Utilization of Alloplastic Ceramics in Repair of Alveolar Clefts and Correction of Skeletofacial Deformities in Patients with Cleft Palate

Abstract

The introduction of porous and nonporous hydroxylapatite materials for utilization in the repair of alveolar clefts and skeletofacial deformities has been discussed. We conclude from the review the following. First, autologous particulate bone marrow is still the best material with which to graft alveolar cleft defects. Second, hydroxylapatite should not be used for grafting alveolar cleft defects in growing patients if teeth are expected to erupt through the grafted cleft area or require orthodontic movement into the grafted area. In those situations, autogenous bone is much preferable. Third, hydroxylapatite, if it covers an erupting tooth, will cause destruction of the erupting dentition, and if an orthodontic force attempts to mobilize teeth within the grafted area, external root resorption is to be expected. Fourth, resorbable tricalcium phosphate should not be used as alveolar cleft grafting material in growing children or adult patients. Fifth, porous hydroxylapatite, granules and blocks, should not be used to close alveolar cleft defects in adults. Sixth, nonporous hydroxylapatite granules can be utilized in closing alveolar cleft defects in adults where teeth erupt into the grafted area. Seventh, when utilized as inter- positional grafting material, Interpore 200 in porous blocks is the material of choice and is used in combination with miniplate fixation. Finally, when utilized as extrafacial or extracranial augmentation material, the porous hydroxylapatite blocks are superior to nonporous hydroxylapatite.