Enhancing Titanium Implants with rhBMP-2 for Improved Osseointegration

Abstract

Early dental implant occurs failure due to poor osseointegration between the bone tissue and implant surface. Adding osseoinductive biomaterials such as bone morphogenetic proteins to the surface of the implant improves the quality and osseointegration of osseointegration. They trigger the conversion of mesenchymal stem cells into osteoblast cells producing new bone. This study aimed to assess the effects of adding bone morphogenetic proteins (rhBMP-2) to the implant surfaces on the extend and strength of osseointegration. This review used studies from Dentistry and Oral Sciences Source, Medline on EBSCo host platform, and CINAHL Ultimate Databases. In-vivo studies with randomised controlled trials from 01/01/2013 to 12/31/2023 were included. Seven animal studies on the surface modification of SLA implants with rhBMP-2 on different carriers were selected based on the inclusion criteria with low risk of bias. The bone area, volume, and bone-implant contact in the new bone formed were measured. The strength of osseointegration was measured in two studies as removal torque and implant stability quotient. Statistically significant increase in new bone formation and boneimplant contact was seen in rhBMP-2 immobilized on heparinised implant surface. Three studies showed significant increase in bone formation when rhBMP-2 was added. bone-implant contact showed statistically significant increase in the experimental group in only two studies. There was no significant difference in the bone-implant contact, removal torque and implant stability quotient analysis in five studies. The biofunctionalisation using rhBMP-2 is promising to increase the extent and strength of osseointegration. It influences the outcome measures of osseointegration even though to display statistical significance rhBMP-2 should have sustained release and concentration. Carriers such as Hydroxyapatite (HAp), Heparin and poly (D,L lactide-co-glycolide) (PLGA) microspheres can biofunctionalise implant surfaces with rhBMP-2. Further studies are needed to identify the ideal carriers and doses needed to increase in the bone implant contact and strength of osseointegration.