Real Opportunity for the Present and a Forward Step for the Future of Bone Tissue Engineering

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Excerpt

Rebuilding an atrophic jaw is a constant challenge for clinicians and oral surgeons. “Function” and “Aesthetics” are goals not always be easily reached. In the last 50 years, several reconstructive options have been published and documented in order to obtain adequate maxillary bone volume previously lost due to pathological or traumatic events.1–8
The effective treatments for managing atrophic ridge bone defects have been debated in recent literature and are often related to the nature of the atrophic ridge defects (vertical, horizontal, or both). The material used for the bone regenerative techniques may include autologous, homologous, xenogeneic, and allogeneic grafts. Even though autogenous bone is still considered the best option due to its integration histological features, the main limit of its application is connected to the pain and discomfort experienced by the patient at the grafted area. Therefore, the emergence of some new predictable therapeutic options, such as a viable alternative to common bone grafts, is related to avoiding harvesting bone from extra oral sites when performing maxillofacial reconstruction procedures because of the morbidity associated with the regenerative surgery. It must be remembered how, in the last 10 years, tissue engineering has made significant steps based on data resulting from in vitro, animal, and clinical studies.8–15
In 2007, the Federal Drug Administration finally granted approval on rhBMP-2 (Infuse Bone Graft-Medtronic, Memphis, TN) as an option to autogenous bone graft used for sinus lift surgical procedure and for atrophic bone ridge augmentations of the jaw. This statement was based on data recorded from 312 patients enrolled in a total of 5 clinical multicenter studies.9,10,16 This was the result of a growth factor research started a long time ago by Dr Urist and then developed by Prof PJ Boyne at the beginning of 1990s. In 2007 and 2009, Prof Maiorana, Head at Milan University, gave me the chance to spend my research training at the Loma Linda University working with Prof Boyne and Prof Herford. I was involved in an animal study about growth factors and tissue regeneration procedures. I was in my early 20s and so curious about this research: it was as attractive to me as a bear is to honey irresistible. Boyne was the “science,” and he reflected his passion to discover and solve the problems of all the scientific protocols in which we were involved. Working together, Boyne and Herford had the ability to transfer what they had discovered in animal studies onto common people surgery. They gave an opportunity to the surgeon; they gave a therapeutic, predictable option. I saw with my own eyes young patients affected by large tumors of the jaw treated without extra oral bone graft sites. It was “the” moment, it was a fundamental step, and it was a novelty in the field of bone reconstruction. I have documented such important clinical results, and sincere thanks from the patients and, above all, from the patient's relatives. The clinical application of growth factor was, at first, a possibility and then it became predictable, safe, and useful.
Today, we know well the rhBMP-2 chemical and clinical features; however, important steps should still be performed. The published researches give us information about its use and clinical applications. For example, rhBMP-2 should not be used in the proximity of a resected tumor, in patients with any active malignancy, in infected sites nor on pregnant woman.
Several authors have highlighted how rhBMP-2 safely induced adequate volume bone on premaxillary clefts treatment using a collagen sponge carrier.
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