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Numerous autogenous bone-grafting procedures are available for the recovering of large continuity defects of the mandible. However, these surgical techniques present several limitations involving postoperative morbidity and pain. The development of new bone technique reconstruction not involving autogenous bone graft would offer new opportunities for facial bone reconstruction. This report highlights the possibility of recombinant human bone morphogenetic protein type 2 (rhBMP-2) application without concomitant bone grafting material in the restoration of continuity critical-sized defects after tumor resection in the mandible. The presented case shows a large mandibular reconstruction after tumor removal in a 31-year-old white man affected by ameloblastoma. In this case, the rhBMP-2 application with a carrier consisted on absorbable collagen sponge gives excellent newly formed bone at 18 months of control clinical and radiologic follow-up. The results indicated that the use of rhBMP-2 without concomitant autogenous bone grafting materials in large critical-sized mandibular defects secondary to large mandibular tumor produced excellent regeneration of the treated area.

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.

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