Poster 177: Effects of Free-Priosteum Grafting and Titanium Mesh Plate on the Vertical Bone Formation by Secondary Bone Grafting in Alveolar Clefts

Abstract

Secondary bone grafting to the maxillary alveolar clefts has been used for many clinical advantages including bone support for the permission of the adjacent canine eruption to the clefts, permanent stability of the maxillary segments, and closure of the oro-nasal fistula. It has been shown that acceptable vertical bone formation is obtained only in about 60 to 70% of cases by conventional secondary bone grafting. Therefore, some modification on the surgical technique for bone grafting to the alveolar clefts is required to obtain better results. Three different grafting methods of PCBM alone, PCBM with free-periosteum, and PCBM with titanium mesh plate were performed on 48 (mean age 10.7 ± 1.2 years), 43 (mean age 9.9 ± 1.1 years), and 2 (mean age 9.6 ± 0.8 years) alveolar clefts, respectively. The periosteum or titanium mesh plate was placed on the top of the grafted PCBM, and the grafted PCBM was covered with the gingival mucoperiosteum flaps. The vertical bone formation was evaluated by dental radiographs as follow; (the height of the interalveolar septum) / (the length of the central incisor root adjacent to the alveolar cleft). Score 1; ≤ 0.25, score 2; 0.26 to 0.50, score 3; 0.51 to 0.75, and score 4; > 0.75. In bilateral cleft patients, a separate evaluation was made on each side. Data are expressed as mean ± S.D. Statistical significance was assessed by χ2-test or Mann-Whitney U-test, and p values < 0.05 were considered significant. We investigated the effects of free-priosteum grafting and titanium mesh plate on vertical bone formation by secondary particulate cancellous bone and marrow (PCBM) grafting in alveolar clefts. Vertical bone formation which scored 3 or 4 was obtained in 81.3% of the control group, while it was obtained in 97.7% of the free-periosteum grafted group and in 100% of the titanium mesh plate group. The rate of postoperative wound dehiscence was 10.4% in the control group, 25.6% in the free-periosteum grafted group, and 100% in the titanium mesh plate group. In the wound dehiscence cases, however, the grafted periosteum and the titanium mesh plate covered the grafted bone, and prevented bone loss. The titanium mesh plate had to be removed to rescue the wound healing, while the periosteum was not because the dehiscence was closed within 2 weeks. These results suggest that PCBM with free-periosteum grafting is most useful for bone formation in alveolar clefts.