Is Bone Morphogenetic Protein-2 as Effective as Alveolar Distraction Osteogenesis for Vertical Bone Regeneration?

PURPOSE: The aim of this study was to assess the clinical effectiveness of alveolar distraction osteogenesis (ADO) versus recombinant human bone morphogenetic protein-2 (rh-BMP-2) for vertical ridge augmentation. Few data have been published on vertical bone regeneration using rh-BMP-2. MATERIALS AND METHODS: The authors implemented a retrospective cohort study and enrolled a sample composed of patients with deficient alveolar vertical bone height. The primary predictor variable was vertical augmentation with BMP-2 and a titanium mesh or ADO. The primary outcome variable was gain in vertical bone height (millimeters) measured using computed tomography. The secondary outcome variable was postoperative complications, namely need for further grafting before or simultaneous with implant placement, soft tissue dehiscence, paresthesia, infection, implant failure, and pain. Other outcomes included implant stability at time of placement and follow-up (implant stability quotient by resonance frequency analysis), surgical time (minutes), and total treatment time until implant placement (weeks). Other study variables included location of reconstruction (maxilla or mandible). Appropriate bivariate statistics were computed and statistical significance was set a P value less than .05. RESULTS: The retrospective review yielded 21 patients in the BMP group and 19 in the ADO group. For the BMP-2 group, the average vertical bone gain was 2.96 ± 1.8 mm overall (maxilla, mean 3.6 ± 3.1 mm; mandible, mean 2.32 ± 1.8 mm). For the ADO group, this gain was 4 ± 1.69 mm overall (maxilla, mean 2.8 ± 1.94 mm; mandible, mean 5.2 ± 4.67 mm). For complications, group BMP showed a statistically minor tendency for more postoperative problems, such as wound dehiscence. For implant survival, group BMP showed a 92.2% survival rate versus 96.3% in group ADO at 3 to 45 months after delivery of the prosthesis (average, 22 months). CONCLUSION: The 2 techniques showed similar values in absolute vertical bone gain. Group ADO showed a slightly better outcome in outright vertical regenerative potential, albeit with a more frequent need for regrafting before and simultaneous with implant placement. Group BMP showed a lesser need for regrafting, despite having a higher postoperative complication rate.

Facially Driven Rehabilitation of a Cleft Lip and Palate Patient with an Implant-Supported Complete Fixed Dental Prosthesis: Outcome of a Multidisciplinary Approach.

Patients with a facial malformation due to a cleft lip and palate (CLP) usually suffer from a reduced ability to function normally associated with a poor oral health-related quality of life. This condition often requires multiple significant surgical interventions, and the prosthetic restoration, when needed, is not always included in the initial treatment plan. In order to obtain the highest possible degree of functional, occlusal, and phonetic performance, as well as esthetics, a facially guided prosthodontic treatment sequence should be established. The case presented in this publication shows a multidisciplinary approach for reconstruction of a compromised maxilla with an implant-supported prosthesis via a minimally invasive, digitalized approach.