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JOMS study: Use of bone-growing protein in cleft reconstruction shows promise

March 3, 2019

ROSEMONT, Ill. – The use of bone morphogenetic proteins (BMPs) for cleft lip and palate reconstruction delivered positive results for those with one-sided cleft palate during a 10-year follow-up after application, according to a study published in the March issue of the Journal of Oral and Maxillofacial Surgery. The results were less promising for those with both sides of the front of their palate clefted.

Researchers are studying the use of BMPs – which stimulate bone growth – in cleft palate reconstruction as a way to avoid harvesting bone from another site in the patient to put into the cleft, which is associated with pain, scarring, swelling and changes in sensation. The study published in the official Journal of the American Association of Oral and Maxillofacial Surgeons (AAOMS) showed the use of BMPs led to successful bone formation in those with a one-sided cleft in the front part of their palate.

The study examined a clinical trial with 11 patients ranging from 8 to 11 years old who had an alveolar cleft, a bone defect in the upper jaw. Nine of the patients had a one-sided cleft palate (unilateral cleft lip and palate, UCLP) while two had clefts on both sides (bilateral cleft lip and palate, BCLP). Recombinant human bone morphogenetic protein-7 (rhBMP-7) – a laboratory-produced protein that spurs bone growth – was applied to the cleft site during surgery. Patients made annual cleft care visits for10 years, and X-rays were taken according to protocol.

Researchers reported the surgical sites healed well, swelling was similar to that of routine procedures involving extracting teeth, and no critical issues occurred. For those with UCLP, bone growth was similar to patients whose reconstruction were completed with grafted bone. None of these cases required additional grafting.

The two patients with BCLP did not experience the needed growth and ultimately went through traditional grafting procedures for reconstruction. Researchers believe the reason for the failure was the amount of protein applied. Increasing the dose, however, was not an option due to the potential risk of excessive bone growth.

According to the study, concerns surround the safety of using BMPs, especially in regards to skeletal immaturity in children and evidence BMPs might play a role in certain cancers. The study, however, showed no adverse or unexpected results and no development of tumors.

The authors of “The Clinical Application of Recombinant Human Bone Morphogenetic Protein 7 for Reconstruction of Alveolar Cleft: 10 Years’ Follow-Up” are from Glasgow Dental Hospital & School, Glasgow, Scotland: Ashraf Ayoub, PhD, FDSRCS(Ed), FDS RCPS(Glas), MDS, and Toby Gillgrass, FDS, RCS. 

The full article can be accessed at www.JOMS.org/article/S0278-2391(18)30996-0/fulltext.

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The Journal of Oral and Maxillofacial Surgery is published by the American Association of Oral and Maxillofacial Surgeons to present to the dental and medical communities comprehensive coverage of new techniques, important developments and innovative ideas in oral and maxillofacial surgery. Practice-applicable articles help develop the methods used to handle dentoalveolar surgery, facial injuries and deformities, TMJ disorders, oral and head and neck cancer, jaw reconstruction, anesthesia and analgesia. The journal also includes specifics on new instruments and diagnostic equipment, and modern therapeutic drugs and devices.