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Oral Surgery/dental implants teen - need for bone graft

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Question
My daughter needs dental implants #7 and #10 for congenitally missing teeth. We have had 4 consultations with surgeons and all of them differ in opinion in one way or another regarding what method is best for bone grafting. All agree she needs bone grafting, one only uses autografting, 2 only use cadaver bone, and one uses all three but believes that the "gold standard" is to use BMP2 on at least one side that is missing more bone. You can imagine how frustrating this is as there are different risks and a great cost difference, the greatest being BMP.  I am an RN and understand and work with growth factor products in wound care.  I believe that they all must work rather well or they would not be used. I guess my question is, is one really better than the other or is it just the progression of the science that has lead surgeons trying different things?  

Frustrated mother in Northern California!!

Answer
I would say that each surgeon has their own preferences based on a number of factors including their understanding of the research literature, their clinical experience and their level of comfort with different surgical procedures.  Obviously, I can not give you any information about your daughters specific situation.  What I can tell you is that this use of BMP2 (infuse bone graft) would likely be an off label use of the product.  While there is nothing wrong with off label uses, I would certainly question the surgeon regarding his experience with it for that specific indication (especially given the cost).   Once you have decided on BMP2 or not, the gold standard for bone grafting is autogenous bone.  Anything else, while it may work is considered to be a less predictable choice.  I hope that helps.

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Jeff Bressman, DDS, Diplomate ABOMS

Expertise

I am a board certified oral and maxillofacial surgeon with over 24 years of experience. The majority of my practice involves dental implants, removal of wisdom teeth, treatment of areas of oral pathology. Please note that this site is designed for general information and I can not give you medical advice specific for you.

Experience

I have over 24 years of private practice experience

Organizations
American Association of Oral and Maxillofacial Surgery, Fellow American Board of Oral and Maxillofacial Surgery, Diplomate National Dental Board of Anesthesia, Fellow American Dental Society for Anesthesia

Education/Credentials
BS, University of Illinois with honors DDS, University of Illinois, with high honors Board Certified, American Board of Oral and Maxillofacial Surgery

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