Abstract
(1) Background: Continuing to observe the grafted bone mineral density (BMD) is essential to ensure the success of alveolar bone grafting (ABG) in patients with cleft lip and palate. This study elaborates on three methods that can be used to evaluate the progressive BMD. (2) Methods: Forty patients with unilateral or bilateral clefts receiving ABG were enrolled. Cone beam computed tomography (CBCT) scans were taken at 6 months (T1) and 2 years (T2) postoperatively. In CBCT, measurements were obtained on three different planes using the circle located 1 mm from the adjacent teeth (Method A), the largest circle within the defect (Method B), or the central circle with a diameter of 2 mm (Method C). The BMD was the average density of the three planes and was adjusted by pogonion density. Bland–Altman plots were used to evaluate the agreement of each method. Inter-rater reliability was confirmed by the intraclass correlation coefficient (ICC). (3) Results: For Method A, B, and C, the mean-adjusted BMD (BMD/pogonion density, BMDa) was 17.44%, 17.88%, and 17.69%, respectively, at T1 (p = 0.495), and 22.51%, 22.87%, and 22.74%, respectively, at T2 (p = 0.690); the density enhancement rates were 40.54%, 38.92%, and 43.15% (p = 0.382). Significant differences between the BMDa at T1 and T2 were observed (p < 0.001, <0.001, and 0.001, for Method A, B, and C, respectively). The volume of the grafted tissue remained stable during T1 and T2, and no significant correlation between density enhancement rate and volume loss was observed. (4) Conclusions: A significant increase in the BMD of grafted tissue was observed in the 2-year postoperative follow-up. The three methods for measuring BMDa via CBCT can be applied in post-ABG evaluations.
Highlights
Secondary alveolar bone grafting (ABG) is a standard and necessary procedure for treating patients with cleft lip and palate (CLP) [1,2]
We performed analysis of variance (ANOVA) with repeated measurements to compare the differences between the three methods with respect to BMDa measurements and density enhancement rates; a Friedman test was used for the bilateral group due to a small sample size
The first (T1) and second (T2) follow-up Cone beam computed tomography (CT) (CBCT) were taken at 6.67 ± 0.82 months and 24.04 ± 5.15 months after ABG (Table 1)
Summary
Secondary alveolar bone grafting (ABG) is a standard and necessary procedure for treating patients with cleft lip and palate (CLP) [1,2]. Imaging assessment of ABG outcomes is conducted using two-dimensional radiography and scales, such as the Bergland scale; computed tomography (CT)based studies have indicated that conventional radiographs tend to overestimate bone growth [3,6,7]. Cone beam CT (CBCT) is characterized by a low radiation dose and cost effectiveness; it can be performed using high-quality three-dimensional (3D) image acquisition and reconstruction parameters, including the characteristics of the maxillary alveolar anatomical boundaries; researchers are increasingly using CBCT for diagnostic and therapeutic evaluations of ABG [8,9,10]. Many studies have examined bone height; few have proposed methods for assessing the BMD of grafted tissue and tracking the progression of BMD. We used the aforementioned CBCT images to design a new and easier method for evaluating the BMD of grafted tissue. We compared the density of grafted tissues with adjacent bony tissue in the growth stages and assessed the density enhancement rate in the first 2 years after surgery
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