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Use of recombinant human Bone Morphogenetic Protein (rhBMP-2) in reconstruction of maxillary alveolar clefts
1Balaji Dental & Craniofacial Hospital, 30, KB Dasan Road, Teynampet, Chennai-18, India.
Background:
Use of rhBMP2 has been demonstrated to be an ideal bone reconstructive material for alveolar clefts. There is a lack of such studies from Indian cleft patients.
Aim:
To compare rhBMP2 alveolar cleft repair and iliac crest graft treated cases.
Materials And Method:
Retrospective analysis of rhBMP2 alveolar cleft repair and iliac crest graft treated cases.
Predictor Variables:
Gender, type of surgery and type of cleft
Outcome Variables:
Total surgery time, blood loss at surgical and harvest site, length of scar, number of days on antibiotics, serratiopeptidase and NSAIDS; sutured days, number of days to regain masticatory functions, pain VAS on 5th postoperative day and at harvest site on a scale of 10; duration of edema, number of working days lost, time until child could walk 'normally'; mean efficiency of bone deposition.
Statistics:
Descriptive, paired 't' test, one way ANOVA RESULTS: Difference between rhBMP2 and iliac crest graft treated cases in terms of antibiotic use, serratopeptidase, NSAIDS, pain at surgical site, edema, number of working lost for attendees and number of days to walk unaided were statistically significant. The mean length of surgery for unilateral cases was 87.60 minutes whereas it was 108.75 minutes for bilateral cases (p=0.003). The mean efficiency of bone deposition as revealed loss in radiolucency for rhBMP2 treated cases was 91.74% whereas iliac crest graft cases showed a 87.96% (p=0.006).
Discussion:
It is evident that one has to reject null hypothesis in favor of the alternate hypothesis. The rhBMP2 is better than the conventional gold standard of iliac crest graft for restoration of maxillary alveolar clefts in terms of considered surgical, post surgical and radiographic planimetry parameters.
Conclusion:
Sparing children from the procedure of iliac crest harvesting is by itself a compelling reason to favor rhBMP2 use. It avoids the unnecessary surgery, loss of blood and postoperative morbidity of iliac crest harvesting.
