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Title Improved Bone Growth With Bone Morphogenetic Protein 2
Clinical Question Does bone morphogenetic protein 2 (bmp2) stimulate bone growth similarly to an autograft for patients receiving dental implants?
Clinical Bottom Line There is evidence which supports the use of bmp2 to augment bone growth versus an autogenous bone graft in a patient receiving dental implants. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 19686934Triplett/2009160 patients in the US requiring sinus grafting for implant placement with less than 6 mm of native bone growthMulticentered RCT
Key resultsSix months following grafting, there was significant bone growth in both treatments. There was more bone height gained in the bone graft subjects, however the rhBMP-2/ACS (recombinant human bone morphogenetic protein-2 on an absorbable collagen sponge) subjects had significantly denser bone. The success rate for the rhBMP-2/ACS group was 79% (64 of 81 subjects). The autograft group had a 17% rate of complications including long-term parasthesia, pain, or gait disturbance, while there was no adverse events were deemed due to the rhBMP-2/ACS group.
#2) 16297689Boyne/200518 patients receiving 0.75 mg/mL rhBMP-2/ACS, 17 patients receiving 1.5 mg/mL rhBMP-2/ACS, 13 patients receiving bone graftsRCT
Key resultsFour months after grafting, alveolar ridge heights were similar across the three groups (bone graft, rhBMP-2/ACS 0.75 mg/mL, and rhBMP-2/ACS 1.5 mg/mL). There was a statistically significant difference in the bone density of the three groups, 350 mg/cc, 84 mg/cc, and 134 mg/cc for the bone graft, 0.75 mg/mL rhBMP-2/ACS, and 1.50 mg/mL rhBMP-2/ACS treatment groups, respectively (P = .003 vs 0.75 mg/mL, P = .0137 vs 1.50 mg/mL, P = .0188; 1.50 mg/mL vs 0.75 mg/mL). Further, there was a statistically significant difference in alveolar ridge width too (4.7 mm, 2.0 mm, and 2.0 mm, respectively). The proportion of patients who received dental implants that were functionally loaded and remained functional at 36 months post-functional loading was 62%, 67%, and 76% in the bone graft, 0.75 mg/mL, and 1.50 mg/mL rhBMP-2/ACS treatment groups, respectively. Core bone biopsies of the formed bone confirmed normal bone formation.
Evidence Search Search Humans, implant osseointegration Search dental implant, Search bmp 2
Comments on
The Evidence
Both of these articles are randomized controlled clinical trials, although neither are blinded. The patient populations were treated similarly with adequate recall. The investigators did not seem to demonstrate a recall bias.
Applicability These studies demonstrate that the use of rhBMP-2/ACS is a viable alternate to autografts in terms of producing similar success rates of implant function and decreasing the rate of complications from the use of autografts. This patient population would be similar to the ones seen in a clinic that places implants. This treatment is feasible in clinics which place implants.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics)
ID# 578
Date of submission: 04/01/2010spacer
E-mail TompkinsT@livemail.uthscsa.edu
Author Trent Tompkins
Co-author(s) e-mail
Faculty mentor/Co-author Thomas Oates, DMD, PhD
Faculty mentor/Co-author e-mail OATES@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Eojin Hwang, Matt Grace, Naila Zafer (San Antonio, TX) on 01/21/2013
we conducted a PubMed search, PMID #22545428, Levin, 2012, and found similar results as mentioned in the CAT. This study had 6 patients, and the extraction sites treated with rhBMP-2, then received implants. All implants received primary stabilization and were functionally loaded. No lost implants or complications were found.

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