Posterior Maxilla Pg 8

Management of the Posterior Maxilla in the Compromised Patient: Historical, Current, and Future Perspectives


Thomas J. Balshi & Glenn J. Wolfinger
Periodontology 2000, Vol 33, 2003, 67-81.

Future Considerations
Over the next decade, technological and scientific advances have the potential to transform the placement of posterior maxillary implants in all patients — both healthy and compromised — into a mundane and predictably successful operation. Likely developments include the implementation of genetic and tissue engineering in conjunction with bone surgery and implant placement, as well as systemic enhancement of bone metabolism.
These developments are already well underway. More than 35 years ago, Urist coined the term “bone morphogenetic protein” (BMP) to describe the bone-inducing substance that he hypothesized had caused the formation of new cartilage and bone after implantation of decalcified bone matrix in rabbits and rats55. By the late 1980s, a group of proteins from bovine bone had been identified56 and the first recombinant human BMP (rhBMP) had been cloned and characterized.57 Today more than 20 BMPs have been described58.
A number of preclinical studies have demonstrated that rhBMP-2 may be used successfully in animals to augment alveolar defects59-61, and Hanisch and colleagues found significantly greater bone height in augmented subantral space that had been implanted with rhBMP-2 in the Cynomolgus monkey62. Recent human studies have also shown rhBMP delivered on an absorbable collagen sponge (ACS) to be safe, predictable, and effective19.
Other delivery methods seem certain to develop with the introduction of new implant technologies. The TiUnite surface (Nobel Biocare, Göteborg, Sweden), for example, seems a precursor to the eventual ability to lace implant surfaces with genetically engineered proteins to stimulate bone growth.

Platelet Rich Plasma (PRP) in conjunction with autogenous grafting is already in use to biologically reconstruct and graft the sinus area. In the future, the growth factors made available through the use of PRP may very well be available through recombinant technology, thereby simplifying the entire treatment process.

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