The sinus lift technique, introduced in 1976 by Tatum and subsequently described by Boyne in 1980, is nowadays considered a safe and reliable procedure for the rehabilitation of the atrophic upper posterior maxilla. The alveolar antral artery (AAA) is anastomoses between the posterior superior alveolar artery (PSAA) and the infraorbital artery (IOA) and may be present in the sinusal antrostomy. The haemorrhage of this vascular bundle represents the second intra-operatory complication in term of frequency during sinus lift procedure. Purpose of this study was to illustrate and describe a new technique allowing the AAA isolation during sinus lift procedure in cases in which the artery is clearly present inside the surgical area, detectable through CT scan exam. Presence, course and possible identification of the alveolar antral artery are also discussed, according to the studies present in the literature.

The goal of this study was to demonstrate the technique and effectiveness of incorporating recombinant human bone morphogenetic protein-2 (rhBMP-2) to the established sandwich osteotomy technique. Although the success of the sandwich osteotomy procedure has been well documented, we hope to show that the addition of rhBMP-2 will enhance bone formation.We performed a sandwich osteotomy technique in patients who had been treated initially by grafting with suboptimal results. Only defects involving the anterior maxilla (3 patients) or the anterior mandible (1 patient) were included. There were 4 patients, 2 men and 2 women, with an age range of 19 to 62 years. The causes of the ridge deficiencies ranged from pathology to trauma. The height (distance) of distracted transport bone segment was measured. The amount of relapse was measured 6 months after the surgery.All patients exhibited a significant increase in bone height. The amount distracted was 6.75 mm (range, 5-11 mm). The amount of relapse was 8.5% (range, 0%-18%). Dental implants were placed in the reconstructed ridges in all patients. There were no instances of permanent paresthesia. Two patients had exposure of a portion of the hardware, which healed uneventfully.The sandwich osteotomy technique has proven to be an effective method for augmenting deficient alveolar ridges. The addition of rhBMP-2 may aid in its success rate by promoting osteogenesis at the osteotomy site, especially in multiple-operated patients where other traditional techniques have failed to gain the desired ridge height.

Bisphosphonates are a class of agents used for treating osteoporosis and malignant bone metastases treatment. Osteonecrosis of the jaws is the main complication in a subset of patients receiving these drugs. Based on a growing number of case reports and institutional reviews, bisphosphonate therapy can cause exposed and necrotic bone that is isolated to the jaw. This clinical investigation is aimed at analyzing the clinical effect of recombinant human bone morphogenetic protein type 2 (rhBMP-2) application in patients affected by bisphosphonates-related osteonecrosis of the jaws undergoing surgery for necrotic bone removal.A case review was made of 20 patients. The rhBMP-2 in all the cases reported here was used alone with the collagen carrier without concomitant bone materials. The cases involved osteonecrotic lesions of the upper and lower jaws. A total dose of 4 to 8 mg of rhBMP-2 was delivered to the surgical site in concentrations of 1.5 mg/mL (depending on the size of lesion). Patients were followed up over a period ranging 6 to 12 months.Patients had successful healing of the necrotic area. New bone formation in the surgical area could be clinically evaluated by palpation at the end of 3 to 4 months and confirmed by radiographic examination at the end of 12 months.This study indicated that the use of rhBMP-2 without concomitant bone grafting materials was useful in promoting healing of bisphosphonates-related osteonecrosis of the jaws. The use of growth factors, particularly rhBMP-2, should be considered a therapeutic choice in patients affected by osteonecrosis of the jaws related to bisphosphonate therapy.

Recombinant human bone morphogenetic protein-2 (rhBMP-2) is an osteoinductive protein approved for use in oral and maxillofacial defect reconstruction. Growth factors act as mediators of cellular growth on morphogenesis and mythogenesis phases. Utilized as recombinant proteins, these growth factors need the presence of local target cells capable of obtaining the required results. This cell population may be present at the wound site or added to scaffolding material before implantation at the surgical site.The aim of this study is to evaluate the clinical and radiographic results of a reported case with a large bone defect, treated with an absorbable collagen sponge, rhBMP-2 and a titanium plate and mesh. The Authors want to report a case which shows the resulting effectiveness of the rhBMP2 action regarding a large, mandibular defect reconstruction. This case also shows how the removal of a rare tumor such as a ghost cell tumor of the jaw may be treated without harvesting bone from another body site. A quick diagnosis of the lesions is important in order to perform the most suitable treatment. The Authors also underline the clinical and histological steps to insure the correct treatment is carried out to solve the case.Moreover, from results obtained from this case, it is possible to highlight several clinical benefits for the patient by adding rhBMP-2 to the common allograft to not only have alveolar reconstruction defects and sinus floor augmentation, but also to have alveolar cleft reconstruction and to treat segmental defects.

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