Clinical applications of Natural Bone Morphoproteins in dentistry: a narrative review

The need to restore bone loss in maxilla and mandible has led to find natural bone substitutes, such as fresh autogenous bone grafts. Fresh autogenous bone grafts (FABGs) have a remarkable capacity to induce new bone formation, a phenomenon called ‘osteoinduction.’ FABGs are useful in craniomaxillofacial and oral applications to restore bone deficiencies. The isolation of those proteins believed to be responsible for the osteoinductive activity of FABGs, namely Natural Bone Morphogenetic Proteins (NBMPs), led to a new era in bone regeneration. NBMPs have been approved for use in specific oral and maxillofacial applications. Clinical trials and studies of oral and craniofacial surgery have indicated that NBMPs can promote bone repair. Information about the biology, chemistry, and actions of NBMPs has called into question whether NBMPs would result in clinically useful bone induction and morphogenesis. Preclinical and specific clinical trials have indicated the efficacy of NBMPs either combined with autograft or compared with an autograft alone. In light of questions about potency and safety of NBMPs, however, additional high-level evidence is needed for specific clinical indications and appropriate patient populations that would benefit from their use.