Alveolar Cleft Bone Grafting Research Articles

The Need for Lateral Piriform Rim Augmentation in Patients with Unilateral Cleft Lip/Palate During Alveolar Cleft Bone Grafting.

Alveolar bone grafting in unilateral cleft lip/palate (CLP) patients can improve nasal symmetry and facial esthetic. In some cases lateral piriform hypoplasia cannot be compensated by soft tissue thickness of the face, necessitating onlay bone grafting. This study was designed to estimate the proportion of patients among unilateral CLP patients requiring this procedure. In a retrospective study, unilateral CLP patients with severe paranasal deficiency, who were managed by paranasal augmentation with cortico-cancellous bone graft during the alveolar cleft bone grafting, were included. From 85 unilateral CLP patients treated from 2005 to 2011 in the Oral and Maxillofacial Surgery Department, Mashhad University of Medical Sciences, fourteen patients were treated with lateral piriform augmentation technique. Mean age of the patients at the time of operation was 16±4.8years. Follow-up period was 2-6years. Concomitant alveolar bone grafting and lateral piriform augmentation is needed at least in 16.5% of unilateral CLP patients.

Chin bone graft for maxillary alveolar cleft: indications and limitations.

Alveolar bone grafting (ABG) is an important step in the management of patients with cleft lip and palate. Choice of autogenous bone grafting is critical to achieve the goals of alveolar cleft bone grafting. This study was designed to determine which situations are suitable for obtaining bone from the chin in ABG. In a retrospective study, the alveolar clefts that had been bone-grafted from the chin bone were selected from the archived files of the Oral and Maxillofacial Department, Mashhad University of Medical Sciences in 2004 to 2012. The patients were recalled and postoperative panoramic and lateral cephalometry views were obtained. Seventeen patients were included in this study, with 53% females and 70.5% unilateral maxillary alveolar clefts. The follow-up was from 2 to 6 years. The mean age of the patients at the time of surgery was 17 ± 3.8 years. Harvesting bone from the chin is easy and safe, with low morbidity. Considering the fact that the volume of the harvested bone is low, especially in the presence of unerupted mandibular canine, autogenous chin bone is recommended for late ABG, especially in unilateral cases when the plan is to close the gap in the arch orthodontically while there is no need for lateral piriform augmentation.

Quality and Quantity Analysis of rhBMP-2 and Iliac Crest Alveolar Cleft Bone Grafting with Cortical Strut Technique

Quality and Quantity Analysis of rhBMP-2 and Iliac Crest Alveolar Cleft Bone Grafting with Cortical Strut Technique

Isolated keratinized gingiva incision in alveolar cleft bone grafts improves qualitative outcomes: A single surgeon's 23 year experience

BackgroundFew publications have described the flap design of the secondary cleft alveoloplasty. In this article we describe a modified technique of the classical flap design with the purpose of minimizing injury to the dental papillae and periodontium of the involved dentition. We report our long-term experience, specifically with regards to oronasal fistulae recurrence, wound healing and graft exposure and loss. MethodsAll the patients were operated on using the same technique by a single surgeon. A total of 148 clefts have been operated with this approach, involving 117 patients with complete cleft lip and palate with a follow-up between 12 and 240 months. ResultsThe most important finding in this study is the excellent wound healing observed in almost all patients. Only three patients (2%) suffered a dehiscence with oronasal fistulae recurrence and bone loss. Another patient lost the graft without fistula recurrence. Minor dehiscence with partial bone loss occurred in 4 patients (2.7%). These patients did not need surgical closure and only superficial exposed bone particles were lost without compromising the clinical outcome. ConclusionsOur modification presents a flap design that is easy to elevate and mobilize, without disturbing the buccal sulcus or the gingival inter-dental papillae.

Maxillary alveolar bone grafting: the role of Platelet-rich plasma (PRF)

Introduction: Gold standard for alveolar cleft bone grafting is autogenous bone. Advantage of adding the growth factors to the bone is established, so adding PRF to the autogenous bone may have beneficial effects. Methods: Platelet-rich plasma admixed with autogenous bone and as a biologic membrane over the bone grafted alveolar cleft was used. Results: Autogenous bone in all (four cases) was mandibular symphysis the mean age of the patients was 14.2 ± 1.5years. Lateral sliding flap was used for coverage of the mixture in all four cases. Conclusion: Platelet-rich plasma admixed with autogenous bone or as a biologic membrane may have beneficial effect in maxillary alveolar cleft bone grafting. Keywords: Alveolar bone grafting, Autogenous bone, Platelet-rich plasma (PRF).

The last resort for reconstruction of nasal floor in difficult-to-repair alveolar cleft cases: A retrospective study

AimThis article describes four new methods as the last resort for reconstruction of the nasal floor in difficult-to-repair alveolar cleft patients, including bone suture technique, vascularized interpositional periosteal-connective tissue flap from the palate (VIP-CT flap), anteriorly based inferior turbinate flap, and skinless subcutaneous nasolabial flap, with emphasis on indications and limitations. MethodsIn a retrospective study, data were obtained from 214 patients referred to the Department of Oral and Maxillofacial Surgery, Mashhad Dental School, Iran, for alveolar cleft bone grafting in 2004–2013. Eighteen patients had been treated using special techniques other than direct suturing for reconstruction of the nasal floor during alveolar cleft bone grafting. ResultsEighteen patients had been treated using these techniques as the last resort for nasal floor reconstruction; including bone suture technique (50%), inferior turbinate flap (33.3%), VIP-CT flap (11.2%) and nasolabial flap (5.5%). All the patients had a unilateral alveolar cleft, 72.2% of which were located on the left side and 44.5% of the patients were female. ConclusionNasal floor reconstruction in 8.4% of alveolar cleft patients needed special techniques and flaps.

Postoperative Evaluation of Grafted Bone in Alveolar Cleft Using Three-Dimensional Computed Tomography Data

Objective : Postoperative evaluation of bone formation in the alveolar cleft by computed tomography imaging has been reported. We quantitatively evaluated bone grafts in the alveolar cleft preoperatively and postoperatively using three-dimensional data and superimposition of images. Subjects : A total of 12 patients with complete unilateral cleft lip and palate (six left-sided and six right-sided) were studied. Methods : Helical computed tomography scans were taken immediately before surgery and at 6months after surgery and the DICOM files obtained were processed using Mimics and 3-matic software for three-dimensional data analysis. The preoperative and postoperative computed tomography data were superimposed, and the position and length of the unerupted canines and width of the alveolar cleft measured. Results : Strong and significant correlations were observed between bone formation in the alveolar cleft bone graft region and preoperative canine position (r = -.766, p < .01) and canine length (r = .681, p < .05). Stepwise multiple regression analysis demonstrated that only the preoperative canine position was independently and significantly correlated with bone formation in the alveolar cleft. Conclusion : These results indicate that the optimal timing for surgery is when the canine cusp is close to the alveolar plane.

Morbidity of anterior iliac crest donor site following bone harvesting for alveolar bone graft

Background: Alveolar cleft bone grafting is an important procedure for rehabilitation of patients with cleft lip and palate which allows the reconstruction of the maxilla, support of teeth and implant rehabilitation and also gives support to the nasal base. There exists several alternatives to fill up the bone defect, however autologous bone is the Gold Standard due to its great osteoinductive, osteogenic and osteoconductive capacity, besides its inmunocompetence. Within graft donor sites, the anterior iliac crest has some advantages because it allows the obtention of a large amount of bone tissue and facilitates the work of two surgical teams at the same time, it can be performed in patients who have not completed their growth, and it is a low cost procedure.

Modified VIP-CT flap in late maxillary alveolar cleft surgery

ObjectiveThis article describes a new application for the modified vascularized interpositional periosteal-connective tissue flap (modified VIP-CT flap) to solve problematic cases of late maxillary alveolar cleft bone grafting. MethodsThis study analysed the ability of the VIP-CT flap to provide coverage of bone grafts in maxillary alveolar cleft surgery. Donor site morbidity was also evaluated. ResultsThirteen patients were operated on using this technique, seven patients were female, the age range was between 12 and 25 years, and all of them were missing at least one permanent anterior tooth adjacent to the cleft. Two patients had bilateral alveolar clefts. In most of the operated patients one VIP-CT flap was used, but in two patients (cases 3 and 4) bilateral VIP-CT flaps were used for treatment of wide alveolar clefts. In case 3 both of the flaps were used for closure of the oral side and in case 4 one flap was used for nasal closure and another for oral side coverage. Two patients had alveolar cleft only with normal palatal anatomy, and the remaining patients had previously operated cleft palates (11 patients). ConclusionVIP-CT flaps can readily be used in adult patients with cleft lip (alveolar only) and in many operated unilateral and bilateral complete cleft lip and palate patients successfully.

Need for Revision Surgery After Alveolar Cleft Repair

The study assessed the need for revision surgery and the relating factors in alveolar cleft autogenous bone grafting in patients with complete cleft. It was a retrospective study carried out in 2009. The medical records of the 54 patients with alveolar cleft who underwent autogenous bone grafting in the maxillofacial department in Shariati Hospital from 2005 to 2008 were studied. The patients' age, sex, cleft type, age at palatal and alveolar clefts repair, tooth missing, surgery turn, and presence of orthodontic treatment were assessed. The patients' alveolar bone height was evaluated from their postoperative and follow-up panoramic radiographs. In general, 41% (n = 22) of patients needed revision surgery. Among all patients, 20 (37%) had secondary bone grafting and 34 (63%) had tertiary bone grafting. For 77% of the secondary unilateral clefts and 71% of bilateral ones, the remaining bone was at least three-fourths of the normal. Logistic regression model controlling for grafting time, surgery turn, orthodontic supervision, and age at palatal cleft closure showed that orthodontic treatment is associated with a lower need for revision surgery (odds ratio = 0.3; 95% confidence interval, 0.1-1.0). In conclusion, although alveolar cleft bone grafting is necessary for the reconstruction of the complete clefts, all these patients must be under the supervision of orthodontists to benefit from the surgical treatment.

Secondary alveolar bone grafting: Radiographic and clinical evaluation.

Introduction:Secondary bone grafting of maxilla and residual alveolar clefts at the stage of transitional dentition was first introduced by Boyne and Sands. The aim of this prospective case control study was to clinically and radiologically evaluate the success rate of anterior iliac crest graft in primary alveolar cleft.Methods and Material:In this study we evaluated 10 patients who underwent secondary alveolar bone grafting for various types of cleft palate with autologous iliac crest graft. Type of septum measured radiologically was taken as the outcome measure.Results:Postoperative radiographic evaluation revealed Type I inter alveolar septum in 7 cases (87.5%), with complete unilateral cleft lip, palate and alveolus. Non-eruption of canine occurred in 5 patients (50%). Periodontal Examination revealed presence of pocket formation (less than 4 mm) and Grade II mobility in 2 cases (20%).Conclusions:In conclusion, secondary alveolar bone grafting done during the time of transitional dentition, before the eruption of permanent canine is an excellent treatment modality.

Efficacy of Platelet-Rich Plasma in Reduction of the Resorption of the Alveolar Cleft Bone Graft. A Comparative Study

Aims and objectives: The reconstruction of the alveolar cleft is usually achieved through an autologous bone graft and associated with unpredictable results. We sought to analyse the efficacy of platelet-rich plasma in reduction of the resorption of the alveolar cleft bone graft. Patients and methods: 20 nonsyndromic patients with unilateral alveolar clefts treated with alveolar bone grafting during the period between June 2005 and December 2008 were included in this study. The patients were randomly assigned to two groups: In Group 1: the patients treated by autogenous bone graft with Platelet-Rich Plasma. In Group 2: the patient treated by autogenous bone graft only. Clinical and radiological follow-up examinations were carried out at 1, 6 and 12 months. The osseous resorption method was evaluated with the use of digital panoramic radiograph. Results: After 1 month, all cases in the two groups showed Grade I bone resorption. After 6 and 12 months, Group 1 showed higher prevalence of Grade I but with no statistically significant difference compared to Group 2. Of the 10 patients in Group 2, three patients with Grade III bone resorption underwent subsequent alveolar bone graft from intraoral sites (mandibular symphysis, lateral cortex of the mandibular ramus or combination of the previous sites), while one case with Grade IV bone resorption (failed bone graft) was treated by intraoral distraction osteogenesis. Conclusion: Based on the results presented in this study, it is possible to conclude that a more favourable result can be achieved with application of PRP to the alveolar bone graft.

Tertiary bone grafting with or without premaxilla osteotomy in adult alveolar clefts—Techniques and early outcome

The outcome of alveolar bone grafting in adult patients is sparsely reported. Here, we present a description of the surgical techniques used in a Nigerian teaching hospital and a preliminary report of the first five cases of adult alveolar cleft bone grafting accomplished with or without repositioning the premaxilla. Although, evidence of bone resorption was observed within 6 months after the operation, satisfactory bone level and aesthetic outcome was recorded in all cases. We concluded that tertiary alveolar bone grafting is desirable for all cases where alveolar clefts have persisted into adulthood to enhance the psyche of the cleft patients and to motivate them for further rehabilitation. Prompt placement of dental implant into the grafted area is recommended to mitigate subsequent resorption of the bone graft.

Comparison of Minimally Invasive versus Conventional Open Harvesting Techniques for Iliac Bone Graft in Secondary Alveolar Cleft Patients

Autologous bone grafts, often harvested from the iliac crest, are the criterion standard for secondary alveolar cleft repair. The best technique for harvest remains controversial. Minimally invasive techniques have been used for bone graft harvest in cleft patients, but outcome studies have been limited by small numbers of patients. A total of 104 patients undergoing bone grafting for alveolar cleft were reviewed. Fifty-five consecutive patients underwent minimally invasive iliac bone graft harvest using the Acumed power-driven trephine system performed by the same surgeon. These patients were compared with 49 control patients undergoing a similar procedure in which the traditional method of open iliac bone harvest with an osteotome was used. Operative time for the bone graft harvest was significantly shorter with the Acumed device when compared with the osteotome (2.37 hours versus 3.26 hours, p < 0.001). Patients who underwent minimally invasive Acumed bone harvest required significantly less postoperative analgesia than did patients who underwent osteotome harvest, for both narcotic (0.31 mg/kg versus 1.64 mg/kg, p < 0.001) and nonnarcotic (15.1 mg/kg versus 27.2 mg/kg, p < 0.01) pain medication. Acumed patients had significantly less pain on discharge (0.26 versus 3.1 pain scores on a scale from 0 to 10, p < 0.001) and left the hospital more quickly (23.3 hours versus 30.1 hours, p < 0.001). Minimally invasive bone graft harvest technique using the trephine system offers a superior alternative to the conventional open iliac bone harvest method for patients undergoing secondary alveolar cleft repair, with shorter operative time, decreased requirement for pain medications, less pain on discharge, and a shorter hospital stay. Therapeutic, III.

Secondary bone grafting for alveolar cleft in children with cleft lip or cleft lip and palate

Secondary alveolar bone grafting has been widely used to reconstruct alveolar cleft. However, there is still some controversy. To compare the effectiveness and safety of different secondary bone grafting methods. The final electronic and handsearches were carried out on 11 February 2011, and included the Cochrane Oral Health Group's Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Chinese Biomedical Literature Database and WHO International Clinical Trials Registry Platform. All the Chinese professional journals in the oral and dental field were handsearched and conference proceedings consulted. There was no language or time restriction. Only randomized clinical trials were selected. Patients with the diagnosis of cleft lip and alveolar process only, unilateral cleft lip and palate and bilateral cleft lip and palate involving the alveolar process and greater than 5 years of age were included. Two review authors extracted data and assessed the quality of included studies independently. Disagreement between the two review authors was resolved by discussion in the review team. The first authors of the included studies were contacted for additional information, if necessary. Two of 582 potential studies met the inclusion criteria and were included. One trial compared alveolar bone grafting using artificial materials (InFuse bone graft substitute impregnated with BMP-2) with a traditional iliac graft. The other trial investigated the application of fibrin glue to the bone graft.Both trials were small with 21 and 27 patients and were assessed as being at high risk of bias. Any apparent differences between the interventions for outcomes in either study must therefore be treated with great caution and are not highlighted here. Due to the high level of risk of bias in the two included trials there is insufficient evidence to conclude that one intervention is superior to another.

Evaluation of Morbidity Associated with Iliac Crest Harvest for Alveolar Cleft Bone Grafting

To evaluate the morbidity associated with iliac crest harvest for alveolar cleft grafting. 18 patients treated for alveolar clefts in oral and maxillofacial surgery unit at SRM dental college and Hospital were included. Patients were interviewed to fill a questionnaire on postoperative recovery. The donor site was evaluated for the following factors: Pain, neuropraxia, abnormal gait and scar evaluation. The scars were evaluated, according to the satisfactory score-eleven patients (61.11%) had a score 2, Four patients (22.22%) had score 3 and three patients (16.66%) had score 1. The pain score after the first week-thirteen patients (72.22%) had score 2, five patients had score 3 (27.77%). After the first month-four patients (22.22%), had score 2, twelve patients (66.66%), had score 1 and Two patients (11.11%) had score 0. And when evaluated after 3months, two patients (11.11%), had score 1 and sixteen patients (88.88%) had score 0. The gait was examined by asking the patient to walk and evaluated; in the first week, all eighteen patients had abnormality in gait; in the first month, five patients had abnormality in gait (27.77%), and in the third month, none of the patients had any abnormality in gait. Harvesting cancellous bone from anterior iliac crest in young patients is well tolerated, allows early resumption of normal activities, has no effect on growth, has minimal morbidity and a reasonable aesthetic outcome.

Le Fort I Distraction Using Internal Devices for Maxillary Hypoplasia in Patients With Cleft Lip, Palate, and Alveolus

In recent years, advancement has been made in distraction osteogenesis in the facial area. It has been applied actively to treat maxillary hypoplasia in patients with cleft lip, palate, and alveolus. Le Fort I distraction using internal devices does not lead to disability in daily living, including during the retention period, and has low surgical invasiveness, facile management, and superior aesthetics. Thus, there have been occasional reports on this procedure in recent years. Because an internal device is unidirectional, the greatest disadvantage is the inability to adjust the direction of distraction after its placement. However, past reports have emphasized its advantages, and its complications have rarely been discussed. We performed Le Fort I distraction using internal devices on 15 young patients. Our results showed notable complications in a few cases. When serial cephalometric analysis was performed after maxillary distraction, it demonstrated that the maxilla assumes various three-dimensional distraction morphologies. In particular, cases with insufficient bone grafting of alveolar clefts developed collapse mainly in the alveolar cleft region during postoperative distraction. Mobility and deviation of the maxillary bone fragment occurred. We implemented preventative measures against complications such as using modifications to place the devices parallel on the left and right sides and using a bite splint for distraction. These measures produced improved outcomes, and we describe here the details.

Management of Failed Implant Site with Symphyseal Graft in Combination with Xenograft and 4-year Follow-up Post-reimplantation

Implant failure results in a considerable bony defect, often requiring multistaged treatment for achieving optimal hard and soft tissue volumes prior to reimplantation. Fresh autogenous cancellous bone is ideal for secondary alveolar cleft bone grafting, for such defects, because it supplies living, immunocompatible bony cells that integrate fully with the maxilla and are essential for osteogenesis. When combined with a slowly resorbing particulate graft like a xenograft, a stable platform for implant placement can be expected.

Retrospective Review of 99 Patients With Secondary Alveolar Cleft Repair

The purpose of the present review was to evaluate the protocol and technique used in a large population of patients with cleft lip and palate when secondary grafting is performed during the early mixed dentition stage, as determined by eruption of the central incisor. In the United States, most investigators have recommended alveolar grafting at the 9- to 11-year age range or before eruption of the permanent canines. An institutional review board-approved chart review of 99 patients undergoing alveolar cleft bone grafting during a 7-year period at a single institution was performed. Data were collected regarding demographics, operative time, length of hospitalization, follow-up time, complications, and additional procedures performed. The cases were divided by patient age into 2 groups: group 1, aged 6 to 8 years (n = 61); and group 2, aged 9 years and older (n = 38). Statistical analysis was performed for various comparisons in the study. The average operative time for groups 1 and 2 was 86 and 103 minutes, respectively. The complication rate, length of stay, and follow-up time between the 2 groups was not statistically significant at the P = .05 significance level. We recommend earlier bone grafting at or before the eruption of the central incisor, rather than delaying until the cuspid tooth root is 25% formed. We believe this will provide better bone support for the dentition, a decreased burden of treatment for the patient, and improved quality of life. Performing the procedure at this time can lead to decreased operative times, with comparable postoperative outcomes.

Secondary Alveolar Bone Grafting: the Dilemma of Donor Site Selection and Morbidity

Fresh autogenous cancellous bone is ideal for secondary alveolar cleft bone grafting because it supplies living, immunocompatible bony cells that integrate fully with the maxilla and are essential for osteogenesis. Recent animal studies have shown that the dynamics of cancellous inlay bone grafts are different from those of cortical onlay bone grafts, and they refute the assumption that membranous bone grafts are superior to endochondral bone grafts because of their embryological origin. These studies prove that inlay endochondral cancellous specimens have a higher percentage increase in actual bony volume than cortical membranous and cortical endochondral inlay bone grafts. There are various donor sites for secondary alveolar cleft bone grafts. Currently the main sites for autogenous cancellous bone are iliac crest, calvarium, mandibular symphysis, and tibia. Some authors have suggested that the iliac crest donor site causes an unacceptably high degree of postoperative morbidity, but it is still the first choice for secondary alveolar cleft bone grafts and should not be rejected solely because of such concerns. Recombinant human bone morphogenetic protein-2 (rhBMP-2) is now an attractive bony substitute that promotes the differentiation of pluripotential cells into bone-forming cells that lay down new host bone in the site of the defect. Much more research and development are necessary to find a suitable carrier for rhBMP-2, and to study the properties of newly formed bone that it has induced before it can be a substitute for autogenous bone.