Alveolar Cleft Defects Research Articles

"Primary anterior septoplasty in a cleft repair improves deviation of the anterior septum but not that of the posterior bone structure."

Evaluation of the result on the nasal septum (NS) of primary anterior septoplasty in cleft surgery is lacking. The deviation in patients with a cleft between those with (S+) and without (S-) primary anterior septoplasty during a cleft lip repair was compared. This was a retrospective, descriptive, single-center study. The NS was evaluated on computed tomography scans obtained pre-operatively from patients who underwent surgery for an alveolar cleft defect. Deviation of the NS was evaluated based on the following parameters: 3D configuration of the NS; anterior, middle, or posterior severity of the NS deviation; location of the most projected point; and severity index. The mean age of evaluation was 6.18 years. A total of 44 (S-) and 48 (S+) patients were included. The NS was less prominent in the (S+) than in (S-) group, 6.25% vs 25%. respectively. In the anterior part, the NS was normal in 79% (S+) and 1% (S-) of the patients. In the posterior region, the prominent deviation rate was approximately 7% in both groups. The greatest deviation point location was identical in both groups. The severity index was higher in the (S-) than in (S+) group, except in the middle part of the NS. Primary anterior septoplasty corrects only the anterior aspect of the NS in most children with CL and CLP. However, the posterior aspect of the NS remains deviated. A posterior deviation is likely to lead to nasal obstruction therefore regular monitoring is required all along the growing period.

The Use of Platelet Concentrates in the Reconstruction of the Alveolar Cleft Defect: A Systematic Review and Meta-Analysis.

Evaluate quantitative and qualitative outputs when comparing the incidence of platelet concentrates (PCs) combined with autogenous bone grafts to an autograft control group for the reconstruction of alveolar cleft defects. Systematic review and meta-analysis. Randomized and nonrandomized controlled clinical trials where PCs were used in the reconstruction of alveolar cleft defects. Use of PCs in combination with autogenous bone graft in the experimental group and autogenous bone graft alone in the control group. Average bone formation and bone density were evaluated, mean differences were calculated and pooled by a meta-analysis technique. Additionally, clinical outcomes such as wound dehiscence, closure of the oronasal fistula, pain, swelling, discharges, infections, and bleeding were considered in the qualitative synthesis. After an evaluation of forty-nine articles, nineteen were considered for the review. The qualitative assessment of bone density, bone formation, and clinical outcomes showed no differences between groups in most of the included studies. The meta-analysis showed no statistical differences between PCs groups when compared to the control group in bone density at three months (mean difference 45.67 HU, P = .23) and six months (mean difference 48.57 HU, P = .64). Neither were statistical differences in the percentage of regenerated bone volume at six months (mean difference 6.39%, P = .15) and the volume of newly formed bone at 12 months (mean difference 0.37 mm3, P = .99). There were no significant differences in terms of bone formation, bone density, and clinical outputs between groups.

Interim use of Hyrax Screw Assembly for Single-Step Closure of Small Alveolar Cleft before Anterior Maxillary Distraction Osteogenesis

Anterior maxillary distraction osteogenesis (AMDO) is often used for the correction of maxillary retrognathia in select cleft lip and palate cases. The restoration of alveolar arch continuity is desirable before the initiation of AMDO in these cleft maxillary deformities; however, AMDO is technically difficult in a patient with coexisting alveolar cleft where there is a discontinuity of the defect that presents a challenge in terms of adequate vector control of the movement of the anterior segment and the potential risk of tipping of teeth, which already have compromised anchorage/bone support on the cleft side. The treatment becomes more challenging when ongoing management is compounded by failed previous alveolar cleft grafting procedures, along with the patient’s reluctance to undergo further grafting of alveolar clefts. This technical note demonstrates a novel application of the modification of the Hyrax screw where an initially fully opened Hyrax screw was utilised as an interim assembly for accomplishing the single-step closure of a small alveolar cleft before the commencement of anterior maxillary distraction osteogenesis. This technique may prove to be feasible for patients presenting with alveolar cleft defects of smaller widths of up to 5 mm and relatively well-aligned upper arches. Keywords: Distraction Osteogenesis; Cleft Palate; Cleft Alveolar; Maxillary Osteotomy; India.

Treatment of critical bone defects using calcium phosphate cement and mesoporous bioactive glass providing spatiotemporal drug delivery

Calcium phosphate cements (CPC) are currently widely used bone replacement materials with excellent bioactivity, but have considerable disadvantages like slow degradation. For critical-sized defects, however, an improved degradation is essential to match the tissue regeneration, especially in younger patients who are still growing. We demonstrate that a combination of CPC with mesoporous bioactive glass (MBG) particles led to an enhanced degradation in vitro and in a critical alveolar cleft defect in rats. Additionally, to support new bone formation the MBG was functionalized with hypoxia conditioned medium (HCM) derived from rat bone marrow stromal cells. HCM-functionalized scaffolds showed an improved cell proliferation and the highest formation of new bone volume. This highly flexible material system together with the drug delivery capacity is adaptable to patient specific needs and has great potential for clinical translation.

Stem Cell-Based Tissue Engineering for Cleft Defects: Systematic Review and Meta-Analysis.

This study aimed to analyze the efficacy of stem cell-based tissue engineering for the treatment of alveolar cleft (AC) and cleft palate (CP) defects in animal models. Systematic review and meta-analysis. Preclinical studies on alveolar cleft repair in maxillofacial practice. Electronic search was performed using PubMed, Embase, and Cochrane databases. Pre-clinical studies, where stem cell-based tissue engineering was used in the reconstruction of AC and CP in animal models were included. Quality of the selected articles was evaluated using SYRCLE (SYstematic Review Centre for Laboratory animal Experimentation). Review of alveolar cleft bone augmentation interventions in preclinical models. Outcome parameters registered were new bone formation (NBF) and/or bone mineral density (BMD). Thirteen large and twelve small animal studies on AC (21) and CP (4) reconstructions were included. Studies had an unclear-to-high risk of bias. Bone marrow mesenchymal stem cells were the most widely used cell source. Meta-analyses for AC indicated non-significant benefits in favor of: (1) scaffold + cells over scaffold-only (NBF P = .13); and (2) scaffold + cells over empty control (NBF P = .66; BMD P = .31). Interestingly, dog studies using regenerative grafts showed similar to superior bone formation compared to autografts. Meta analysis for the CP group was not possible. AC and CP reconstructions are enhanced by addition of osteogenic cells to biomaterials. Directions and estimates of treatment effect are useful to predict therapeutic efficacy and guide future clinical trials of bone tissue engineering.

Volumetric Analysis of Unilateral Alveolar Bone Defect Using Modified Subtraction in Older Chinese Patients.

A large number of older patients (≥13y old) with alveolar clefts missed the optimal alveolar bone grafting time period in China. This study aimed to determine the accuracy and repeatability of modified computer-aided engineering subtraction for volumetric measurement of these patients. In addition, the study aimed to determine whether the volume of defect is correlated with cleft type (cleft lip and alveolus, cleft lip and palate), cleft location, age, and sex. Preoperative computed tomography data from 100 patients of unilateral alveolar cleft patients without secondary alveolar bone grafting were measured using 2 methods. The maxillary resin model around the alveolar cleft was printed using the 3-dimensional (D) printing method, and the volume of the defect was measured using the drainage method. In the modified subtraction method, Mimics software was used to simulate fracture filling by layer drawing, and the defect volume was determined by subtracting the preoperative fracture template from the filled 3D skull template. The mean time taken to calculate an alveolar cleft defect volume by modified subtraction method was 3.2 minutes. The average defect volume measured using the 3D printing and modified subtraction methods were 1.58±0.41 and 1.55±0.42cm 3 , respectively. Findings suggest that cleft location and age do not affect the defect volume of older patients with alveolar cleft, unlike cleft type and sex. The modified computer-aided subtraction method provides good accuracy, consistency, and reproducibility in measuring alveolar ridge defect volume. Moreover, this method is more efficient and cost-effective than the 3D-printed model method.

A Comparative Volumetric Assessment of Cancellous and Cortico-Cancellous Bone Graft in the Management of Unilateral Alveolar Cleft Defect using Cone Beam Computed Tomographic Scan-A Randomized Controlled Trial.

The most commonly preferred procedure for surgical correction of alveolar bone defect and restoration of bony contour is anterior iliac crest graft. Since the ancient time, cancellous bone graft is considered as a gold standard, but it has a high resorption rate and many other disadvantages, and hence we conducted this study to evaluate the efficacy of Cortico-cancellous bone graft harvested from anterior iliac crest to find out whether it can be used as a substitute for cancellous bone graft or not. The objectives of present study were to compare and evaluate the bone bridge formation rate, resorption rate, and uptake of bone graft at recipient site using cancellous and corticocanellous bone graft harvested from anterior iliac crest for complete unilateral cleft alveolus defects. Total 20 patients were divided into two groups by lottery method of randomization. Each group comprises of total 10 patients treated with cancellous bone graft in group 1 and corticocancellous bone graft in group 2 patients harvested from anterior iliac crest. Preoperatively and postoperatively CBCT scans were taken for each patient to calculate the volume of cleft defect and volume of newly formed bone after 6 months, respectively. Grafting fill rate was calculated and mean graft filling rate observed in the patients of group 1 was 1.14±0.03, and in patients of group 2, it was 1.17±0.03. The mean bone bridge formation rate observed in the patients of group 1 was 91.85±0.81 and in patients of group 2 it was 87.89±0.75. The mean bone resorption rate obtained in the patients of group 1 was 18.74±0.42 and in patients of group 2 it was 16.87±0.52. The present study concluded that accurate estimation of the amount required for bone grafting in the alveolar cleft can be performed by CBCT scan data using Planmeca Romexis viewer version 5.0 software. Even though the corticocancellous bone graft has some drawbacks, it is equally good as cancellous bone graft because of its less resorption than cancellous bone graft and can be considered as a second best option for secondary alveolar bone grafting.Clinical trial registration no (REF/2020/09/031605)/(CTRI/2020/09/028001).

Comparison of conventional impression making and intraoral scanning for the study of unilateral cleft lip and palate.

Patients with cleft lip and palate (CLP) encounter various problems, including disorders related to feeding, esthetics, and pronunciation. We compared two impression methods, conventional impression making and intraoral scanning, to study unilateral cleft lip and palate (UCLP). Patients with UCLP (n=7) were selected, and palatal impressions were taken by two steps: (1) impressions were obtained using an addition silicone rubber impression material, and a plaster model was prepared and (2) optical impressions were obtained using a desktop three-dimensional (3D) scanner and stereolithography (STL). Data were generated by two impression system combinations through STL. The results were analyzed using the Kruskal-Wallis or Mann-Whitney U test. There were no significant differences in the dimensions of the models between both groups. The measured depth of the alveolar cleft defects was deeper in the plaster model group (STL) than in the intraoral scanner group (STL). Digital models may prevent the risk of aspiration and respiratory disorders by using impression materials for preoperative jaw treatment of newborns and infants. We compared the results of both impression methods in the same patient and found that a shift to the 3D printer model is a safe alternative for preoperative jaw correction, as evidenced from the amount of tissue displaced due to the pressure applied during impression taking. In the future, we would like to conduct clinical research with a larger sample size of CLP patients to further corroborate these findings.

Synergistic Benefits on Combining Injectable Platelet-Rich Fibrin and Bone Graft Porous Particulate Materials

The main aim of this study was to perform an integrative review on the enhanced bone healing by combining a flowable (injectable) platelet-rich fibrin (PRF) and bone graft porous materials. A bibliographical search was carried out on several databases (PubMed, Embase, Cochrane, Scopus, and Web of Science) for relevant studies on the combined effect of platelet-rich fibrin and bone substitutes for bone healing. The chemical, biologic, and physical properties of flowable PRF combined with bone graft biomaterials were discussed in this review. The repair of different bone defects was reported such as alveolar cleft reconstruction, sinus floor elevation, socket preservation, jaw defects, and impacted teeth. Regarding studies evaluating alveolar cleft defects, results showed potential benefits of PRF to enhance bone formation when mixed with autogenous bone graft. Two studies on socket preservation found enhanced bone growth when combining PRF to bone substitutes, although one study found similar results with or without bone substitutes. Also, the addition of PRF to demineralized bovine bone mineral improved the bone healing in the repair of jaw defects. No synergistic effect was reported in bone formation when PRF was associated to particulate bone graft in sinus floor elevation. The combination of PRF and bone graft materials revealed significant outcomes when compared to solely use of bone graft materials in alveolar cleft and jaw defects. In socket preservation, bone healing was improved when PRF and bone graft materials were applied in comparison to the solely use of PRF. On the reconstruction of larger bone defects, PRF can be mixed with a low resorption rate graft material to maintain biological and mechanical stability into the bone defect. In fact, PRF and particulate graft materials appear to exhibit a synergistic effect during bone tissue healing.

Osteoconductive Silk Fibroin Binders for Bone Repair in Alveolar Cleft Palate: Fabrication, Structure, Properties, and In Vitro Testing.

Osteoconductive silk fibroin (SF) binders were fabricated for the bone repair of an alveolar cleft defect. Binders were prefigureared by mixing different ratios of a mixture of random coils and SF aggregation with SF fibrils: 100:0 (SFB100), 75:25 (SFB75), 50:50 (SFB50), 25:75 (SFB25), and 0:100 (SFB0). The gelation, molecular organization, structures, topography, and morphology of the binders were characterized and observed. Their physical, mechanical, and biological properties were tested. The SF binders showed gelation via self-assembly of SF aggregation and fibrillation. SFB75, SFB50, and SFB25 had molecular formation via the amide groups and showed more structural stability than SFB100. The morphology of SFB0 demonstrated the largest pore size. SFB0 showed a lowest hydrophilicity. SFB100 showed the highest SF release. SFB25 had the highest maximum load. SFB50 exhibited the lowest elongation at break. Binders with SF fibrils showed more cell viability and higher cell proliferation, ALP activity, calcium deposition, and protein synthesis than without SF fibrils. Finally, the results were deduced: SFB25 demonstrated suitable performance that is promising for the bone repair of an alveolar cleft defect.

Biomechanical consequences of alveolar cleft defect

Cleft palate is a common birth defect, requiring interventions that must be timed according to maxillary growth and patients often require multiple procedures to repair an alveolar cleft defect. Mechanical variables, such as pre‐surgical defect shape and size, have been suggested to affect the success of surgical repair, but the biomechanical consequences of these variables are not well understood. We hypothesize that mechanical performance of bony craniofacial structures will vary with cleft morphology.3D surface models of alveolar cleft defects were created from cone‐bean (CB) CT scans of adolescent and young adult patients (n=36; IRB: 201601711). Surface semilandmarks were used to conduct a cluster analysis, identifying common axes of variation which broadly differentiated between defects that are mediolaterally wider from those that are superoinferiorly taller.The centroid cleft defect shape from Cluster I was selected for preliminary biomechanical analysis. To isolate the mechanical effects of a defect of this shape/size, we used a previously published human cranial finite element model (FEM) as a baseline for model construction and comparison of performance. Patient CBCT was scaled and registered to the FEM and used to reconstruct the defect in the maxilla of the baseline model. Identical boundary conditions (material properties, muscle forces and joint and bite constraints) were applied to the cleft and non‐cleft FE models, to simulate biting on different teeth.Our results reveal notable and unexpected differences in deformation and strain regimes of the cleft and non‐cleft models. Although both models show characteristic regions of elevated strain on the biting‐side, the cleft‐model experiences a marked reduction (50‐90%) in strain on the balancing (non‐biting) side, due to the cleft disrupting the transmission of internal forces across the maxilla and palate from the biting to the balancing side. Importantly, regions that experience diffuse low‐level shear strains in our baseline model drop to nearly undetectable levels in the cleft model.We conclude that it is possible that the reduction of strain below this critical threshold could impede osteogenic mechanical signaling. This has important clinical implications for alveolar cleft defect repair and the development of novel scaffold‐based methods that both survive in vivo and restore functional orofacial load paths.

A Novel and Practical Protocol for Three-Dimensional Assessment of Alveolar Cleft Grafting Procedures.

To evaluate the reproducibility and accuracy of a new, easy-to-use volumetric assessment of the alveolar cleft. Twelve cone-beam computed tomography (CBCT) datasets of patients with a unilateral cleft lip, alveolus, and palate were evaluated by two investigators. Residual alveolar cleft calcified volume one year after surgery was analyzed by using standardized landmarks to determine the borders of the cleft defect and semi-automatically segment the alveolar cleft defect. The Dice-coefficient between observers for the segmented preoperative alveolar cleft defect was 0.81. Average percentage of residual alveolar cleft calcified material was 66.7% one year postoperatively. This study demonstrates a reliable and practical semi-automatic three-dimensional volumetric assessment method for unilateral clefts using CBCT.

Rehabilitation using dental implants following closure of large alveolar cleft defect by HYDIS-TB appliance

Restoration of missing oral tissues in patients with cleft lip and palate is the biggest challenge in their rehabilitation. In this report, we described the postdistraction rehabilitation and 1-year follow-up of the regenerated bone by implant-supported prosthesis and orthodontic tooth movement. A novel distraction appliance regenerated natural bone which is compatible for both implant placement and orthodontic tooth movement, thereby restoring adequate function and esthetics.

Effectiveness and Pitfalls of Intraoral Distraction in Wide Alveolar Clefts: An Experience

Statement of the problemRestoration of alveolar cleft defects is both essential and challenging for the craniofacial team. The technique of distraction is useful in large alveolar clefts, especially after the failure of conventional grafting procedures. The study aimed to analyze the effectiveness and problems of an intraoral tooth-borne distraction device. Materials and methodsSince 2015, 16 patients with nonsyndromic clefts were operated on. Because the defect was large, a trifocal distraction appliance was designed wherein the distractor appliance was completely tooth-borne and incorporated 2 hyrax screws. All distraction devices were individualized according to the patients’ situation. The appliance was cemented intraoperatively, and a latent period of 1 week was allowed. The distraction was performed twice daily at the rate of 0.5 mm/day. Methods of data analysisSingle-institution prospective study. ResultsAll patients were treated with distraction strictly following the natural curve of the dental arch. CBCT was taken prior to surgery and after 8 months of the last activation to visualize bone formation. Only 2 patients needed additional bone grafting procedure to fill the residual defect. In these patients, the required bone was small and was harvested intraorally. A failure of gingivoperioplasty (dehiscence) was observed in 1 patient. Outcomes dataAll patients were treated with distraction strictly following the natural curve of the dental arch. The mean width of the alveolar cleft was found between 11 and 17 mm. CBCT was taken after 8 months of the last activation to visualize bone formation. The continuity of bone could be seen in the majority of cases. The area of the residual defect was found to be between 28.24 and 39.24 mm. ConclusionThe intraoral distraction appliance was successful in the closure of a large alveolar cleft with the 2 transport segments docking successfully. Thus, a hyrax expansion screw used as a distractor could bring about controlled bony transport with the desired directional vectors. Its exclusive tooth-borne usage minimizes the invasiveness of the procedure, and the simplicity of the appliance eliminates the need for costly distractors, making such therapy feasible for a greater number of patients. The intraoral distraction appliance can be used successfully for the controlled closure of large alveolar clefts.

OROFACIAL CLEFTING –AN EXTENSIVE REVIEW

Groove in the palatal vault makes an abnormal communication between oral and nasal cavity is known as oro-facial cleft. It is an uncommon presentation in day-to-day clinical practice. According to World Health Organization, children with the complaint of oro-facial clefts found to be high in India. Children are commonly suffering from functional and aesthetical problems due to Oro-facial clefting. Globally, an estimated 200,000 babies are born with a cleft lip, palate or both each year in the United States. Etiology may be congenital or acquired. Palatal and Alveolar cleft defects are the most common etiological factors. Cleft lip and cleft palate can sometimes develop in combination with a syndrome due to genetic causes. The acquired causes may be infections, trauma, postsurgical complications, neoplasms, periapical pathology, radio and chemo necrosis. Clinical features like defective speech, and upper respiratory tract and ear infections, fetid odor, bad taste, nasal regurgitation of food are the associated consequences of oro-nasal communication. Therefore, this malformation syndrome is an important public health problem. Many cleft palate and cleft lip develops due to the combination of genetic and environmental factors. There are more than 400 genes linked to formation of cleft lip and palate. Some environmental factors associated with cleft include medications, deficiency of folic acid, and cigarette, drugs or alcohol conception during pregnancy. In this article we review the anatomy, embryology, epidemiology clinical manifestations and treatment options of the oro-facial cleft
 Key words: Oro-facial Cleft, Classification, , Anatomy , Embryology, Morphology, Incidence, Congenital Anomaly

Repair of alveolar cleft bone defects in rabbits by active bone particles containing modified rhBMP-2.

Objective: A model of alveolar cleft phenotype was established in rabbits to evaluate the effect of active bone particles containing modified rhecombinant human BMP-2 on the repair of the alveolar cleft. Methods:2-month-oldJapanese white rabbits were selected and randomly divided into fourgroups: normal, control, material and BMP groups. Blood biochemical analysis, skull tomography (microfocus computerized tomography), and histological and immunohistochemical staining analysis of paraffin sections were performed 3 and 6months after operation. Results: Both types of collagen particles showed good biocompatibility andpromoted bone regeneration. The effect of active bone particles on bone repair and regeneration wasbetter than that of bone collagen particles. Conclusions: Active bone particles containing modified rhecombinant human BMP-2 can be usedfor incisors regeneration.

Evaluation of 3D computer-assisted patient’s specific scaffold seeded with autogenous stem cells and platelet-rich fibrin in alveolar cleft repair.

Purpose: Evaluation of the treatment outcome of using patient-specific implantable scaffolds seeded with autogenous bone marrow mononuclear cell layer containing stem cells and platelet-rich fibrin in the treatment of alveolar cleft defect. Materials and methods: 12 alveolar cleft defects were divided into 2 groups; group A, six alveolar defects were treated using 3D printed patient’s specific implantable PLLA scaffolds seeded with autogenous bone marrow mononuclear cell layer containing stem cells and platelet-rich fibrin. Group B, six alveolar defects were treated with standard anterior iliac crest cortico-cancellous alveolar bone grafting procedures. Clinical and radiographic assessments were done to compare between two groups. Results: The results Showed that after 6 months group A was radiographically significantly less dense than the autogenous grafting group and when compared to Bergland’s scale there was no significant difference in bone loss after 6 months. Conclusion: Although this technique may not be the best choice regarding the density of bone formation, however within the limitations of this study, the results showed that this technique may be a new solution for transformation of the persistent cases of chronic oronasal fistula patients who underwent multiple failed autogenous bone grafting from a state of chronic fistulation to normal alveolar bone augmentation candidates.

Evaluation of Platelet Rich Fibrin Sandwiching technique with mixture of alloplastic bone graft and Hyaluronic Acid in repair of Recurrent Oronasal Fistula

Aim: is to evaluate efficacy of platelet rich fibrin (PRF) sandwiching technique associated with hyaluronic acid (HyA) mixed with alloplastic bone graft in closure of recurrent oronasal fistula after previously alveolar cleft grafting. Subjects and Methods: Our study conducted on 24 patients with recurrent unilateral oronasal fistula complaining of oronasal leakage. They were divided into two random equal groups. Group I, alveolar cleft defect was packed with alloplastic bone graft ( osteon II collagen) between two layers of PRF gel. While, in group II, alveolar cleft defect was packed with a mixture of alloplastic bone graft (osteon II collagen) and HyA between the two layers of PRF gel. All patients were observed clinically and radiographically (CBCT) for evaluation after three and six months postoperatively. Results: Our clinical results revealed that, all patients had uneventful wound healing except 4 cases in group I and one case in group II which had wound dehiscence and graft exposure at 1-week postoperatively. The radiographic results by CBCT scans showed a better new bone formation and good osseous union obliterating the oronasal defect.in group II than group I. There was a significant difference between bone density and bone resorption values in both groups at all intervals. Conclusion : Our results demonstrated that PRF sandwiching technique combined with a mixture of alloplastic bone graft and HyA could provide a favorable bony and soft tissue barriers for closure of recurrent oronasal fistula in alveolar cleft patients.

Closure of large alveolar defect by maxillary alveolar distraction using a vector-controlled distractor appliance in cleft patients: A pilot study

ObjectiveTo assess the treatment outcome of custom made maxillary transport distractor appliance for closure of large alveolar clefts. MethodA pilot study was conducted on 12 large alveolar cleft defects present in 11 non-syndromic cleft lip and palate patients (1 bilateral and 10 unilateral) in the age group of 16–25 years. All the subjects underwent pre-surgical orthodontics followed by alveolar distraction using custom-made distractor appliance. Study models, lateral cephalogram, panoramic radiograph and cone beam computed tomograms were obtained pre-surgically (T0) and after distractor removal (T1). The reduction in the width and volume of the alveolar cleft defect and change in the mesiodistal axial inclination of the teeth in transport segment following distraction were recorded. P value ​< ​0.05 was considered statistically significant. ResultsSignificant reduction in cleft width (9.18 ​mm), volume (89.82 ​mm3) and the change in the mesiodistal axial inclination of the teeth in the transport segment (3.05°) (P ​< ​0.05) were observed. SNA (1.75°), ANB (1.58°), maxillary length (1.58 ​mm), upper incisor inclination (3°) and distal movement of anchorage teeth (0.95 ​mm) also showed significant change (P ​< ​0.05). ConclusionThe custom-made tooth borne distraction appliance successfully closed the large alveolar cleft defect with minimal or no inadvertent effects on the oral tissues.

The effectiveness of mineralized plasmatic matrix in the closure of alveolar clefts with volumetric assessment.

Objectives: The purpose of this study is to assess the effectiveness of mineralized plasmatic matrix in the soft tissue closure of naso-alveolar fistula, to estimate the postoperative bone fill and volume of the graft placed in the alveolar cleft defect using cone-beam computed tomography (CBCT) at 3rd- month and 6th- month. Material and methods: 10 patients, in the age group of 15‑30 years were included in this study. They were diagnosed with unilateral cleft lip and alveolus defects with or without a cleft palate requiring late secondary alveolar bone grafting. Alveolar cleft defects were closed with mineralized plasmatic matrix (MPM), a combination of autogenous iliac bone graft and platelet rich plasma (PRP) and platelet rich fibrin (PRF). Results: The mean defect volume pre-operatively is 0.75 cm3 and at the end of 3rd-month postoperatively is 0.51 cm3 and at 6th-month postoperatively is 0.27 cm3. The average percentage of bone fill between preoperative (A) & 3th- month postoperatively (B) is 33.4% and between 3rd-month (B) and 6th-month post operatively (C) is 49.5%. Conclusions: Utilization of this new matrix (MPM), has shown to be effective in the closure of the cleft defect, oro-nasal fistula and also reduction in the volume of the residual cleft defect seen with sequential cone-beam computed tomography (CBCT) radiographs.