Evaluation of the combination of advanced platelet-rich fibrin (A-PRF) and allogenic bone for alveolar cleft grafting. A comparative retrospective study included 20 patients with unilateral alveolar clefts who underwent alveolar cleft reconstruction. The patients enrolled in the study were allocated into 2 groups depending on the graft material used. The 2 groups are group A, which includes 9 patients, where their alveolar cleft defects were grafted with autogenous anterior iliac crest bone graft (AIC), and group B, which consists of 11 patients, where their alveolar cleft defects were grafted using a combination of A-PRF together with allogenic bone (demineralized freeze-dried bone, DFDB). Computed tomography (CT) was performed to evaluate both the quantity and the quality of the newly formed bone. Sufficient bone bridging had formed in both groups. At 12 months postoperatively, the newly formed nonvolume percentages were 82.6%±3.9% in group A. While in group B, the rate was 76.66% ± 5.82%. The statistical results showed no significant differences between the 2 groups. At the same postoperative period, the mean bone density of the formed bone of group B was comparable to that of group A. There were insignificant differences between the 2 groups, with slightly higher bone volume in group A and somewhat higher bone density in group B. A-PRF combined with an allograft for alveolar cleft reconstruction is believed to be a promising technique. Moreover, this combination may decrease the risk of intraoperative and postoperative complications, reduce surgery time, prevent secondary surgical site infections, and yield comparable results.

Alveolar Cleft Reconstruction and Orthodontic Management of Patients with Cleft Lip-Palate.

Late secondary alveolar bone grafting using autologous versus alloplastic material for treating patients with cleft lip and palate with one year follow-up-A retrospective comparative study.

Abstract: Gnatoschizis, or cleft alveolus, is a common congenital anomaly in Indonesia. This condition significantly impacts dental and facial development, and often requires alveolar bone grafting to stabilize the maxillary arch, facilitate tooth eruption, and improve facial aesthetics. This was a serial case study involving 11 patients aged 12–18 years with gnatoschizis who underwent alveolar bone grafting using autologous iliac cancellous bone at Prof. Dr. R. D. Kandou Hospital. The results showed that the majority of patients were female, with labiopalatoschizis being the most common type. Surgical procedures included orthodontic preparation, iliac crest bone harvesting, and peri-alar augmentation. Postoperative outcomes demonstrated successful upper dental arch continuity and alar base reconstruction, with minimal donor site morbidity. In conclusion, this study provides valuable insights into the patient profile and clinical outcomes of gnatoschizis post alveolar bone graft. The predominance of female patients and the high incidence of labiopalatoschizis highlight the need for targeted interventions and comprehensive care strategies. A multidisciplinary approach is essential for optimal outcomes. Future research should focus on optimizing treatment protocols and exploring novel therapeutic modalities to further improve patient outcomes. Additionally, long-term follow-up studies are necessary to assess the stability and durability of the surgical outcomes, as well as the overall quality of life of patients with gnatoschizis. Keywords: gnatoschizis; alveolar bone grafting; cleft alveolus

ObjectiveTo describe the timing of surgeries, characterize the number of surgical and anesthetic events, and describe the total number and timing of cleft-related and ancillary surgical procedures from birth to late adolescence, stratified by cleft subtype and syndrome status.DesignRetrospective, cross-sectional clinical review of medical and surgical records.SettingA tertiary children's hospital with a dedicated Cleft and Craniofacial Surgical Unit in Adelaide, South Australia.ParticipantsChildren aged 0 to 18 years who underwent surgical intervention for orofacial clefts at the Women's and Children's Hospital between 1985 and 2021.InterventionsSurgical management of orofacial clefts and ancillary procedures performed under general anesthesia (GA).Main Outcome Measure(s)Timing and number of cleft-related surgeries; total number of procedures performed under GA; comparisons by syndrome status and cleft subtype.ResultsA total of 746 children were included. The mean age at primary lip repair was 4.8 months, and palate repair was 18.4 months. Alveolar bone grafting was typically performed at a mean age of 129.4 months. Later procedures included lip/nasal revision and orthognathic surgery. The mean number of GA procedures per child was 3.9 (SD ± 3.3), significantly higher in syndromic children (mean 6.5, SD ± 5.3) than nonsyndromic children (mean 3.4, SD ± 2.3). Noncleft-related procedures, such as grommet insertion (45.6%) and dental treatment under GA (28.1%) added to the total surgical burden.ConclusionsChildren with orofacial clefts experience multiple surgical procedures throughout development, especially those with syndromic diagnoses. These findings reinforce the importance of long-term, multidisciplinary planning and provide data to guide cleft care protocols and family support.

ObjectiveTo establish correlations between skeletal jaw relationship measured on lateral cephalograms and Goslon Yardstick scores for dental arch relationship (DAR) on orthodontic study models for unilateral cleft lip and palate (UCLP).DesignRetrospective review of consecutive cases.SettingMultidisciplinary cleft and craniofacial clinics at two tertiary care centers in the Western Cape, South Africa.PatientsForty-nine consecutive patients with nonsyndromic UCLP before they received orthodontic treatment and secondary alveolar bone graft (SABG).InterventionsFourteen cephalometric angles measured by two observers and Goslon Yardstick scores determined by three observers. Inter- and intraobserver reliability determined using Cohen's Weighted Kappa statistic.Main Outcome MeasuresAge, gender, and side of cleft were recorded. Cephalometric measurements and Goslon scores compared with regression analysis to determine correlations between angle ANB (cephalometric angle indicating anteroposterior relationship between the maxilla and mandible) and Goslon scores.ResultsMean age 10.7 years; 22 males and 27 females. Thirty-four (69.4%) of the clefts were left-sided. Kappa statistics ranged from good to very good for inter- and intraobserver reliability for cephalometric measurements and Goslon scores. No statistically significant differences between genders for cephalometric measurements and Goslon scores (P > .05). Mean ANB = 0.2(2.39) indicates Class III skeletal relationships for these individuals. Mean Goslon score 2.89. There was a moderate negative correlation of r = -0.5691 (P = 0) between ANB and Goslon score.ConclusionModerate negative correlation between ANB and Goslon Yardstick provides evidence that Goslon scores are valid and reliable indicators of skeletal jaw discrepancy for UCLP without the errors encountered using cephalometric radiographs.

The goal of the present study was to analyze the auditory-perceptual and acoustic characteristics of sibilant and vowel sounds over the course of rapid palatal expansion treatment in children with cleft lip and palate (CLP). A Nasometer headset was used to record vowel-consonant-vowel (VCV) nonwords with the sibilants "s, z, sh" and the vowels "a, i, u" in 28 children with CLP at six time points. Auditory-perceptual and acoustic analyses of 4,500 VCV productions were obtained. Perceived sibilant errors increased after expander insertion (T2) and gradually returned to pretreatment levels. The s-sound was distorted most frequently (38.3%), while the fewest errors were noted for sh (28.6%). Auditory-perceptual and acoustic measures of nasality increased from the baseline before expander insertion (T1) to the final time point after secondary alveolar bone-grafting (T6). Variability between repeated productions was noted for 26.6% of consonant productions. A cluster analysis showed that 13 children with a higher error rate of 43.9% at T1 had a lower rate of 37.4% at T6 while 15 children with a lower error rate of 16.1% at T1 had a higher rate of 26.6% at T6. Speech errors increased at T2, followed by gradual improvement until T6. The cluster analysis found that some patients in this study showed an increase of pathological speech characteristics over the course of the palatal expansion treatment. More research is needed to investigate how the cleft team can identify and mitigate possible adverse effects for speech.

Alveolar cleft repair: A 30-year follow-up.

Early Secondary Alveolar Bone Grafting and Lip Revision in Mixed Dentition: A Case Report

This study aimed to compare the postoperative clinical outcomes between the conservative bone trocar and open conventional techniques for iliac crest bone harvesting for alveolar bone grafting. The study included 20 unilateral cleft patients aged between 8 and 11 years, just before canine eruption, who suffered from oro-nasal communication, and were divided into two groups. Group A: ten patients using the open technique with a 4cm incision at the anterior superior iliac crest for harvesting bone chips. Group B: ten patients using a conservative technique with a 1cm incision at the anterior superior iliac crest using a special bone trocar extractor and curette. Postoperative evaluation included the Visual Analogue Scale (VAS) for pain assessment to compare the level of pain postoperatively. Also Vancouver scale was used for scar wound evaluation through clinical examination of wound size and concerning tissue vascularity, pigmentation, pliability, and height. There were no postoperative complications observed, including infection, dehiscence, and graft resorption in both groups. Two weeks postoperative: Group A reported significantly higher pain (7.8 ± 0.79) compared to Group B (3.6 ± 0.97) & p < 0.001, indicating statistically significant lower pain levels in Group B. Regarding the Vancouver Scar Scale, two weeks postoperative: Group A had significantly higher scar severity (9.1 ± 0.88) compared to Group B (3.0 ± 0.82) and p < 0.001, suggesting better scar satisfaction in Group B. One month postoperatively, Group B over time confirmed better scar appearance. Autogenous iliac crest using a conservative technique with a bone trocar is significantly more beneficial, less painful, and provides better wound scar healing satisfaction than the standard open approach in terms of VAS pain scale and Vancouver scar scale.

IntroductionEnhanced Recovery After Surgery (ERAS) protocols are evidence-based perioperative management pathways designed to optimize surgical outcomes. The American Society of Craniofacial Surgeons (ASCFS) Presidential Task Force has developed a series of ERAS protocols for patients with cleft and craniofacial anomalies. We outline an ERAS protocol for secondary alveolar bone grafting using cancellous bone graft from the iliac crest for patients with cleft lip and palate.Design and settingThe authors extracted information from existing peer-reviewed literature and our institutional experience at a large, tertiary pediatric hospital through retrospective chart review to guide surgeons in the pre-hospitalization, preoperative, intraoperative, and postoperative phases of care of alveolar bone grafting.ResultsIn the pre-hospitalization phase, our ERAS protocol emphasizes family education and expectation management, as well as minimization of preoperative fasting. In the preoperative phase, oral midazolam is recommended to reduce patient anxiety. In the intraoperative phase, we emphasize multimodal pain control with regional nerve blocks, bupivacaine-soaked absorbable sponge in the iliac crest, and ketorolac to minimize postoperative narcotic use. To prevent postoperative nausea and vomiting, we emphasize the use of an oropharyngeal pack prior to incision and nasogastric tube evacuation of the gastric contents at the completion of surgery, as well as a combination of ondansetron with dexamethasone intraoperatively. In the postoperative phase, we recommend dexmedetomidine, early postoperative oral feeding and hydration, and early ambulation with Physical Therapy consultation.ConclusionsThe present study sought to outline an ERAS protocol for secondary alveolar bone grafting in pediatric patients with cleft lip and/or palate to optimize surgical outcomes.

ObjectiveThis study aimed to assess the impact of two-stage palatoplasty incorporating a vomer flap on facial growth of individuals with bilateral cleft lip and palate (BCLP).SettingHospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil.DesignA cross-sectional study involving patients who underwent labial adhesion and anterior palatoplasty with a vomer flap at 3 and 5 months, followed by posterior palatoplasty at 12 months. Individuals without prior orthodontic treatment or secondary alveolar bone grafting were included. Cephalometric radiographs were obtained during mixed or early permanent dentition. A control group of untreated class I individuals without clefts was evaluated.ParticipantsThe sample comprised 49 individuals with BCLP (17 females, 32 males; mean age 8.91 years) and 44 control subjects (17 females, 27 males; mean age 8.91 years).Main Outcome MeasureCephalometric analysis was conducted using Dolphin Imaging software (version 11.95). Intergroup comparisons were performed using independent t-tests and Mann-Whitney U tests (P < .05).ResultsNo significant difference between groups was found in maxillary sagittal position. However, BCLP group showed a significantly smaller SNB angle (mean difference -2.1°, P < .003) and a more convex skeletal profile compared to the noncleft group. Additionally, BCLP group exhibited severe lingual inclination of the maxillary incisors, (MD = -31.6°, P < .001) and a high prevalence of anterior crossbite.ConclusionAt the time of observation, the maxillary sagittal position appeared comparable between groups. However, mandibular retrusion contributed to a more convex profile. The severe retroinclination of maxillary incisors determined a negative overjet. Longitudinal follow up are needed to confirm long-term maxillofacial growth outcomes.

Case of adult unilateral cleft lip and alveolus treated with occlusal reconstruction at alveolar bone graft site following removal of giant surgical ciliated cyst

Osteogenesis rate and success of secondary alveolar bone grafting: A 3D volumetric prognostic value.

ObjectiveTo evaluate how patient-reported outcomes change from pre- to post-operation after common procedures in patients with cleft lip and/or palate (CL/P), as well as compared to patients who did not undergo surgery.DesignRetrospective chart review.SettingTertiary care hospital in the United States.PatientsAll patients with CL/P who had multiple CLEFT-Q completions from 2021 to 2025.Main Outcome MeasureCLEFT-Q scores.ResultsTotally, 256 patients with 594 CLEFT-Q responses were included. Sixty (23.4%) patients received 66 craniofacial operations between CLEFT-Q completions. Of these operations, 16 (24.2%) were dental extractions/exposures, 15 (22.7%) rhinoplasties, 10 (15.2%) velopharyngeal insufficiency repairs, 6 (9.1%) alveolar bone grafts, 6 (9.1%) orthognathic surgeries, and 4 (6.1%) oronasal fistula repairs. Surgical patients had lower first CLEFT-Q scores across nearly all domains compared to those in the non-surgical cohort (P < .05). Patients who underwent rhinoplasty (n = 15) demonstrated increased face (64.1 vs 49.6, P = .006), nose (64.8 vs 43.3, P = .003), nostrils (62.0 vs 34.2, P = .001), teeth (59.5 vs 41.3, P = .008), and lips (63.5 vs 48.4, P = .007) scores post-operatively. Jaw scores increased following orthognathic surgery, though this did not reach significance (71.2 vs 55.8, P = .100). No other operation had a statistically significant impact on CLEFT-Q scores (P > .05).ConclusionsPatients who underwent surgery demonstrated improvements in post-operative CLEFT-Q scores compared to patients who did not undergo surgery during this surveyed period. Of those who underwent surgery, rhinoplasty was associated with the most significant improvements in patient facial perception post-operatively.

Patients with cleft lip and cleft palate (CLCP) require multiple interventions for structural and functional deficits. Revision palatoplasty may be performed during childhood for velopharyngeal insufficiency (VPI), while alveolar bone grafting (ABG) is performed during mixed dentition to stabilize the maxillary arch and close oronasal fistulas. This study evaluates the safety and efficacy of combining revision palatoplasty with ABG. A retrospective review was conducted of pediatric patients with CLCP who underwent ABG and/or revision palatoplasty at an academic children's hospital (2017-2024). Data included demographics, surgical indications, operative characteristics, and outcomes. Patients were grouped by procedure: ABG alone, revision palatoplasty alone (Palate), and combined ABG + Palate. Bone graft success was confirmed by imaging ≥ 6 months postoperatively. Revision outcomes were assessed via speech-language pathology (VPI improvement) and clinician evaluation (fistula closure). Among 180 patients included, 100 (55.6%) underwent ABG alone, 66 (36.7%) underwent Palate alone, and 14 (7.8%) underwent ABG + Palate. Grafting methods and success rates were similar between the ABG and ABG + Palate groups. The ABG + Palate group had a higher age at VPI diagnosis compared with the Palate group (8 versus 5y, P = 0.02) but similar time to revision (4mo). Both Palate and ABG + Palate groups showed comparable VPI improvement (83.7% versus 88.9) and fistula closure rates (92.3% versus 100%), with speech improvement from moderate to mild hypernasality. Combining revision palatoplasty with ABG is safe and effective, potentially minimizing the number of surgeries in this complex patient population.

To examine the relation of maxillary permanent central incisor rotation with the primary palatal margin (PPM) and overjet in the mixed dentition in complete unilateral cleft lip and palate (cUCLP). Dental casts and preorthodontic records taken before alveolar bone grafting were examined to exclude patients having permanent teeth distal to the cleft side maxillary central incisor (CS1) and mesial to the cleft. Maxillary central incisor rotation, the angle between PPM and midline, proximity of the lingual surface of the central incisor to PPM, and overjet were measured from standardized occlusal photographs of the dental casts of 54 children with repaired cUCLP (38 M, 16 F; aged 8.7 ± 1.0 years). Descriptive analysis and correlation statistics were performed. Rotations were noted in 92.6% of the CS1. Their magnitude (111.2 ± 24.2°) was significantly greater than the noncleft side maxillary central incisor (NCS1) rotations (76.7 ± 15.7°). Rotations were predominantly distolabial for the CS1 and distopalatal for the NCS1. The PPM was located within 2 mm of the lingual surface of the CS1 in 35.2% of the sample. Severe CS1 rotation existed in 48.2% of the sample and was significantly correlated with the PPM angle (r = 0.3; P = .046) and when its proximity to the PPM was within 2 mm (φ = 0.3; P = .028). Overjet was not significantly correlated with the magnitude of rotation. The angle between PPM and the midline and its proximity to CS1 are associated with the severity of CS1 rotation in repaired cUCLP. Orthodontic implications are discussed.

This study aimed to develop and implement a standardized 3D workflow for surgical planning and outcome assessment in secondary alveolar bone grafting (SABG) using cone-beam computed tomography (CBCT). A 3D protocol was developed using medically certified software for semiautomatic segmentation, mirroring, voxel-based alignement of the maxilla and volumetric analysis of cleft and graft regions. This workflow was applied on a retrospective cohort of patients with unilateral cleft lip and alveolus (CLA) and/or cleft lip and palate (CLP) who received iliac bone mixed with synthetic biphasic calcium phosphate for bone grafting. CBCT scans (preoperative, immediate postoperative, and six-months follow-up) from 23 patients with unilateral clefts were analysed. The non-cleft side was mirrored to serve as reference for symmetric reconstruction. Measured parameters included alveolar cleft volume, grafted bone volume, integrated bone volume and missing volume. The workflow enabled reliable volumetric quantification. The preoperative cleft volume averaged 1505 mm3 (SD 425 mm3) and graft volume 1983 mm3 (SD 407 mm3). After six months, the mean integrated bone volume was 851 mm3 (SD 294 mm3), corresponding to a mean graft resorption of 57% (SD 13%) and alveolar cleft restoration of 58% (SD 19%). This 3D CBCT-based protocol provides a robust methodological framework for assessing SABG outcomes. It enhances quantification of cleft morphology and graft integration, supporting improved surgical planning, follow-up, and cross-study comparability.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-15083-9.

In vitro evaluation of novel composite bioceramic filaments for alveolar bone regeneration

Association Between the Vertical Position of the Inferior Turbinate and Alveolar Bone Bridge Morphology After Secondary Alveolar Bone Grafting in Patients with Unilateral Cleft Lip and Palate: A Retrospective Study