A Comparative Volumetric Assessment of Cancellous and Cortico-Cancellous Bone Graft in the Management of Unilateral Alveolar Cleft Defect using Cone Beam Computed Tomographic Scan-A Randomized Controlled Trial.

Abstract

The most commonly preferred procedure for surgical correction of alveolar bone defect and restoration of bony contour is anterior iliac crest graft. Since the ancient time, cancellous bone graft is considered as a gold standard, but it has a high resorption rate and many other disadvantages, and hence we conducted this study to evaluate the efficacy of Cortico-cancellous bone graft harvested from anterior iliac crest to find out whether it can be used as a substitute for cancellous bone graft or not. The objectives of present study were to compare and evaluate the bone bridge formation rate, resorption rate, and uptake of bone graft at recipient site using cancellous and corticocanellous bone graft harvested from anterior iliac crest for complete unilateral cleft alveolus defects. Total 20 patients were divided into two groups by lottery method of randomization. Each group comprises of total 10 patients treated with cancellous bone graft in group 1 and corticocancellous bone graft in group 2 patients harvested from anterior iliac crest. Preoperatively and postoperatively CBCT scans were taken for each patient to calculate the volume of cleft defect and volume of newly formed bone after 6 months, respectively. Grafting fill rate was calculated and mean graft filling rate observed in the patients of group 1 was 1.14±0.03, and in patients of group 2, it was 1.17±0.03. The mean bone bridge formation rate observed in the patients of group 1 was 91.85±0.81 and in patients of group 2 it was 87.89±0.75. The mean bone resorption rate obtained in the patients of group 1 was 18.74±0.42 and in patients of group 2 it was 16.87±0.52. The present study concluded that accurate estimation of the amount required for bone grafting in the alveolar cleft can be performed by CBCT scan data using Planmeca Romexis viewer version 5.0 software. Even though the corticocancellous bone graft has some drawbacks, it is equally good as cancellous bone graft because of its less resorption than cancellous bone graft and can be considered as a second best option for secondary alveolar bone grafting.Clinical trial registration no (REF/2020/09/031605)/(CTRI/2020/09/028001).