Abstract
Alveolar cleft bone graft in the second stage of surgery was a crucial part of the cleft palate treatment protocol with many advantages: reconstructing bone for tooth eruption, supporting the periodontal structure for the teeth adjacent to the cleft, supporting and lifting the arch and preventing from collapsing of maxillary arch. Grafting technique and material are selected based on the treatment purpose that for orthodontic moving tooth into the arch or for dental implant rehabilitation. Cancellous material provides rapid vascularization and healing facilitating for tooth moving into the cleft site but easy to resorb that unsuitable for dental implant placement. While dense material is difficult to move teeth into the cleft but increase initial stability. Therefore, we offered a method that limit bone resorption, easily obtain the implant initial stability, quick osseointegration called two iliac cortical bone blocks sandwich technique for a purposes of dental implant rehabilitation. Treatment protocol started with orthodontic treatment prior alveolar bone grafting to create proper space for implant restoration. Our clinical experience with 32 cleft sites using two iliac cortical bone blocks sandwich had shown potential clinical application in follow-up time up to 96 months. Evaluation criteria of bone grafting for alveolar cleft included soft tissue condition of graft area, nasal fistula closure, bone grafting outcome, success in osseointegration and implant prosthesis. This chapter described in detail treatment procedure and outcomes of a new technique of two iliac cortical bone blocks sandwich for alveolar cleft in patients with unilateral cleft palate.
Highlights
Anatomical deformity in patients with cleft lip and palate was a complex abnormality including both soft tissues and hard tissuesRecent Advances in the Treatment of Orofacial Clefts
Seventy-five percent of patients with cleft lip or cleft lip and palate was recognized with an anterior alveolar bone defect that can affect tooth development and contribute to the collapse of alveolar segments
The results showed that successful bone graft was recorded in 87 patients (96.6%) and failed bone graft was recorded in 3 patients (3.4%)
Summary
Recent Advances in the Treatment of Orofacial Clefts (teeth, alveolar bone and hard palate). This defect affected the formation of tooth development, tooth eruption, malocclusion, masticatory function, deformities of the facial middle and lower third, pronunciation, esthetic and psychological problems [1]. Seventy-five percent of patients with cleft lip or cleft lip and palate was recognized with an anterior alveolar bone defect that can affect tooth development and contribute to the collapse of alveolar segments. Two main obstacles for rehabilitation of alveolar cleft were the bone grafting and orthodontic treatment, because arch-width deficiency and dental crossbite was usually present due to maxillary hypoplasia. This chapter presented the new treatment technique for alveolar cleft in patients with unilateral cleft palate based on previous clinical researches [3–5]
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