Use of Recombinant Human Bone Morphogenetic Protein-2 Associated With Lyophilized Bovine Bone in Reconstruction of Atrophic Maxilla

Abstract

Cases of severely atrophic edentulous maxilla require reconstruction techniques employing bone grafts to promote adequate bone dimension for the successful placement of dental implants for prosthetic rehabilitation that reestablishes the patient's function and aesthetics. This study aims to present a severely atrophic edentulous maxilla reconstruction with the off-label use of recombinant human bone morphogenetic protein type 2 (rhBMP-2) associated with lyophilized particulate bovine bone xenograft for the prosthetic rehabilitation with osseointegrable dental implants. The paper describes a case of severely atrophic edentulous maxilla in a 42-year-old woman referred to the dental school with complaint of failure in adaptating to the dentures. The patient reported 27 years of maxilla edentulism and consecutive treatment failures, so the proposed therapy was the reconstruction of the maxilla with an association of rhBMP-2 and lyophilized bovine bone xenograft for increasing bone volume and further prosthetic rehabilitation with osseointegrated dental implants. The present report illustrates a case of atrophic edentulous maxilla in which the off-label use of rhBMP-2 was successful and the patient's prosthetic rehabilitation could be concluded. The 8 dental implants received prosthetic functional load during 1 year of follow-up with no complications. Based on the case presented, the association between rhBMP-2 and a bovine bone xenograft could be considered a viable option for the reconstruction of atrophic edentulous maxilla. After a year of functional prosthetic load follow-up, the patient is asymptomatic and satisfactorily adaptated to the prosthesis, which restored her functional and aesthetic demands.

Reconstrução de região infraorbitária após ressecção de displasia fibrosa com enxerto ósseo bovino liofilizado

“…Considerando a morbidade na área doadora, sua indicação foi descartada para este caso. A possibilidade de utilização do enxerto ósseo bovino liofilizado para reconstrução na região maxilofacial já foi investigada em modelos animais e em humanos (Al Qabbani et al, 2018;Soares et al, 2019;Trotta et al, 2014;Zanettini et al, 2018). No relato de caso foi utilizado o enxerto ósseo liofilizado bovino desenvolvido por Galia (2008), cuja obtenção está baseada no protocolo de Kakiuchi et al (1996).…”

A Prosthetic and Surgical Approach for Full-Arch Rehabilitation in Atrophic Maxilla Previously Affected by Peri-Implantitis

“…Trying to overcome the disadvantages of autogenous bone graft, guided bone regeneration with bone substitute materials and growth factors (recombinant human bone morphogenetic protein-2 (rhBMP-2), plasma-rich platelets (PRP), and leukocyte-and platelet-rich fibrin (L-PRF)) have been proposed and tested [23,24]. Although positive results have been demonstrated with guided bone regeneration and rhBMP-2 [25,26], the elevated costs of rhBMP-2 (infuse bone graft), healing time, surgical morbidity, and risk of membrane and biomaterial exposure decrease patient acceptance. On the other hand, L-PRF seems to allow early placement of dental implant in maxillary sinuses [27] and increased bone formation when combined with demineralized bovine bone mineral (DBBM) [28].…”