Enhanced Efficacy of Combined Iliac Crest Bone Graft and Recombinant Human Bone Morphogenetic Protein for Alveolar Bone Grafting

Background This study compares clinical and radiographic outcomes in alveolar bone grafting (ABG) using iliac crest bone graft (ICBG) alone, demineralized bone matrix (DBM) with recombinant human bone morphogenetic protein-2 (rhBMP-2), and ICBG with recombinant human bone morphogenetic protein-2 with demineralized bone matrix (rhBMP2/DBM). Purpose We evaluated differences in clinical success and radiographic bone formation among grafting techniques for secondary alveolar cleft repair. Study Design, Setting, and Sample Retrospective cohort study of patients undergoing secondary ABG for cleft alveolus between 2017 and 2023 at a tertiary children's hospital. Independent Variable Type of grafting technique: ICBG alone, DBM with rhBMP-2, or ICBG with rhBMP-2. Main Outcome Variables The primary outcome was radiographic success (bony bridging on cone-beam computed tomography). Secondary outcomes included vertical bone height and reoperation. Covariates Age, sex, cleft laterality, and graft type. Analyses Descriptive statistics and comparative analyses were performed. Statistical significance was set at P < .05. Results A total of 432 patients (527 clefts) were included: 196 ICBG, 284 DBM + rhBMP-2, and 47 ICBG + rhBMP-2. Radiographic success was highest in the ICBG + rhBMP-2 group (89.4%) compared with ICBG (65.3%; P = .001) and DBM + rhBMP-2 (61.6%; P < .001). Mean vertical bone height was greater in the ICBG + rhBMP-2 group (7.4 ± 2.6 mm) versus ICBG (4.7 ± 1.9 mm; P < .001) and DBM + rhBMP-2 (4.4 ± 1.2 mm; P < .001). Conclusions and Relevance ICBG combined with rhBMP-2 demonstrates improved radiographic bone formation and vertical height compared with alternative grafting strategies, without increasing reoperation rates.