Trends in Alveolar Bone Grafting and the Use of Recombinant Bone Morphogenetic Protein (RhBMP) in the United States

Objectives: To gather information about current practices and assess the opinions, preferences, and clinical knowledge of surgeons who perform alveolar bone grafts. In addition, surgical training differences in correlation to techniques and outcomes are evaluated. Methods: A survey with both multiple choice and narrative answers regarding surgeons' practices for alveolar bone grafting was designed and sent via email to members of the American Cleft Palate/Craniofacial Association (ACPA) identified as general craniofacial or oral maxillofacial surgeons. Responses were collected via an anonymous online survey tool. Participants: Members (336) of ACPA identified as craniofacial or oral-maxillofacial surgeons were contacted, and 62 responses were recorded. Results: The majority of survey respondents were oral-maxillofacial surgeons in practice for more than 15 years. 98.4% of respondents had used iliac crest and at least one additional source for grafting, while only 52.7% had performed grafting using recombinant bone morphogenetic protein (RhBMP). 82% used cone beam CT as their evaluation of choice for graft assessment and the majority (62.9%) waited more than 8 weeks postoperatively to image. Chi-square analysis demonstrated significantly longer time in practice for practitioners without craniofacial fellowship training. Conclusions: The results of this study demonstrate that there remains significant variation in alveolar bone grafting practices among surgeons. While some consensus exists, new innovations and technologies will require continued evaluation of surgical practices and outcomes. Long-term follow-up studies are needed especially with regard to the use of RhBMP in alveolar clefts.