Off-label use of recombinant human bone morphogenetic protein-2 (rhBMP-2) for reconstruction of mandibular bone defects in humans.

PURPOSE: The off-label use of recombinant human bone morphogenetic protein-2 (rhBMP-2) for the treatment of mandibular bone defects was evaluated in 5 patients. The rhBMP-2 was used as an alternative to autogenous bone grafting. PATIENTS AND METHODS: A total of 5 patients had mandibular defects reconstructed with rhBMP-2, 1.5 mg/mL, soaked collagen sponges alone or in combination with bone marrow cells and allogenic cancellous bone chips. Four of the patients had mandibular continuity defects and the fifth patient had 2 large bone cavities following removal of dentigerous cysts. Radiographs and clinical examinations were used to evaluate healing. The longest patient follow-up was 22 months after reconstruction. RESULTS: Radiographic and clinical assessments revealed bone regeneration and restoration of the mandibular defects in 3 of the 5 patients. The rhBMP-2 failed in 2 patients with continuity defects. Both patients with failed rhBMP-2 grafts were successfully repaired using autogenous harvested from the iliac crest. CONCLUSION: Mandibular bone defects can be successfully reconstructed using rhBMP-2 soaked sponges with and without including bone marrow cells and allogenic bone. Further studies are needed to determine the ideal combination of components that will predictably and reliably regenerate bone in different types of bone defects.

A prospective randomized clinical trial comparing 2.0-mm locking plates to 2.0-mm standard plates in treatment of mandible fractures.

PURPOSE: The purpose of this study was to compare standard 2.0-mm monocortical plates to 2.0-mm locking plates in the treatment of mandible fractures. PATIENTS AND METHODS: A prospective randomized clinical trial was conducted at Harborview Medical Center in Seattle, WA, from January 1, 2002, to February 1, 2003, to compare 2.0-mm locking plates to 2.0-mm standard plates in treating consecutive mandible fractures. Patients were randomly assigned to receive locking 2.0-mm plates (group A) or nonlocking 2.0-mm plates (group B). Complications were divided into major and minor categories. Each complication was analyzed according to which plate was used and where the fracture occurred. The number of days from injury to operation, average age, gender, American Society of Anesthesiologists (ASA) classification,compliance, and social habits were all reviewed. RESULTS: Ninety patients with 122 fractures met the inclusion criteria. Sixty-four fracture sites were treated with locking plates and 58 with standard plates. A total of 6 complications occurred: 2 occurred at the angle, 3 at the parasymphysis, and 1 at the body. Three complications occurred in the locking group and 3 in the standard group with complication rates equaling 4.6% and 5.2%, respectively. When comparing the overall complication rates according to plates used, the Fisher exact test showed no statistically significant difference between the locking and standard plates (P = .90). The 95% confidence interval for the odds ratio is from 0.1 to 7. CONCLUSION: Mandible fractures treated with 2.0-mm locking plates and standard 2.0-mm plates present similar short-term complication rates.