Current Status of Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2) in Maxillofacial Surgery: Should It Be Continued?

Abstract

Recombinant human bone morphogenetic protein-2 (rhBMP-2) has shown potential in maxillofacial surgery owing to its osteoinductive properties. However, concerns about its safety and high cost have limited its widespread use. This review presents the status of rhBMP-2 use in maxillofacial surgery, focusing on its clinical application, efficacy, safety, and limitations. Studies have demonstrated rhBMP-2's potential to reduce donor site morbidity and increase bone height in sinus and ridge augmentation; however, it may not outperform autogenous bone grafts. In medication-related osteonecrosis of the jaw treatment, rhBMP-2 has been applied adjunctively with promising results, although its long-term safety requires further investigation. However, in maxillofacial trauma, its application is limited to the restoration of large defects. Safety concerns include postoperative edema and the theoretical risk of carcinogenesis. Although postoperative edema is manageable, the link between rhBMP-2 and cancer remains unclear. The limitations include the lack of an ideal carrier, the high cost of rhBMP-2, and the absence of an optimal dosing regimen. In conclusion, rhBMP-2 is a promising graft material for maxillofacial surgery. However, it has not yet become the gold standard owing to safety and cost concerns. Further research is required to establish long-term safety, optimize dosing, and develop better carriers.

Keywords: BMP; alveolar ridge augmentation; bone graft; bone morphogenetic proteins; maxillary sinus augmentation.

Figure 1

A case representing an example of alveolar ridge augmentation using rhBMP-2/ACS. A 35-year-old male patient with a cystic mass on the left mandibular posterior area underwent cyst enucleation, surgical extraction of the mandibular left second molar, and application of rhBMP-2/ACS. He showed no significant symptoms associated with the use of rhBMP-2. After uneventful healing, he underwent implant installation one year after surgery. (a) Preoperative panoramic view; (b) immediate postoperative panoramic view; (c) intraoperative clinical photo showing the defect after cyst enucleation and surgical extraction; (d) intraoperative clinical photo showing the defect filled with rhBMP-2/ACS; (e) preoperative coronal view of cone beam computed tomography (CBCT) image; (f) coronal view of CBCT image eight months after surgery; (g) panoramic view six months after surgery; (h) panoramic view one year after surgery.

Figure 2

A case represents an example of MRONJ treatment using rhBMP-2/ACS. A 68-year-old female patient with MRONJ on the mandibular right posterior area underwent sequestrectomy, surgical extraction of the mandibular right second premolar, and application of rhBMP-2/ACS. She showed no significant symptoms associated with rhBMP-2 other than usual postoperative edema. Although sufficient bone regeneration was not achieved at the surgical site, she presented uneventful healing and underwent the fabrication of removable partial dentures. (a) Clinical photo showing denuded bone and pus discharge due to MRONJ; (b) clinical photo showing removed sequestrum and granulation tissue; (c) intraoperative clinical photo showing the defect after sequestrectomy and surgical extraction; (d) intraoperative clinical photo showing the defect filled with rhBMP-2/ACS; (e) preoperative three-dimension (3D)-reconstructed CBCT image; (f) 3D-reconstructed CBCT image six months after surgery; (g) preoperative panoramic view; (h) immediate postoperative panoramic view; (i) panoramic view three months after surgery; (j) panoramic view two years after surgery.