The History of Bone Reconstruction

Replacing a significant amount of bone has long been a challenge in cases where extensive bone loss occurs, such as with missing teeth, prolonged denture use, or the presence of cysts and tumors in the mouth. In the past, reconstructive procedures often involved using bone from the hip or ribs. These procedures required harvesting bone from the patient’s own body and transferring it to the jaw. However, such procedures typically required hospitalization and long recovery times.

Advancements in tissue engineering have revolutionized bone reconstruction, enabling procedures to be performed in-office with lower risk, shorter recovery periods, and less invasive techniques.

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What is Tissue Engineering?

Tissue engineering is a medical approach that uses biological and technological methods to stimulate bone formation. It involves three key components:

  1. Scaffold: A structure that provides support for new bone growth.
  2. Signal: Growth factors or synthetic proteins that guide and stimulate the healing process and bone formation.
  3. Stem Cells: These “mother cells” have the potential to differentiate into various types of tissue, including bone.

By combining these components, tissue engineering enables the creation of new bone in a controlled environment. Different modalities, such as BMP (bone morphogenetic proteins), PRP (platelet-rich plasma), Gem 21, and BMAC (bone marrow aspirate concentrate), are commonly used in bone regeneration.

Song Oral and Maxillofacial Surgeons are experts in tissue engineering and use these techniques to create a solid foundation for dental implant placement.

What is PRP?

PRP, or Platelet-Rich Plasma, is a form of stem cell technology that uses the patient’s own blood to promote healing and tissue regeneration.

How Do Platelets Help Heal?

Platelets play a critical role in coordinating tissue repair. They release growth factors that stimulate the regeneration of various tissues, including bone and gum tissue. PRP is a concentrated form of platelets and growth factors derived from the patient’s blood. It acts like a biological adhesive, holding bone grafts together and enhancing healing at the surgical site by releasing growth factors that attract stem cells.

Key growth factors in PRP include:

  • Platelet-Derived Growth Factor (PDGF)
  • Transforming Growth Factor Beta (TGF-β)
  • Vascular Endothelial Growth Factor (VEGF)

These growth factors send signals to recruit stem cells that can differentiate into bone-forming cells (osteoblasts) and gum tissue cells (endothelial cells).

When Can You Use PRP?

PRP is a safe and effective way to enhance healing in minimally invasive procedures. It is particularly beneficial in cases of non-healing or large defects, such as after cyst or tumor removal, or in preparation for dental implants. PRP is often used in combination with BMP and bone grafting materials to reconstruct bone and prepare the area for implant placement.

What is the Process?

The blood draw for PRP is done at the same time as the bone grafting procedure in the office. The blood is then placed in a centrifuge, where it is processed for about 15 minutes to concentrate the platelets and growth factors.

Is PRP Safe?

Because PRP is derived from your own blood, it carries no risk of foreign body reaction. The risks are similar to those associated with a blood draw or IV placement.

Contraindications for PRP

PRP may not be suitable for patients with:

  • Platelet dysfunction
  • Anemia
  • Certain cancers (hematologic or bone marrow involvement)
  • Bleeding disorders

Consult with your surgeon or physician to determine if PRP is appropriate for you.

Why is PRP a Great Adjunct to Bone Grafting?

PRP acts like a biological glue, helping to hold the bone graft in place while also promoting the healing process by recruiting stem cells. This enhances the conversion of graft material into new bone. Song Oral and Maxillofacial Surgeons are experts in combining PRP with bone grafting techniques. Ask them if PRP is the right choice for you.

What is BMP?

Bone Morphogenetic Protein (BMP) is a protein that plays a vital role in bone formation by signaling the body to recruit stem cells to the site of injury or reconstruction.

One commonly used form is rh-BMP-2 (recombinant human BMP-2), a synthetic version of the protein. It has been used in orthopedics for years and is now widely utilized in dental reconstructions to aid in bone regeneration. BMP is often used in conjunction with bone grafting procedures like sinus lifts and ridge augmentation to create a solid bone structure necessary for implant placement.

When is rh-BMP-2 Used?

Rh-BMP-2 accelerates the healing of bone grafts and is often used with PRP and cadaveric or bovine (cow) bone for procedures such as sinus lifts and ridge augmentations. Think of implant placement as building a house: just as a solid foundation is needed for a house, a strong bone base is required for successful implants. Tissue engineering, using BMP, PRP, and other growth factors, helps provide that stable foundation.

BMAC (Bone Marrow Aspirate Concentrate)

What is BMAC?

BMAC stands for Bone Marrow Aspirate Concentrate, a technique used to harvest stem cells from the patient’s own bone marrow. These stem cells have the potential to become bone and gum tissue, making BMAC a valuable tool in bone regeneration.

When is BMAC Used?

BMAC is typically used for larger defects caused by pathology (such as the removal of tumors or cysts) or traumatic injury. When a significant amount of bone needs to be regenerated, BMAC is used alongside BMP and PRP to encourage bone growth.

Where is BMAC Harvested From?

The most common site for BMAC harvesting is the iliac crest (the top part of the hip bone), which is rich in bone marrow containing stem cells and growth factors.

How is BMAC Collected?

BMAC is collected in a hospital setting under general anesthesia. A needle is inserted into the hip bone to aspirate bone marrow. The collected marrow is then processed in a centrifuge to concentrate the stem cells and growth factors before being used for grafting.

Is BMAC Safe?

BMAC is minimally invasive and a highly effective method of obtaining large quantities of stem cells. Most patients are able to walk on the same day as the procedure.

If you’re considering BMAC, consult with Song Oral and Maxillofacial Surgeons to determine whether it is the right option for your bone regeneration needs.

Conclusion

Bone reconstruction using tissue engineering techniques like PRP, BMP, and BMAC has revolutionized the way oral and maxillofacial surgeons treat bone loss and defects. These innovative approaches allow for less invasive procedures, faster recovery, and more predictable outcomes. If you are facing significant bone loss or are in need of implant-based reconstruction, speak with your oral surgeon to explore the best options for your individual case.