Augmentation of alveolar bone and dental implant osseointegration: Clinical implications of studies with rhBMP-2 - A comprehensive review

Background: The surgical placement of dental implants is governed primarily by the prosthetic design and secondarily by the morphology and quality of the alveolar bone. Implant placement may be difficult, if at all possible, due to alveolar ridge aberrations. In consequence, prosthetically dictated dental implant positioning often entails augmentation of the alveolar ridge and adjacent structures. The objective of this review is to discuss recent observations of the biologic potential, the clinical relevance, and the pe rspectives of the application of recombinant human bone morphogenetic prote in-2 (rhBMP-2) technology for alveolar bone augmentation and dental implant fixation. Methods: Our studies use discriminating, critical-size, supraalveolar defec ts in dogs to evaluate the biologic potential of the rhBMP-2 technology. We also use clinical modeling, including peri-implantitis and alveolar ridge defects and the maxillary sinus in preparation for clinical indications, in dogs and inhuman primates. Results: The results suggest that rhBMP-2 has substantial potential to augm ent alveolar bone and support dental implant fixation and functional loadin g. Conclusion and Clinical Relevance: Inclusion of rhBMP-2 for alveolar bone a ugmentation and dental implant fixation will not only enhance the predictab ility of the existing clinical protocol but will also allow new approaches to these procedures.