rhBMP-2/DBM vs. Iliac Crest Bone Graft in Alveolar Cleft Reconstruction:
A 3D Evaluation of Outcomes
Fan Liang MD1, Stephen Yen DMD PhD2, Luke Sanborn BS2, Leia Yen BS2, Ellynore Florendo BS2, Mark Urata MD DMD1, Jeffery Hammoudeh MD DMD2
For the past 60 years, autologous bone grafting has been viewed as the gold standard for treatment of the alveolar cleft. More recently however, studies indicate that human recombinant bone morphogenic protein-2 (BMP) on a demineralized bone matrix scaffold (DBM) results in comparable if not better bone re-constitution, while bypassing donor site morbidity. Postoperative 2D occlusal radiographs demonstrate similar alveolar cleft repair for each of these two techniques.
Occlusal radiographs, while economical and easily attainable, are limited in their ability to visualize volumetric changes within the actual alveolar space. Here, we use an emerging technology, Cone Beam Computed Tomography (CBCT), to obtain a highly accurate depiction of three dimensional changes within the alveolar cleft after reconstruction with either iliac bone graft or BMP/DBM.
A prospective study was performed on 34 patients undergoing secondary alveolar cleft repair over a 2-year period at the Children’s Hospital of Los Angeles. 21 patients received BMP/DBM and 13 patients underwent iliac bone grafting. No significant demographic differences were noted between the two study arms.