Reconstruction of Mandibular Defects Using Bone Morphogenic Protein: Can Growth Factors Replace the Need for Autologous Bone Grafts? A Systematic Review of the Literature

Autogenous bone is still considered the “gold standard” of regenerative and reconstructive procedures involving mandibular defects. However, harvesting of this material can lead to many complications like increasing morbidity, expanding of the surgical time, and incomplete healing of the donor site. In the last few years many authors looked for the development of effective reconstruction procedures using osteoinductive factors without the need for conventional bone grafting. The first-in-human study involving the use of Bone Morphongenic Proteins (rhBMP) for mandibular reconstruction was performed in 2001 by Moghadam. Only few articles have been reported in the literature since then. The purpose of this study was to search and analyze the literature involving the use of rhBMP for reconstruction of mandibular defects. In all the studies reported, authors agree that the use of grown factors may represent the future of regenerative procedures with more research necessary for confirmation. 1. Introduction Tissue engineering holds great promise for revolutionizing many grafting procedures. Continuity defects of the mandible frequently result from tumor removal or significant trauma, and reconstruction of these defects can be challenging. For defects with extensive hard and soft tissue loss, microvascular free tissue transfer often provides an excellent reconstructive option. However, significant site morbidity as well as non ideal bone stock for dental implant rehabilitation may occur [1]. The development of bone morphogenic proteins (BMPs) has offered an alternative to traditional bone grafting, which has been the gold standard for oral and maxillofacial reconstruction [2]. Clinical application of BMPs has evolved to include defects of the facial skeleton including those involving the mandible and maxilla [3]. There have been many reports of the use of BMPs regarding orthopaedic as well as alveolar augmentation. There have been few studies addressing the use of BMP in reconstructing critical-size defects of the mandible. The purpose of this study is to evaluate the different study present in the literature concerning the use of growth factors for the reconstruction of mandibular defects, comparing the method and the finals results. A well-identified guideline is in fact not still available and, because of that, significative differences could be find analysing the literature on that topic. 2. Background Failure to adequately restore mandibular continuity defects often result in poor function for the patient postsurgically. Various bone grafting and bone