bone morphogenetic protein as bone additive around dental implant and its impact on osseointegration: a systematic review

Statement of the problem: bone morphogenetic protein (bmp), a potential osteoinductive agent, was systematically reviewed for merits and demerits when used as a bone additive that was intervened during the surgical phase of dental implant placement; and suitable drug carriers that could withstand the functional load and deliver bmp at its lowest concentration.purpose: to identify the carriers and concentration of bmp acceptable during surgical phase of implant placement and evaluate its efficacy in bone gain and osseointegration.materials and method: the study design was systematic review. literature search as per pico format was carried out within a time range from 2000 to july 2021. the review followed prisma guidelines and registered with the prospero (crd42020171667). the focus question included the population with an intraoral implant placed in both animal and human models that were intervened with bmp2 as an external additive biomaterial during the surgical phase. 2631 articles selected from the initial search were systematically filtered and yielded 16 articles that were qualitatively analysed.results: the interrater reliability and level of agreement were 93.71%, κ(kappa)>0.81 respectively. results revealed the collagen carrier was commonly used for bmp delivery but lacked the property to withstand functional load and sustained release. bmp concentration varied in the range of 0.215µg to 0.8mg and the study revealed significantly indifferent outcome with low dose compared to the highest dose. bmp supplement showed better osseointegration in comparison with nonsupplemented sites during the early period (within 6 months).conclusion: bmp at lower concentrations and with appropriate carriers, collagen sponge, hydroxyapatite/tricalcium phosphate (ha/tcp) with a bio ceramic bulking agent, and poly (d, llactidecoglycolic acid) (plga)  reinforced with gelatin/ha/tcp accelerated bone growth during the initial stages of healing. further longterm clinical trials for dental implant, analysing the sustained release of bmp with biodegradable and loadbearing carriers should be considered.