My oral surgeon uses this all the time for ridge augmentation. He achieves excellent vertical augmentation as well as great bone.

What are the limits of the material?

I dont see the value in spending 900 dollars to place this in the socket when a 30 dollar bottle of bone works fine. Otherwise the other comments on this thread are spot on for infuses use.

In general I would not use this in a routine socket. Not worth the price. But I would use it in a socket where I knew that because of teh amount of infection and bone loss I would probably need to do additional surgical procedures to get an implant in there.

Infuse my save you a surgery or 2.

This seems pricey to me placing this in a socket. Is it worth it?

I am a restorative dentist and my surgeon uses infuse. The patients come in with alot of swelling and I am frequently tap dancing to give them answers. How do I reduce the patients fear after they have this product used on them?

Those of you that have used it in the socket what is your justification? What was your results? Was it better then just sticking graft in the socket?

I would agree with what with has been said.

I use it for GBR and sinus grafts. GBR, Ti-mesh is a must. I mix the infuse collagen with FDBA.

For sockets I dont see the value as I can get great results with Nu-oss, Bio-oss or FDBA in a socket without BMP. Infuse adds to much expense.

Swelling can be a killer in this case. The flaps must be released or the flap will open from the swelling.

I saw a lecture by Craig Misch at the IJPRD using infuse in a socket that has tremendous loss of bone due to infection. He placed the infuse in the socket with some allograft and 5 months later he had great bone.

I think infuse in sockets like this may enhance healing and avoid doing major grafting after the extraction.

Opinions?

This to me is a promising material. While expensive it give us the opportunity to provide patients and option when no other option is out there.

I have use BMP-2 on 20 cases. I have two failures. The bone has been type 4 in most cases with some type 3. My type 3 cases I have mixed the infuse with particulate and I think that makes the difference.

I have several success cases utilizing ti-mesh and an inion membrane.

I have used it in sockets that have been extremely destroyed by infection and doing nothing would have resulted in a defect that would have required multiple surgeries to correct.

I would love to hear of other experience

Sergio

First off great discussion.

Just met with my local Medtronic rep about Infuse BMP-2. The cost for the Infuse XX small is $876.00. The is the smallest amount of BMP they sell and is enough for a single area/one socket site for grafting.

How much do you charge to take out a tooth and socket graft with this?

Does this become cost prohibitive?

While it may be a good product, it is hard from a private practice prospective to charge for this especially in this economy.

Opinions on how your handle this in your practice

BMP-2 has shown alot of promise but I dont think its there yet.

While I have not used the product I think there are better forms of growth factors (Like PRGF and PRF) which has less complications and less expense.

I also am concerned about how complicated your surgery has to be to build the ridge. I am concerned with a product that needs ti-mesh, membranes, thick soft tissue in order to have any hope of working.

Opinions?

Brooke

I am not an experienced surgeon but I do take out teeth and graft with NuOss cow bone.

Is BMP-2 a better way to graft the socket? Is the bone better?

I think case selection is key. I have only done two cases in the sinus and the results were great. Type 3 bone.

To avoid the slumping issue I add bone as decribed in this Tarnow article.

Int J Periodontics Restorative Dent. 2010 Apr;30(2):139-49.

Maxillary sinus augmentation using recombinant bone morphogenetic protein-2/acellular collagen sponge in combination with a mineralized bone replacement graft: a report of three cases.
Tarnow DP, Wallace SS, Testori T, Froum SJ, Motroni A, Prasad HS.

sswdds.sinus@sbcglobal.net

Abstract
The objective of the following case reports was to assess whether mineralized bone replacement grafts (eg, xenografts and allografts) could be added to recombinant human bone morphogenetic protein-2/acellular collagen sponge (rhBMP-2/ACS) in an effective manner that would: (1) reduce the graft shrinkage observed when using rhBMP-2/ACS alone, (2) reduce the volume and dose of rhBMP-2 required, and (3) preserve the osteoinductivity that rhBMP-2/ACS has shown when used alone. The primary outcome measures were histomorphometric analysis of vital bone production and analysis of serial computed tomographic scans to determine changes in bone graft density and stability. Over the 6-month course of this investigation, bone graft densities tended to increase (moreso with the xenograft than the allograft). The increased density in allograft cases was likely the result of both compression of the mineralized bone replacement graft and vital bone formation, seen histologically. Loss of volume was greater with the four-sponge dose than the two-sponge dose because of compression and resorption of the sponges. Vital bone formation in the allograft cases ranged from 36% to 53% but, because of the small sample size, it was not possible to determine any significant difference between the 5.6 mL (four-sponge) dose and the 2.8 mL (two-sponge) dose. Histology revealed robust new woven bone formation with only minimal traces of residual allograft, which appeared to have undergone accelerated remodeling or rhBMP-2-mediated resorption.

I have not used this product and I like reading about others clinical experience and I am hoping to gain some more insight from others opinions here.

Infuse comes with a hefty price tag. Base on what I am reading is it worth the price?

Thank you

Musin

I would concur with all that has been said but I would add the following:

1) For GBR you have to use ti-mesh. I tried several cases without the mesh using bio-oss and the infuse and it was a disaster.

2) For sockets it is very nice, I add a small amount of FDBA or Puros to the matrix and I can go back into a socket 8 weeks later and place the implant in solid bone.

3) you need to inform the patients about the swelling. Patient management can be an issue when you have to explain a month after the surgery why they are swollen.

Tim

Doctors;
I like the open discussions on this topic. BTW, I would say thick tissue, passive closure and graft stability are a must for most any regenerative protocol regardless of BMP-2 use or not.
There is success and failure on all techniques but some more than others.
I am not anti-BMP-2, I do use and perform procedures using it. I simply choose to ask more questions and want more science on the "dental" side.
Those who have used it on this forum, have the results been "much better", has the failure rate with Ti-mesh been less, has the bone quality been better, the same or worse. How about post loading of this bone with implants and then prosthetics, how does it respond at 6-12 months clinically and radiographically?? Does it remain or does it resorb??
These are ALL very important questions we as a profession need answers to.
I choose to be more critical right now especially considering the cost of this product. I have spoken to many who use and lecture on this topic and I have heard mixed statements.
Dr. S

You are indeed correct the only on label use is for Sinus grafting. I am not sure if sockets are on or off label.

I saw Craig Misch present a year ago using infuse in blown out sockets and he had some impressive results. So the application is there

I have had some success using Mesh and infuse for ridge defects. There is alot of swelling that why passive flaps are a must.

The problem with getting this to work isnt with infuse, the problem is with the Mesh as it easily gets exposed and if the flap exposes your case is done.

Thick tissue is a must, if I dont have thick tissue I will augment the tissue first with CTG or Alloderm to thicken it and do the infuse graft at a later date.

Guy

I do far less blocks now then when I first started doing implants. Today I am able to rebuild a ridge defect with putty's or particulate.

That being said I still do block grafts and they have their place. In general if the ridge defect is 5 mm or more I am using a block or infuse with ti-mesh.

Tim

This is a tough question. To me everything has its place, you need to have many tools in your bag of tricks in the day of implant dentistry.

I think you need to be able to do blocks and ti mesh. One will not replace the other.