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Three-Dimensional Cone Beam Computed Tomography Volumetric Outcomes of rhBMP-2/Demineralized Bone Matrix versus Iliac Crest Bone Graft for Alveolar Cleft Reconstruction

Liang, Fan, M.D.; Yen, Stephen L-K., D.M.D., Ph.D.; Imahiyerobo, Thomas, M.D.; Sanborn, Luke, B.S.; Yen, Leia, B.S.; Yen, Daniel, B.A.; Nazarian, Sheila, M.D.; Jedrzejewski, Breanna, M.P.H.; Urata, Mark, M.D., D.M.D.; Hammoudeh, Jeffrey, M.D., D.M.D.

Plastic and Reconstructive Surgery: October 2017 - Volume 140 - Issue 4 - p 767-774
doi: 10.1097/PRS.0000000000003686
Pediatric/Craniofacial: Original Articles
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Background: Recent studies indicate that recombinant human bone morphogenetic protein-2 (rhBMP-2) in a demineralized bone matrix scaffold is a comparable alternative to iliac bone autograft in the setting of secondary alveolar cleft repair. Postreconstruction occlusal radiographs demonstrate improved bone stock when rhBMP-2/demineralized bone matrix (DBM) scaffold is used but lack the capacity to evaluate bone growth in three dimensions. This study uses cone beam computed tomography to provide the first clinical evaluation of volumetric and density comparisons between these two treatment modalities.

Methods: A prospective study was conducted with 31 patients and 36 repairs of the alveolar cleft over a 2-year period. Twenty-one repairs used rhBMP-2/DBM scaffold and 14 repairs used iliac bone grafting. Postoperatively, occlusal radiographs were obtained at 3 months to evaluate bone fill; cone beam computed tomographic images were obtained at 6 to 9 months to compare volumetric and density data.

Results: At 3 months, postoperative occlusal radiographs demonstrated that 67 percent of patients receiving rhBMP-2/DBM scaffold had complete bone fill of the alveolus, versus 56 percent of patients in the autologous group. In contrast, cone beam computed tomographic data showed 31.6 percent (95 percent CI, 24.2 to 38.5 percent) fill in the rhBMP-2 group compared with 32.5 percent (95 percent CI, 22.1 to 42.9 percent) in the autologous population. Density analysis demonstrated identical average values between the groups (1.38 g/cc).

Conclusions: These data demonstrate comparable bone regrowth and density values following secondary alveolar cleft repair using rhBMP-2/DBM scaffold versus autologous iliac bone graft. Cone beam computed tomography provides a more nuanced understanding of true bone regeneration within the alveolar cleft that may contribute to the information provided by occlusal radiographs alone.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Los Angeles, Calif.; and Providence, R.I.

From the Keck School of Medicine and the School of Dentistry, University of Southern California; the Children’s Hospital Los Angeles; and the Warren Alpert Medical School, Brown University.

Received for publication April 9, 2016; accepted March 28, 2017.

Presented in part at the 94th Annual Meeting of the American Association of Plastic Surgeons, in Scottsdale, Arizona, April 11 through 14, 2015.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Fan Liang, M.D., Division of Plastic Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Suite 415, Los Angeles, Calif. 90033, fan.liang@med.usc.edu

Copyright © 2017 by the American Society of Plastic Surgeons