Bone Morphogenetic Proteins (BMP)
Bone Morphogenetic Protein is a growth factor that is normally found in small quantities in our body. It is a natural occurring substance that our body produces when we have an injured bone. Countless scientists have worked to isolate the growth factor and make it a manufactured active ingredient in INFUSE® Bone Graft , made by Medtronics, which is rhBMP-2 . The magic of BMP is that it stimulates the bones natural reparative mechanisms.
These proteins, or BMPs, have been studied for decades because of their remarkable ability to heal bone or stimulate bone growth. This has allowed us to decrease or eliminate bone graft harvesting (taking bone from another part of the body) and may replace the use of other graft materials. Six of the BMP’s discovered appear capable of initiating bone growth. BMP-2 has been studied the most and is FDA approved for use in certain spinal bone regeneration, leg (tibial) bone growth and in oral surgery for moderate to major areas of bone loss.
Naturally occurring BMP within the bone itself is found in small amounts. To have enough BMP to stimulate your body’s reparative mechanisms BMP is manufactured in a special facility. Molecular biology techniques are used to isolate the gene that stimulates BMP production and using genetically engineered cells, allowing production of large quantities of rhBMP-2. This process is similar to the manufacture of other proteins, such as insulin. This rhBMP-2 is identical to the natural form and its ability to grow new bone.
During treatment, rhBMP-2 is soaked onto an absorbable collagen sponge (ACS) that is designed to resorb, over time and many times it is mixed with human freeze dried bone to decrease the total volume of BMP needed. The sponge and the added bone are resorbed by the body (as with other bone grafts) and the rhBMP-2 stimulates the cells to produce new bone. The rhBMP-2 is also resorbed once it has completed its task of initiating the normal bone healing process.
In situations of jaw bone resorption or loss due to the lack of teeth to stimulate the bone (denture wearers in particular), rhBMP-2 is placed at the site of the jaw bone that needs to be built back up in preparation for dental implants. It also stimulates some repair of the soft tissue as well. The down sides of BMP use in growing bone for dental implants are few: It is pricey. It also stimulates the body’s reparative mechanism so well that the swelling patients get after placement is more significant. In spinal applications there have been concerns about growing bone where we don’t want it, yet in the dental setting I have not heard nor read any reports of this
Professionally, I received a Master’s degree in bone regeneration, using bone transferred from one site to another. Since 1999 I saw my first patient that was part of some of the original studies on this remarkable material. Since 2010 I have been using BMP more routinely, along with other growth factors to decrease the trauma and increase the predictability of growing bone. To date, I have been very pleased with the material. . I am following publications, what others say and our results closely as with any newer technology. So far the results have been very positive and it is gaining slow, steady acceptance by dental implant surgeons.
These are images of bone grown with BMP, looked at under a microscope. The bone is purple and clearly it grows right up to the dental implants on all sides of the implant.