Alveolar Bone Grafting: Outcomes Utilizing Synthetic HA/TCP and rhBMP-2 versus Autologous Graft Types.

Abstract

Alveolar ridge defects associated with cleft lip and palate are typically repaired using alveolar bone grafting (ABG), with autologous grafting as the standard despite donor-site morbidity. This study investigated outcomes of using hydroxyapatite/ß-tricalcium phosphate (HA/TCP) as a synthetic graft alternative. A retrospective cohort study identified 118 patients who underwent ABG by means of CPT codes and were divided into 3 groups: autologous iliac crest bone graft (ICBG) ( n = 37), ICBG plus recombinant human bone morphogenetic protein-2 (rhBMP-2) ( n = 65), and 15% HA/TCP plus rhBMP-2 ( n = 16). Primary outcomes included need for regrafting and percentage graft take, assessed by means of cone beam computed tomographic imaging. Secondary outcomes included complication rates (swelling, wound dehiscence, surgical-site infection) and perioperative data (surgery length, hospital stay). Patients who received HA/TCP plus rhBMP-2 experienced similar rates of need for regrafting to the other groups. The median percentage graft take was higher for HA/TCP plus rhBMP-2 (68.0%; interquartile range [IQR], 45.9% to 93.1%) compared with ICBG (25.1%; IQR, 5.2% to 43.5%; Z = 3.16; P = 0.002) and ICBG plus rhBMP-2 (44.2%; IQR, 24.5% to 63.1%; Z = 2.19; P = 0.028). Complication rates were similar across groups (dehiscence, P = 0.319; surgical-site infection, P = 0.357), except for a higher rate of postsurgical facial swelling for HA/TCP plus rhBMP-2 compared with ICBG (OR, 6.8; 95% CI, 1.44 to 32.00; P = 0.0157). HA/TCP plus rhBMP-2 is a viable alternative to ABG, showing comparable success to ICBG and ICBG plus rhBMP-2, with superior percentage graft take and no increased complication risk, aside from increased postsurgical facial swelling compared with ICBG.