Abstract
A precise volumetric assessment of maxillary alveolar defects in patients with cleft lip and palate can reduce donor site morbidity or allow accurate preparation of bone substitutes in future applications. However, there is a lack of agreement regarding the optimal volumetric technique to adopt. This study measured the alveolar bone defects by using two cone-beam computed tomography (CBCT)-based surgical simulation methods. Presurgical CBCT scans from 32 patients with unilateral or bilateral clefts undergoing alveolar bone graft surgery were analyzed. Two hands-on CBCT-based volumetric measurement methods were compared: the 3D real-scale printed model-based surgical method and the virtual surgical method. Different densities of CBCT were compared. Intra- and inter-examiner reliability was assessed. For patients with unilateral clefts, the average alveolar defect volumes were 1.09 ± 0.24 and 1.09 ± 0.25 mL (p > 0.05) for 3D printing- and virtual-based models, respectively; for patients with bilateral clefts, they were 2.05 ± 0.22 and 2.02 ± 0.27 mL (p > 0.05), respectively. Bland–Altman analysis revealed that the methods were equivalent for unilateral and bilateral alveolar cleft defect assessment. No significant differences or linear relationships were observed between adjacent different densities of CBCT for model production to obtain the measured volumes. Intra- and inter-examiner reliability was moderate to good (intraclass correlation coefficient (ICC) > 0.6) for all measurements. This study revealed that the volume of unilateral and bilateral alveolar cleft defects can be equally quantified by 3D-printed and virtual surgical simulation methods and provides alveolar defect-specific volumes which can serve as a reference for planning and execution of alveolar bone graft surgery.
Highlights
Secondary alveolar bone grafting (ABG) using autologous iliac crest bone tissue is a standard procedure for the management of patients with cleft lip and palate (CLP); a successful alveolar cleft defect repair produces maxillary arch continuity, provides adequate bony support, facilitates the eruption of permanent teeth, preserves periodontal health of teeth adjacent to the cleft, permits orthodontic tooth alignment, allows the placement of implants, and improves alar base symmetry [1,2]
Two-dimensional radiography has routinely been used for the diagnostic evaluation and treatment planning of maxillary alveolar cleft defect reconstructions [3,4]; this imaging modality is associated with drawbacks, such as no volumetric information, enlargement, distortion, and overlap of anatomical structures, and limitations for anatomical landmarks identification, affecting the accurate planning [5,6]
A total of 128 Cone beam computed tomography (CT) (CBCT)-based 3D models (64 printed and 64 virtual models) from 32 patients with unilateral (n = 22, 13 boys and 9 girls, mean age 9.1 ± 0.2 years) or bilateral (n = 10, six boys and four girls, mean age 9.6 ± 0.7 years) clefts were used in this study
Summary
Secondary alveolar bone grafting (ABG) using autologous iliac crest bone tissue is a standard procedure for the management of patients with cleft lip and palate (CLP); a successful alveolar cleft defect repair produces maxillary arch continuity, provides adequate bony support, facilitates the eruption of permanent teeth, preserves periodontal health of teeth adjacent to the cleft, permits orthodontic tooth alignment, allows the placement of implants, and improves alar base symmetry [1,2]. If the required volume for alveolar cleft defect reconstruction is defined preoperatively, a defect-specific quantity of iliac bone tissue can be harvested using minimally invasive techniques, thereby maximizing the unique properties of autologous tissue while minimizing the harvest volume, reducing morbidity features related to complications at the donor site This may improve the overall satisfaction with the treatment course by attenuating the burden of the longitudinal cleft rehabilitation process [14,15,16]. It is paramount that 3D surgical simulation models using CBCT imaging-based techniques be tested because they may have broad clinical and educational applications This includes ABG planning and execution with the implementation of need-based iliac bone harvesting and grafting, implementing a shared decision-making process based on discussions between patients or parents and members of multidisciplinary cleft teams, and training residents and fellows (oral; ear, neck, and throat; head and neck; plastic; and maxillofacial surgeons). The authors hypothesized that both 3D surgical simulation models would present similar results for the volume parameter
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