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Regenerative effect of recombinant human bone morphogenetic protein-2/absorbable collagen sponge (rhBMP-2/ACS) after sequestrectomy of medication-related osteonecrosis of the jaw (MRONJ)

대한구강악안면외과학회지 2020년 46권 3호 p.191 ~ 196
민송희 ( Min Song-Hee ) - Ajou University School of Medicine Department of Oral and Maxillofacial Surgery

강노을 ( Kang No-Eul ) - Ajou University School of Medicine Department of Oral and Maxillofacial Surgery
송승일 ( Song Seung-Il ) - Ajou University School of Medicine Department of Oral and Maxillofacial Surgery
이정근 ( Lee Jeong-Keun ) - Ajou University School of Medicine Department of Oral and Maxillofacial Surgery

Abstract


Objectives: Beyond the original application approved by the U.S. Food and Drug Administration, recombinant human bone morphogenetic pro-tein-2 (rhBMP-2) is used for medication-related osteonecrosis of the jaw (MRONJ) treatment because of its bone remodeling enhancement proper-ties. The purpose of the study was to investigate the bone formation effect of rhBMP-2/absorbable collagen sponge (ACS) in patients with MRONJ.

Materials and Methods: In this retrospective cohort study, 26 female patients diagnosed with MRONJ and who underwent mandibular se-questrectomy at Ajou University Dental Hospital from 2010 to 2018 were included. The experimental group was composed of 18 patients who received rhBMP-2/ACS after sequestrectomy, while the control group was composed of 8 patients who did not receive rhBMP-2/ACS after se-questrectomy. A total dose of 0.5 mg of rhBMP-2 was used in the experimental group at a concentration of 0.5 mg/mL. Follow-up panoramic X-rays were taken immediately after the surgery and more than 6 months after the surgery. Using those X-rays, a radiographic index of bone defect area was calculated using the modified Ihan Hren method, which measures radiographic density of the normal bone and the defect site.

Results: This study suggests that rhBMP-2 contributes to new bone formation. The mean radiographic index immediately after surgery and more than 6 months after the surgery for the experimental group was 68.4% and 79.8%, respectively. The mean radiographic index immediately after surgery and more than 6 months after the surgery for the control group was 73.4% and 76.7%, respectively (Wilcoxon signed rank test, P>0.05). The mean radiographic index increased 11.4% in the experimental group and 3.27% in the control group (Mann?Whitney U-test, P<0.05).

Conclusion: Based on the results, use of rhBMP-2/ACS on bone defect sites after sequestrectomy could be a successful strategy for treatment of MRONJ patients.

키워드

Recombinant human bone morphogenetic protein-2; Osteomyelitis; Bisphosphonate-associated osteonecrosis of the jaw; Osteonecrosis
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