D50. Assessment and Validation of Preoperative Three-dimensional Volumetric Analysis to Predict Bone Graft Success in Alveolar Cleft Reconstruction

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PURPOSE: The success of alveolar bone grafting (ABG) can be attributed to many factors, such as graft type, preoperative cleft size, cleft phenotype, and timing of repair. We aim to identify the best predictor for successful bony bridge formation in ABG. METHODS: A retrospective review evaluated patients undergoing ABG from 2016-2022. Patients with genetic syndromes, bilateral clefts, and missing postoperative cone beam computed tomography (CBCT) were excluded. The cleft width and 3-dimensional volumetric defect sizes were calculated using preoperative CBCT scans. The area under the curve (AUC) using receiver-operating characteristic analysis was used to determine the strongest predictor of graft success among age at ABG, preoperative cleft width, and volumetric size. AUC>0.700 was the marker of adequate sensitivity and specificity. RESULTS: Among 148 patients screened, 62 met inclusion criteria and underwent ABG with either iliac crest bone graft (ICBG) (n=28) or bone morphogenic protein/demineralized bone matrix (rhBMP-2/DBM) (n=34). Graft failure did not vary between bone graft types (p=0.768). Across both cohorts, preoperative volumetric size had a larger area under curve (AUC) (0.858; p=0.007) compared to preoperative cleft width (0.689; p=0.007) and age (0.642; p=0.024). Individually, volumetric cleft size strongly predicted graft failure among both ICBG (AUC: 0.967) and BMP cohorts (AUC: 0.781). CONCLUSION: Our findings identified preoperative volumetric cleft size as the strongest predictor for successful bony bridge formation in ABG. Clinicians can prioritize volumetric analysis via CBCT to better predict graft failure among clefts of varying sizes.