Long Term Clinical Outcomes Of Recombinant Human Bone Morphogenic Protein-2 In Primary Alveolar Bone Grafting In Patients With Cleft Lip/palate
Kristine Carbullido, BS, George N. Kamel, MD, Robert Jacob, DDS, Samuel Lance, MD, Amanda Gosman, MD.
UC San Diego/Rady Children's Hospital, Division of Plastic Surgery, San DIego, CA, USA.
Background: Primary alveolar bone grafting (PABG) with recombinant human bone morphogenic protein-2 (rhBMP-2) is thought to decrease donor site morbidity and midface growth restriction. However, there remains a paucity of data detailing the long-term outcomes. The purpose of this study was to assess clinical and radiographic outcomes of non-syndromic patients who underwent PABG using rhBMP-2.
Methods: An IRB approved retrospective chart review of patients who underwent PABG with rhBMP-2 at Rady’s Children Hospital San Diego was performed. PABG take was analyzed using the Chelsea score. Goslon Yardstick on plaster, digital, and CBCT models were used to characterize occlusion. Statistical analysis was performed using IBM SPSS.
Results: Eighteen patients who had PABG with rhBMP-2 were identified. Five patients were lost to follow-up. Average postoperative follow-up was 8.3 years. Eight patients had imaging analysis with either a CBCT or panorex and all patients were in mixed dentition phase. The average Chelsea scoring was 7/8: 67% of patients were category A and 33% of patients were category B. Seven patients had models suitable for Goslon Yardstick analysis. Five patients were categorized as group 4 and were deemed to need extensive orthodontic treatment with possible orthognathic surgery. Two patients were considered group 5, requiring future surgery.
Conclusion: Despite high Chelsea scores indicating good bone graft take, occlusal analysis using the Goslon Yardstick showed that all patients will require extensive orthodontic treatment with possible orthognathic surgery. This study suggests that use of PABG with rhBMP-2 may be associated maxillary growth restriction.
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