Dental Reconstruction Using Secondary Bone Graft Followed by Implant Placement in Alveolar Cleft of Patients with Cleft Lip and/or Palate

Abstract

Alveolar cleft is the major problem during the formation of the ideal dental arch and dental reconstruction in cleft lip and/or palate (CLP) patients. In 1972, Boyne and Sands introduced secondary autogenous particulate cancellous bone and marrow (PCBM) grafting for the treatment of alveolar and residual palatal clefts (Boyne and Sands, 1972) Nowadays, a golden standard protocol for the dental reconstruction of patients with CLP is to perform bone grafting (BG) before canine eruption and subsequent orthodontic closure of the dental arch without using prosthesis, as described in previous reports. (Abyholm, et al., 1981; Enemark, et al., 1985; Bergland, et al., 1986). However, because of the excessively long treatment period or a wide interdental space resulting from several congenitally missing teeth, prosthodontic treatment such as bridgework or denture is sometimes necessary. Verdi et al. firstly reported the use of osseointegrated implant for dental rehabilitation in patients after the repair of the alveolar cleft (Verdi et al., 1991). Since then, numerous reports indicated that the use of dental implants placed in grafted alveoli after repair of an alveolar cleft using a secondary BG with particulate PCBM is a viable option for the dental reconstruction of patients with cleft lip or palate (CLP) (Ronchi et al., 1995; Takahashi T et al., 1997; Jasma et al., 1999; Hartel et al., 1999; Dempf et al., 2002). Since 1993, we have used this treatment procedure in patients with graft alveolar clefts. (Takahashi et al., 1997, 2008). In this chapter, dental reconstruction using secondary BG followed by dental implant placement in alveolar cleft of patients with CLP is described. The main purpose of this chapter to demonstrate the surgical procedure, long-term clinical outcome, and the impact on the preservation of the grafted alveoli after implant placement of this treatment procedure.