Mandibular Reconstruction With Transforming Growth Factor-β1

• Published in: The Laryngoscope 1998-03, Vol.108 (3), p.368-372
• Main Authors: Sherris, David A., Murakami, Craig S., Larrabee Jr, Wayne F., Bruce, A. Gregory
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; bone; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; mandible; Maxillofacial surgery. Dental surgery. Orthodontics; Medical sciences; osteogenesis; osteoinduction; reconstruction; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Transforming growth factor-β
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1097/00005537-199803000-00011

Hypothesis: Transforming growth factor‐β1 (TGF‐β1) plus demineralized bone matrix (DBM) will reconstruct a critical mandibular defect devoid of periosteum in a canine model. Study Design: Randomized, blinded, placebo‐controlled, prospective animal pilot study. Methods: Canine critical mandibular defects devoid of periosteum were reconstructed with DBM (group 1, n = 3) and DBM plus TGF‐β1 (250 μg TGF‐β1/g DBM) (group 2, n = 3). Radiologic, histologic, and biomechanical testing was performed on the test group and control group specimens at 12 weeks after implantation. Results: A palpable bone bridge was present in the group 2 subjects 5 to 6 weeks after implantation and was never present in the group 1 subjects. Radiologic and histologic examination at the time of harvest (12 weeks after implantation) demonstrated a solid bone bridge in the group 2 subjects and a fibrous union in the group 1 subjects. Group 2 specimens demonstrated failure in four‐point bending testing at an average maximum moment of 9.9 ± 2.2 N‐m. This value was 9.4% of the maximum moment of the contralateral nonoperated side. Group 1 specimens were palpably flexible on plate removal and had a biomechanical strength of 0. The difference in strength between group 1 and group 2 was statistically significant (P < 0.02), supporting the hypothesis that the addition of TGF‐β1 to the DBM carrier resulted in the formation of significantly stronger bone in the critical gap. Conclusion: The addition of TGF‐β1 to DBM results in healing of a critical bone defect devoid of periosteum in a higher mammalian model.