Long-Term Analysis of Secondary Bone Grafting in 79 Cleft Lip and Palate Patients By Cone Beam Commuted Tomography

Abstract

Evaluating the outcomes of the alveolar bone grafting procedures in patients has been challenging for a multitude of reasons, including the limited number of patients, their demographic heterogeneity and complex anatomy, and differences in treatment protocols at various institutions. The purpose of this study was to use Cone Beam Computed Tomography (CBCT) analysis to evaluate the long-term radiographic outcomes of anterior iliac crest bone grafting (AICBG) on cleft lip patients who had an associated alveolar cleft with the aim to discover patient or clinical factors that influence the long-term radiographic success of the surgically repaired cleft sites. The records from 225 patients who underwent anterior iliac crest bone grafting by a single surgeon over 6 years at our institution were reviewed and 79 were selected after meeting criteria. Their most recent post-operative CBCT was analyzed using an adapted version of the assessment tools established by Suomalainen et al and Wangsrimongkol et al. The modifications allowed for quick and repeatable analysis, but were also strict in terms of defining favorable outcomes. Measurements were taken to evaluate the cleft sites vertically, horizontally and superiorly in terms of nasal support (for unilateral clefts only), then assigned corresponding scores of 0-4 to help determine radiographic success. The alveolar bone on the distal surface of the tooth mesial to the cleft was used for measurements. The sites were interpreted as poor (0 or 1), acceptable (2 or above), or favorable (3 or above). Similarly, clefts overall (vertical + horizontal) were poor (0-3), acceptable (4 or above) or favorable (5 or above). Statistical analysis was used to characterize patient demographics, subgroup comparisons, and to assess the association between specific factors and success. More specifically, univariate analyses and multivariate analyses were performed in effort to identify factors specifically predictive of favorable outcomes.