ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Use Of Bone Morphogenetic Protein-2 Increases Osseointegration Of Dental Implants At The Time Of Surgical Implant Placement
Clinical Question Will the addition of BMP-2 to titanium dental implants at the time of surgical placement in adult humans increase osseointegration compared to placement without BMP-2?
Clinical Bottom Line When used at the time of implant placement, rhBMP-2 exhibits marked osseointegration of the implant into surrounding bone, however, over a 3 year period of time, rhBMP-2 does not demonstrate extended osseogenesis.
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) 19489935Jung/200911 human patients, ranging from 27-75 years old, each patient received a minimum of 2 implants (1 test implant site and 1 control implant site). Overall, the group received 34 implants: 18 were test sites and 16 were control sites. Split-Mouth RCT
Key resultsAt both the 3 and 5 year follow-up visits all 34 implants were stable and osseointegrated (note that at the 5 year follow-up, two patients were excluded because they had moved from the area). Differences in probing pocket depths (PPD) between test and control sites were statistically insignificant at both the 3- and 5-year follow-up appointments. Test sites did not exhibit statistically significant levels of bone level changes ( < 0.2 mm compared to test sites) at both the 3 and 5 year follow-ups.
#2) 21802186Jensen/201210 human patients with maxillary edentulous Cawood class V who presented with maxillary sinus pneumatization subnasallyCase Series
Key resultsThe study showed that the use of BMP-2 as a simultaneous grafting material allows implant loading to occur immediately following implant placement. While BMP-2 graft material was slow to mineralize, it induced highly vascularized bone that lacked both scar formation and foreign-body response. The use of BMP-2 in the maxillary sinus floor provided osteogenesis around the implant (this response was absent in allograft or xenograft alone. Twelve-month follow-up CT scans showed good bone fill in the trans-sinus grafting locations, adequate consolidation, and trans-sinus integration. Based on these results, simultaneous BMP-2 grafting in the sinus floor, implant placement, and subsequent immediate implant loading represents a viable alternative technique to zygomatic implant placement.
#3) 17300917Lan/20078 Japanese white rabbits, each with 2 implants placed in each femur (4 implants per rabbit). 16 group A implants (rhBMP-2); 16 group B implants (no rhBMP- 2). Animal study
Key resultsGroup A (rhBMP-2 implants) showed statistically stronger (P < 0.05) bone formed as well as increased bone formation around group A implants (P < 0.05) when compared to group B (no rhBMP-2) at weeks 4, 8, and overall. Results were determined using mechanical pull-out testing and scanning electron microscopy (SEM). The authors noted that more studies are needed to determine the optimal dose range of rhBMP-2.
Evidence Search (("Implants, Experimental"[Mesh] AND "Bone Morphogenetic Protein 2"[Mesh]) AND "Osseointegration"[Mesh]) OR ("Dental Implantation, Endosseous"[Mesh] AND "Bone Morphogenetic Protein 2"[Mesh])
Comments on
The Evidence
The evidence presented are: an RCT, a case series and an animal study. None of the studies are blinded. In the Jung, et. al., article, the 11 patients are treated the same in that they all received at least one test implant site and one control implant site. The only difference between patients in this study is that some patients received more than two total implants. In the Jensen, et. al., study, all 10 patients were treated the same and received implants with exposed trans-sinus implant threads grafted with 1.5 mg of recombinant human BMP-2 bovine collagen. Lan, et. al., had two groups, participants in both groups were similar at the start and were handled the same; the only difference between the two groups was the presence or absence of rhBMP-2 delivery at the time of implantation. Jung, et. al., should have recorded data more often than the 3- and 5-year follow-up appointments described in the article. If Jung, et. al., had obtained more frequent follow-up appointments and results, they most likely would have observed a difference between the test and control implant sites due to the presence or absence of rhBMP-2, which would have indicated that rhBMP-2 is involved in early osseointegration of dental implants into existing bone. The Lan, et. al., study could have used a longer timeline to show if the non-rhBMP-2 implants osseointegration rate ever matches the rhBMP-2 implant group. The investigators in all three studies did not seem to demonstrate a recall bias. None of the three study exhibited competing interests.
Applicability This evidence shows promising advances in dental implant success through the use of BMP-2, which exhibits marked osseogenesis and osseointegration, reduced patient morbidity, ease of use for the dental professional, and allows for a widened potential implant patient pool. More clinical trials are needed prior to use in the clinical setting.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics)
Keywords BMP-2, dental implant, osseointegration
ID# 2216
Date of submission: 04/06/2012spacer
E-mail phillipsst@livemail.uthscsa.edu
Author Sara T. Phillips
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Archie Jones, DDS
Faculty mentor/Co-author e-mail JonesA@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
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Chelsea Reid, Alex Dougherty (San Antonio, TX) on 11/28/2017
A PubMed search was completed in November 2017 to search for new research related to this CAT. In a recent RCT (Thoma 2017, PMID 29150957) testing bone quality and quantity after bone graft with and without loaded rhBMP-2,found that both treatments were successful in regenerating bones for implant placement, but "a higher amount of mineralized tissue was observed for the control group at 4 months" These results support the CAT's original bottom line.
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