair should be considered one of the steps of a larger comprehensive orthodontic management plan. In conjunction with closure of the oronasal fistula, a variety of grafting materials can be used in the alveolar cleft. Autogenous grafts have been found to have greater efficacy compared with allogenic or xenogeneic bone, substitute bone, and alloplasts but with more donor site morbidity.
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Affiliation(s)
- Hilary McCrary
- Division of Otolaryngology-Head and Neck Surgery, University of Utah, 50 North Medical Dr., SOM 3C120, Salt Lake City, Utah 84132, USA
| | - Jonathan R Skirko
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona, Tucson, AZ, USA; Banner Diamond Children's Hospital, Tucson, AZ, USA.
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New biomaterials versus traditional techniques: advances in cleft palate reconstruction. Curr Opin Otolaryngol Head Neck Surg 2018; 24:330-5. [PMID: 27261944 DOI: 10.1097/moo.0000000000000279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Cleft lip and palate still remains one of the most common congenital anomalies, and consequently surgical correction of these anomalies is still commonplace. Despite numerous existing surgical techniques having good outcomes, it is still recognized that the morbidity of certain surgical procedures and success rates regarding outcomes can be improved. The purpose of this review is to evaluate new literature and techniques compared with the time tested procedures that are commonly used. RECENT FINDINGS As technology continues to advance, the understanding of details regarding biochemical pathways responsible for the development of cleft defects and also the efficacy of biomaterials that can be used in their correction are being discovered and better understood. Many studies have been conducted in both animal and human study participants that further the understanding of these questions. The efficacy and benefit of newly devised biomaterials seems to indicate that these biomaterials are a viable adjunct and often an alternative in the treatment of cleft palate patients. SUMMARY In this review of recent literature, the discussion begins with a review of the more traditional and widely accepted iliac crest bone grafting and then evolves into a discussion of several animal and human studies to delineate the progress being made in this field. The literature exploring the details regarding biochemical pathways and cellular mediators that are involved in cleft formation, as well as biomaterials used in surgical repair are evaluated. The findings in the literature suggest that there is a bright future in better understanding the cause of cleft formation on a molecular level and associated attempts that can be made in altering some of these factors along with discovering new biomaterials that can be a useful adjunct to existing techniques.
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Comparison between autogenous iliac bone and freeze-dried bone allograft for repair of alveolar clefts in the presence of plasma rich in growth factors: A randomized clinical trial. J Craniomaxillofac Surg 2017; 45:1698-1703. [DOI: 10.1016/j.jcms.2017.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 06/28/2017] [Accepted: 08/01/2017] [Indexed: 11/18/2022] Open
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