BMP-2 in oral-maxillofacial bone augmentation: a systematic review and meta-analysis.

BACKGROUND

Bone morphogenetic protein-2 (BMP-2) has been widely applied in oral and maxillofacial bone augmentation procedures. This study aimed to evaluate the efficacy and safety associated with the use of BMP-2 in oral and maxillofacial bone augmentation procedures across available randomized controlled trials (RCTs).

METHODS

RCTs involving BMP-2 used for alveolar ridge preservation (ARP), alveolar bone augmentation, and maxillary sinus floor elevation were included. The primary outcomes included changes in bone width and height, proportion of newly formed bone and residual graft material, implant survival, and marginal bone level (MBL). Seven databases were searched up to May 1, 2026. The Cochrane risk-of-bias 2 assessment tool was used to assess the risk of bias in the included studies. Meta-analysis, sensitivity analysis, and subgroup analyses were performed using RevMan 5.4.1 and STATA 12.0. (PROSPERO registration number: CRD420250586726).

RESULTS

Twenty-three RCTs involving 990 participants with 1104 sites were included. Meta-analysis revealed that the use of BMP-2 was associated with significantly greater alveolar ridge width at the apical region. However, BMP-2 did not significantly enhance the proportion of new bone nor reduce residual graft material. Subgroup analyses suggested that its performance varies according to the surgical procedures and carriers. No significant differences were found between groups in implant survival, MBL or the incidence of adverse events. The majority of included studies were assessed as having some concerns or high risk of bias.

CONCLUSIONS

Because of substantial heterogeneity across the included RCTs, the overall pooled estimates should be considered exploratory and hypothesis-generating. The use of BMP-2, particularly in ARP, appears to be associated with modest improvements in alveolar bone width (at the apical region), whereas no significant differences were observed in the proportion of newly formed bone, the implant survival rate, or the incidence of adverse events. BMP-2 may be considered selectively in appropriate clinical scenarios after careful evaluation of cost, defect characteristics, and expected clinical benefit.