In situ tissue engineering is the regeneration of 100% normal tissue within the planned anatomical space of the recipient. Related to ridge augmentation, this refers to the gain of sufficient vertical and/or horizontal width without using autogenous bone or leaving unresorbed inert graft particles that can compromise implant placement. This presentation will describe the use of a composite graft consisting of low doses of recombinant human bone morphogenetic protein-2/acellular collagen sponge (rhBMP-2/ACS), platelet-rich plasma (PRP), and crushed cancellous mineralized allogeneic bone (CCMAB), which completes the three legs of the classic tissue engineering triangle of cells-signal-matrix. The specific surgical technique for placing this graft will also be described. The outcome is one of predictable bone regeneration equaling or surpassing that of any other graft system and without the morbidity and second site surgery of autogenous bone or leaving residual inert graft particles at the site. A randomized clinical trial showed this graft system to regenerate bone of equal or better trabecular bone area and gain better implant osseointegration as well as implant lifespan than an autogenous graft. Additionally, this graft system produced less pain and overall morbidity and saved 30 minutes or more of surgical time while keeping the cost comparable to that of an autogenous graft.
Robert E. Marx, DDS, is a professor of surgery and chief of the Division of Oral and Maxillofacial Surgery at the University of Miami Miller School of Medicine. His areas of research include the use of hyperbaric oxygen following radiation therapy, the development of platelet-rich plasma, and the relationship between smoking and carcinogenesis. Dr Marx has received numerous awards, including the Harry S. Archer Award, the William J. Gies Award, the Paul Bert Award, and the Donald B. Osbon Award. His first textbook, Oral and Maxillofacial Pathology: A Rationale for Diagnosis and Treatment (Quintessence, 2002), won the American Medical Writers Associationís Medical Book of the Year Award for 2003.
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