Regenerative Strategies in Cleft Palate: An Umbrella Review.

Inês Francisco,Francisco Vale,Bárbara Oliveiros,Carlos Miguel Marto,Anabela Baptista Paula,Eunice Carrilho,Maria Helena Fernandes

doi:10.3390/bioengineering8060076

Inês Francisco, Francisco Vale + Show 5 more

Open Access

https://doi.org/10.3390/bioengineering8060076

Copy DOI

Abstract

(1) Background: Alveolar bone defects or decreased alveolar bone height and width may have different causes, such as cleft palate. Regenerative procedures in oro-dental defects are challenging due to anatomical factors and the distinct cell populations involved. The iliac crest bone graft remains the gold-standard for cleft palate closure. However, tissue regeneration approaches have been employed and their outcome reviewed, but no conclusions have been made about which one is the gold-standard. (2) Methods: this umbrella review aims to critically appraise the effectiveness of the current approaches in bone defects regeneration in non-syndromic patients with cleft palate. A search was performed in PubMed, Cochrane Library, Scopus, Web of Science and EMBASE databases. (3) Results: Systematic reviews of randomized and non-randomized controlled trials with or without meta-analysis were included. Nine articles were included in the qualitative analysis and five in the quantitative one. The included studies quality was evaluated with AMSTAR2. (4) Conclusions: The use of new regenerative strategies, such as bone morphogenic protein 2, appears to provide similar results regarding bone volume, filling, and height to the standard technique with the iliac crest bone graft.

Highlights

Cleft lip and/or palate (CLP) is a craniofacial malformation with a prevalence in newborns of 14 per 10,000 live births worldwide [1]
New evidence suggests a common basis for orofacial cleft and cortical interneuronopathy, supported by cellular and molecular central nervous system (CNS) alterations in these patients [7]
The search in the different databases resulted in 1317 articles, with no paper retrieved from grey literature or from the manual search

Summary

Introduction

Cleft lip and/or palate (CLP) is a craniofacial malformation with a prevalence in newborns of 14 per 10,000 live births worldwide [1]. Not yet fully understood, several genetic and environmental risk factors are associated with CLP [2]. Gestational diabetes, and genetic association with the IRF6, VAX1, and PAX7 genes are consistently reported [3,4]. Most CLP patients have several hearing, feeding, speaking, and dentofacial development complications, leading to a long-term impact on the patient’s facial anatomy and self-esteem [5,6]. CLP treatment requires a coordinated interdisciplinary team that considers the patient’s and family’s needs [8,9]. One of the endpoints in CLP care is a secondary bone

Methods

Results

Discussion

Conclusion