Demonstration of the Osseoinductive Effect of Bone Morphogenetic Protein Within Endosseous Dental Implants

Demonstration of the Osseoinductive Effect of Bone Morphogenetic Protein Within Endosseous Dental Implants
June 2004
Boyne, Phillip DMD, MS, DSc*; Jones, Shedrick D. DDS*ÇƒÜ
Implant Dentistry: Volume 13(2) June 2004 pp 180-184
Lippincott Williams & Wilkins
*Emeritus Professor, Department of Advanced Education, Oral and Maxillofacial Surgery, School of Dentistry, Loma Linda University, Loma Linda, California.
ÇƒÜClinical Professor, Department of Advanced Education in Prosthodontics (Formerly), Director of Implant Dentistry (Formerly), University of Southern California, School Of Dentistry, Los Angeles, California.
Reprint requests and correspondence to: Shedrick Jones, DDS, 2021 Santa Monica Blvd., Suite 408 East Tower, Santa Monica, CA 90404, Fax: (310) 829-5587
Abstract TOP
The purpose of this case report was to demonstrate the host osseous response in the maxilla after placing bone morphogenetic protein (BMP) within a specially designed implant. Under normal circumstances, it is usually necessary to wait from 4 to 6 months, or even longer in some cases, for osseous integration. Our objective was to assess the ability of BMP, which was carried on an absorbable collagen sponge in horizontal portals of the subject im plant,to affect the formation of bone in a Macaca fascicularis monkey. A control implant was loaded internally with autogenous bone recovered from the preparation of the osteotomy. The results demonstrated that osseous peri-implant healing occurs using BMP in this format.
Clinical experience during the past 30 years has demonstrated that endosseous implants can successfully replace missing teeth. In the 1960s and 1970s, early forms of these implants tended to be encapsulated with fibrous connective tissue or a combination of fibrous connective tissue and bone. The work of Branemark et al. demonstrated that a direct bone-to-implant contact could be achieved. 1 This type of bone contact, called osseointegration, is considered to be the ideal bone-implant interface. 2
Over 35 years ago, Urist demonstrated that protein extracts from bone could induce the local formation of new cartilage and bone when implanted in ectopic sites. Urist called this protein extract bone morphogenetic protein (BMP). 3 One of the main problems encountered by Urist was the limited amount of human bone available for processing to obtain BMP. The advancement of molecular biologic techniques, in particular the use of recombinant DNA, has permitted the production and the characterization of at least 14 BMPs. 4-7 One of these BMPs (rhBMP-2) has been assayed extensively and has been shown to have a very high osteogenic activity. 8,12,13 Thorarinn and coworkers 14 successfully induced peri-implant bone regeneration and osseointegration. Nevins and associates 4 were successful in inducing bone in the goat maxillary sinus using collagen sponges impregnated with rhBMP-2. Howell and coworkers 5 demonstrated radiographic evidence of bone growth in tooth extraction sockets. Boyne and associates 6 were able to induce bone formation in sinus augmentation grafts in humans as demonstrated by means of clinical, radiographic, and histologic methods.
Transforming growth factors (TGFs), despite their molecular similarities to BMPs, have not been demonstrated to be effective in inducing bone formation. 7 TGF-beta does play a positive role in skin and connective tissue healing. 15-17 It has been shown that TGF-B2 in combination with BMP induces osteogenic activity. 18
Autogenous particulate marrow (APM) and cancellous bone (CB) have been considered to be the gold standard for comparing the effectiveness of all osteogenic materials. 19,20 The future use of a dental implant as a carrier of BMP, TFG-B, or autogenous bone is clearly possible. This demonstration case report was undertaken to demonstrate that an optional degree of osseointegration can be achieved in approximately 6 weeks when using BMP and the subject implant.
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