Dental News - Bone-regenerating protein could improve dental implant success

Dental Tribune USA

Tue. 21 February 2012

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NEW YORK, NY, USA: Using a bone-inducing protein to augment the maxillary sinus could improve dental implant success in cases where bone-loss presents a challenge, according to Georgia Health Sciences University researchers. With bone-thinning a common cause and/or consequence of tooth loss, researches are keen on finding better ways to build up bone that is too thin to support the anchoring of dental implants.

The current favored solution is to supplement the area with bone grafts to stabilize the implant base. But that technique can be problematic “primarily because it involves additional surgeries to harvest the bone,” said Dr. Ulf M. E. Wikesjö, interim associate dean for research and enterprise in the GHSU College of Dental Medicine.

In animal studies, he and his team at the GHSU Laboratory for Applied Periodontal & Craniofacial Regeneration found that by implanting bone morphogenetic protein (BMP) in the sinus, more new bone forms in four weeks than does when using conventional bone grafting at the same site.

“We found that BMP induced superior bone quality over that following bone grafts, which improves the chances for successful implants,” Wikesjö said. “BMP is phenomenal, because it’s a true, off-the-shelf product with ease of use that can produce real results, and it could be the new gold standard for this procedure.”

According to the American Association of Oral and Maxillofacial Surgeons, 69 percent of adults ages 35-44 have lost at least one tooth due to decay, disease or trauma, and 26 percent of adults have lost all permanent teeth by age 74. Before dental implants were available, the only options for replacing these missing teeth were dentures and dental bridges, both of which could lead to further bone loss. Implants provide patients with numerous benefits, including improved oral health, appearance, speech, convenience, durability and ability to eat.

The findings of the Wikesjö team’s pilot study were presented at the Academy of Osseointegration annual meeting in Washington, D.C. Wikesjö’s GHSU co-investigators include Drs. Jaebum Lee, Cristiano Susin, Nancy Rodriguez and Jamie de Stefano.

According to the Ontario Ministry of Health, by 2004 two BMP products had already received Health-Canada approval. One approved use is to aid in the treatment of long bone fractures. Another type of BMP was approved for use in spinal fusion procedures in patients with degenerative disc disease, eliminating the traditional need for bone-grafts from the pelvis.

BMPs were discovered by UCLA orthopedic surgeon Marshall Urist. A 2001 obituary for Urist in the Los Angeles Times said, “Urist was probably best known for his discovery in 1965 of bone morphogenetic protein, or BMP, a genetically produced substance that helps bone to regenerate by inducing certain types of connective tissues and other unspecialized cells to become bone cells. In more than 20 years of experimentation, Urist proved that BMP could be used to build living bone tissue around surgical pins and screws used to repair broken hips, shoulders and other bones.”

According to Frost and Sullivan, a 50-year-old global market research and consulting firm, a BMP market began to open up in 2001 with U.S. FDA approval of a BMP product for clinical use. Since then, the market has steadily grown and other BMP products have been approved by the FDA, Health Canada and regulatory agencies in a number of other countries. Prices for treatment remain relatively high, though, especially when compared with the costs of traditional bone grafting. Frost and Sullivan report that regulatory, insurance and patent challenges also have kept growth of the BMP market in check – along with continued research into potential risks associated with use of BMPs in high-concentration.

Focused primarily on spinal fusion surgeries, a September 2008 research report on the BMP market by Frost and Sullivan states: “The primary advantage of bone growth factors compared with allograft bone tissue is that they do not depend on the availability of donated human tissue. In addition, owing to the potential risk of disease transmission, synthetic materials and growth factors may be perceived as safer than allograft-based bone tissue. Many new composite products are also becoming available which seek to harness the combined characteristics of synthetic and natural materials in one single product optimized for rapid bone repair and regeneration.”

(Sources: Georgia Health Sciences University; the Medical Advisory Secretariat, Ontario Ministry of Health and Long-Term Care; and Frost & Sullivan)

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