Alveolar Cleft Bone Grafting Research Articles

A Modified 270 Degree Closure Technique to Address the Prominent or Locked-Out Premaxilla in Bilateral Cleft Palate Repair.

The bilateral cleft deformity with a prominent or 'locked-out' premaxilla presents one of the most challenging repairs in cleft surgery. Despite its relative frequency, traditional hard palate repair techniques fail to fully address this deformity and expose surgeons to the risk of development of a large anterior fistula when flaps cannot approximate the premaxilla. This greatly increases morbidity for the patient and creates unnecessary challenges during fistula repair or alveolar cleft bone graft later in childhood. The 270° closure technique extends the nasal closure 270° around the premaxilla, continuing the hard palate repair through the alveolar clefts. This technique has been performed on 41 patients with mean follow up of 10.8 years. The repair was successful in 93% of patients with 3 patients developing palatal fistulae, all posterior to the 270° closure. The 270° cleft palate repair around the prominent premaxilla fills a void in the literature for managing the immense challenge of this deformity. When presurgical orthopedics are not a viable option, this approach can minimize the risk of large or complex fistula formation posterior to the premaxilla.

Osseous Outcomes of Cleft Alveolar Bone Grafting with Allograft and Platelet-Rich Fibrin: Preliminary Study with Radiological Outcome.

Cleft lip and palate are the most common craniofacial malformations worldwide. The alveolar cleft is treated with a bone graft, between 4 and 7 years of age in mixed dentition. This is an important step because it provides good quality jawbone and a better support of the lip and the alar cartilage on the side of the cleft. Bone autografting with iliac harvesting remains the most commonly used technique, but it is not without risks. Allograft techniques have therefore been described to reduce this morbidity (pain, infectious risk, hemorrhagic risk, fracture risk). The aim of this study was to evaluate, one year after allografting, the efficiency and consolidation of the bone allograft in the alveolar cleft. A retrospective study was conducted in the department of pediatric craniomaxillofacial surgery in the Woman-Mother-Child Hospital in Lyon, France. This series includes 22 patients or 25 alveolar cleft bone grafts, including 16 boys and 6 girls, with an average age of 6.1 years. Quantify the residual bone allograft by evaluating the ratio between the volume of the bone graft and the volume of the initial space on pre- and post-operative cone beam computed tomography. The residual bone allograft percentage at 1 year was 58.5% (± 22.3). Alveolar cleft bone graft with bone allograft is an alternative to iliac autografting to reduce donor site morbidity.

Comprehensive three-dimensional cone beam computed tomography assessment unilateral alveolar cleft reconstruction using autologous iliac cancellous bone combined with deproteinized bovine bone: A clinical retrospective evaluation

Large-volume autologous iliac cancellous bone grafting for alveolar cleft may lead to undesirable bone resorption and susceptible donor-site morbidity, whereas the addition of deproteinized bovine bone (DBB) could optimize outcomes. This study aimed to evaluate the effectiveness of combining autologous iliac bone with DBB using three-dimensional cone beam computed tomography (3D-CBCT) for better analysis of bone generation than conventional evaluation methods. Thirty-six patients with unilateral alveolar cleft were assigned into two groups. Group A (n = 21) underwent autogenous cancellous bone graft harvested from the anterior iliac crests, while Group B (n = 15) received a composite of autogenous iliac cancellous bone and DBB. Patients in Group B displayed higher bone filling rates (P < 0.0001) and lower bone absorption rates (P < 0.001) than those in Group A at both 6 months and 1 year postoperatively. Additionally, there were directional differences in bone absorption within the bone grafts, with more absorption observed on the alveolar crest and palatal sides than that on the nasal and labial sides (P < 0.001). This study demonstrates that employing a combination of DBB and autologous bone in alveolar cleft repair achieves better outcomes of bone grafting.

Three-dimensional comprehensive evaluation of unilateral alveolar cleft bone grafting with iliac bone and chin bone blocks

In this study, we aimed to provide guidance for selecting bone grafting materials in cases of alveolar clefts. Twenty-nine patients with unilateral complete alveolar clefts were categorized into three groups based on the bone grafting material used: Group A (iliac bone block grafts), Group B (iliac cancellous bone grafts), and Group C (chin bone block grafts). Cone-beam computed tomography (CBCT) data were analyzed using Mimics 19.0 software. Results showed that Group A had the highest bone formation rate, with significant differences observed between Groups A and B, as well as between Groups B and C. Group A and Group C had the highest proportion of Type I in volume assessment, while Group B had the highest proportion of Type III, Significant differences were observed in the distribution of volume assessment scores among the three groups. Bone height measurement results indicated that buccal-side measurement points had a higher proportion of Type I bone height than palatal-side measurement points. Bone width measurement results showed that Type I bone width was highest in Group C, while Type IV bone width was highest in Group B. Significant differences were observed in the distribution of implanted bone width among the three groups. Total grafting scores indicated that Types A and D were predominant in Groups A and C, while Group B had the highest proportion of Type D. Significant differences were observed in the distribution of total grafting scores among the three groups. The comprehensive evaluation method provides accurate assessment of alveolar cleft bone grafting outcomes and is applicable in clinical settings. Based on the results, we consider both iliac bone blocks and chin bone blocks as suitable materials for alveolar cleft bone grafting. Grafting material selection should consider preoperative gap volume measured using CBCT, required bone quantity, donor site complications, and overall clinical needs.

Extracorporeal Shockwave Therapy Improves Outcomes Following Secondary Alveolar Bone Grafting

Background: Recent studies have reported that extracorporeal shock wave therapy (ESWT) enhances bone formation during mandibular distraction osteogenesis. This study seeks to investigate the clinical outcomes in children undergoing ESWT alongside secondary alveolar bone grafting procedures at our institution. Methods: Retrospective review of all children that underwent secondary alveolar cleft bone grafting with adjunctive ESWT between 2019 and 2021. Variables including age, gender, cleft type, cleft width, pre-operative cleft dentition, volume of bone graft placed intraoperatively, ESWT settings, pain medication utilization, length of stay (LOS), follow-up, cone beam computed tomography (CBCT) data, and complications were recorded. Results: Twenty patients met inclusion criteria. Median age at surgery was 9 years (range 8-16). Four (20%) patients were female; 16 (80%) were male. Eight (40%) patients had bilateral alveolar clefts; 12 (60%) had unilateral clefts. All (100%) patients were discharged on the day of surgery. Twelve (60%) patients required a median of 1.3 oxycodone doses post-operatively (range 0-6.5). All patients received ESWT treatments intra and post-operatively. All patients demonstrated an increase in bone graft volume visualized on CBCT: median increase of 6.8% (range 1.3%-35.7%) between 106.5 days (17.5% of ideal visualized, range 5%-42%) and 245.5 days (27.9% of ideal, range 8%-55.7%). Three (15%) patients experienced minor complications. Conclusions: Initial outcomes suggest that ESWT may expedite visualization of bone consolidation and facilitate recovery without increasing complications. ESWT could further represent an opportunity to improve care in craniofacial surgery. Pertinent considerations, the role of standardized assessment protocols, and future directions will be reviewed.

Evaluation of Two Computerized Methods for Presurgical Volumetric Analysis in Secondary Alveolar Cleft Bone Grafting: A Prospective Study

The purpose of this study is to evaluate presurgical computerized volumetric analysis in secondary alveolar cleft bone grafting (SABG) and the time taken for calculation using cone-beam computed tomography (CBCT) via two different software programs. Twelve patients with unilateral alveolar clefts were investigated using CBCT. Two independent investigators did presurgical volumetric analysis for each patient's CBCT data using two different methods. Method A involved On-Demand 3D software (Cybermed Inc., Korea), while method B involved InVesalius 3 software (CTI, Brazil). The volume outcomes and time spent for measurements were compared between both software programs. Interobserver reliability and descriptive and t-test statistics were computed, and statistical significance was considered when p ≤ 0.05. There was not a statistically significant difference between clefts' volumetric measurements by the two methods via both investigators (p = 0.186 and 0.069). However, the difference in time taken for these measurements between the two methods was statistically significant (p < 0.001). Intraclass correlation coefficient (ICC) values indicated excellent interobserver reliability for measurements by method A (ICC ~ 0.998), and moderate reliability for method B (ICC ~ 0.626). Both software programs used in this study had comparable volumetric computation. Method B took much less calculating time than method A. The interobserver reliability was high for both methods. These both investigated software programs may show a clinical implication for presurgical alveolar cleft volume measurement, thus reducing the surgical operating time and adequately selecting a donor site with a congruent sufficient amount of bone grafts.

A Preliminary Study of Interdisciplinary Approach with a Single-Stage Surgery in Children with Cleft Lip and Palate.

A two-stage surgical procedure involving labioplasty and palatoplasty is a common surgical modality performed in children with cleft lip and palate. Additionally, an alveolar cleft bone graft is performed prior to the eruption of the canine teeth. These three surgeries impose the burden of general anesthesia separately for each procedure, and the formation of scar tissue from the procedure inhibits maxillary growth. We adopted a single-stage surgical procedure to overcome these drawbacks. To date, there have been no reports comparing the treatment outcomes of alveolar morphology and maxillary growth and development in children who underwent single-stage surgery with those who underwent two-stage surgery using plaster casts and cephalograms. Twenty children aged 5–7 years were equally divided into two groups based on whether they had undergone a two- or single-stage procedure. Cephalometric analysis and analysis of dentition models were conducted. The results showed that the single-stage surgery exhibited significant differences in the sella-nasion angle, point A to McNamara line, maxillary length, mandibular body length, and posterior arch width and length compared with the two-stage surgery. Therefore, it was suggested that the single-stage surgery had a favorable effect on maxillary growth compared with the two-stage surgery.

Alveolar cleft bone grafting at different age periods

Relevance. Anatomical and functional disorders in congenital clefts may be various. Their severity depends on the cleft size and on the combination of a cleft lip with an alveolar cleft. Alveolar cleft bone grafting (ACBG) is one of the most important surgeries for patients with cleft lip and palate rehabilitation. The study aimed to analyze the results of alveolar cleft bone grafting in various age groups, summarizing the available data and supplementing them with our own experience.Materials and methods. In our clinic, 488 patients of different ages (from 4 to 18 years old), including patients with bilateral clefts, underwent ACBG.Results. The result analysis showed the time of surgery should depend not on the child's age but on the orthodontic preparation of the child for ACBG.Conclusion. The literature data and our experience allowed us to develop indications for ACBG at different ages

Does Differential Maxillary Expansion Prior to Alveolar Cleft Bone Grafting Affect Nasal Width?

Determine the effects of differential maxillary expansion on nasal width in patients with unilateral cleft lip and alveolus with or without cleft of the secondary palate (UCLA ± P). Retrospective radiographic study. Institutional. Forty patients with UCLA ± P who had alveolar bone grafting (ABG) between 2015 and 2020 and available preexpansion and postexpansion cone beam computed tomography (CBCT) scans. Twenty patients with UCLA ± P who underwent ABG without expansion were included as controls. Percent change in width at the nasal pyriform, inferior turbinates, and alar base on cleft and noncleft sides. The study included 40 patients (24 males, mean age 9.6 years) and 20 controls (10 males, mean age 10.1 years). After maxillary expansion, there was an increase in width on the cleft and noncleft sides compared to nonexpanded controls at nasal pyriform (10.9% cleft side, P ≤ 0.001 and 4.3% noncleft side, P ≤ .001), inferior turbinate (8.7%, P ≤ .001 and 4.5%, P = .01), and alar base (6.7%, P = <.001 and 0.8% P = .54). The increase in width was greater on the cleft side than the noncleft side at the nasal pyriform (7.1%, P ≤ .001), inferior turbinate (4.3%, P ≤ .001), and alar base (7.0%, P ≤ 0.001) in the expansion group. There was good to excellent intra-rater and inter-rater agreement for measurements. Patients with UCLA ± P who undergo differential maxillary expansion before ABG exhibit greater nasal widening on the cleft side.

Evaluation of the clinical efficacy and safety of modified alveolar cleft bone graft with cone-beam CT digital imaging in children.

BackgroundCone-beam computed tomography (CBCT) is used to observe the bone density and bone height in children with modified alveolar bone graft (ABG) at different times after operation. In this study, the changes of labial-palatal bone mass in the stable period of bone union and in the bone graft area were investigated to provide reference for subsequent treatment.MethodsA total of 140 pediatric patients with unilateral complete alveolar cleft were selected and routinely underwent iliac bone grafting. The original data obtained by ProMax 3D (Planmeca) examination were stored in DICOM format at 3 and 6 months postoperatively, and the images were reconstructed by Simplant software (Dentsply Sirona). The bone density of the healthy side was measured at 3 months and 6 months, and the results were expressed as Hounsfield units (HU). The labial and palatal bone height at the bone graft site at 3 and 6 months postoperatively was classified according to the modified Bergland classification method, and was compared with panoramic film classification.ResultsMean bone density at 3 months after surgery (385.4800±78.39770 HU) was not significantly different from that at 6 months (356.1875±73.67164 HU; P>0.05). There were significant differences between the classification of lip and palatal bone height 3 months after operation and that of the classification of panorama film in the same month (P<0.05); between the classification of lip and palatal bone height 6 months after surgery compared with that of panorama film of the same month (P<0.05); and between the classification of bone height degree in labial, palatal, and panoramic slices at 3 months after operation and that at 6 months after operation (P<0.05).ConclusionsThe labial and palatal classification is different, and the bone height classification 6 months after surgery is lower than that 3 months after surgery, indicating the persistence of bone resorption. CBCT can objectively evaluate the bone quality in the bone graft area, which has clinical application value for surgical evaluation value and posttreatment guidance.

Preliminary efficacy analysis of block iliac bone grafting in patients with alveolar cleft in mixed dentition.

To investigate the efficacy of block iliac bone grafting in patients with unilateral alveolar cleft in mixed dentition. A retrospective study was conducted on patients with unilateral alveolar clefts in mixed dentition who were treated in the Department of Oral and Maxillofacial Surgery, Fujian Medical University Union Hospital. All patients underwent unilateral alveolar cleft bone graft repair with autogenous block iliac bone blocks. The healing of bone blocks was analyzed at 1 week and 6-12 months after surgery. Mimics software was used for the three-dimensional reconstruction and volumetric measurement of the iliac bone blocks on the follow-up imaging data of 15 patients aged 9-12 years without the eruption of canines before surgery, and the bone resorption rate of the iliac bone blocks was comparatively analyzed. In the 37 patients, bone grafting was successful in 32 and failed in five. The success rate of bone grafting was 86.5%. In 15 patients aged 9-12 years without the eruption of canines before surgery, eruption through the bone graft area was observed in two patients 6-12 months after the operation. Cone beam computer tomography showed that the grafted bone block exhibited good bony connections, and its resorption mainly occurred on the crests and palatal sides of the alveolar ridge. Bone resorption rates varied considerably between patients with a mean bone resorption rate of 39.0%±13.8% at 6-12 months after surgery. For patients in mixed dentition, bone grafting with block iliac bone can achieve better osteogenesis effect.

Three-dimensional finite element analysis of the effect of alveolar cleft bone graft on the maxillofacial biomechanical stabilities of unilateral complete cleft lip and palate

BackgroundThe objective is to clarify the effect of alveolar cleft bone graft on maxillofacial biomechanical stabilities, the key areas when bone grafting and in which should be supplemented with bone graft once bone resorption occurred in UCCLP (unilateral complete cleft lip and palate).MethodsMaxillofacial CAD (computer aided design) models of non-bone graft and full maxilla cleft, full alveolar cleft bone graft, bone graft in other sites of the alveolar cleft were acquired by processing the UCCLP maxillofacial CT data in three-dimensional modeling software. The maxillofacial bone EQV (equivalent) stresses and bone suture EQV strains under occlusal states were obtained in the finite element analysis software.ResultsUnder corresponding occlusal states, the EQV stresses of maxilla, pterygoid process of sphenoid bone on the corresponding side and anterior alveolar arch on the non-cleft side were higher than other maxillofacial bones, the EQV strains of nasomaxillary, zygomaticomaxillary and pterygomaxillary suture on the corresponding side were higher than other maxillofacial bone sutures. The mean EQV strains of nasal raphe, the maximum EQV stresses of posterior alveolar arch on the non-cleft side, the mean and maximum EQV strains of nasomaxillary suture on the non-cleft side in full alveolar cleft bone graft model were all significantly lower than those in non-bone graft model. The mean EQV stresses of bilateral anterior alveolar arches, the maximum EQV stresses of maxilla and its alveolar arch on the cleft side in the model with bone graft in lower 1/3 of the alveolar cleft were significantly higher than those in full alveolar cleft bone graft model.ConclusionsFor UCCLP, bilateral maxillae, pterygoid processes of sphenoid bones and bilateral nasomaxillary, zygomaticomaxillary, pterygomaxillary sutures, anterior alveolar arch on the non-cleft side are the main occlusal load-bearing structures before and after alveolar cleft bone graft. Alveolar cleft bone graft mainly affects biomechanical stabilities of nasal raphe and posterior alveolar arch, nasomaxillary suture on the non-cleft side. The areas near nasal floor and in the middle of the alveolar cleft are the key sites when bone grafting, and should be supplemented with bone graft when the bone resorbed in these areas.

Facial Artery Musculomucosal Flap in Alveolar Cleft Surgery.

Introduction:Large anterior palatal fistula and special alveolar clefts, such as edentulous atrophic premaxilla and absent premaxilla (premaxillectomy or agenesis), as well as wide unilateral alveolar cleft, are complicated cases in alveolar cleft bone grafting surgery. A superiorly-based buccinator myomucosal flap is suitable in this regard.Materials and Methods:The cleft patients whose large anterior palatal fistula and superiorly based buccinator myomucosal flap had been used for palatal or alveolar reconstruction were recruited in the study. The reconstruction method of the nasal floor, follow-up time, and hospital length of stay were recorded.Results:A total of 10 patients had been treated by this method. The majority of them were male (6/10), the age range of the patients was 14-25 years. All flaps survived and a case of partial necrosis occurred. Conclusion:As evidenced by the obtained results, a superiorly-based facial artery musculomucosal flap is suitable when the palatal fistula is continuous with the alveolar cleft. Transmaxillary transfer is the other option in patients with closed maxillary arch.

Does Maxillary Expansion for Alveolar Cleft Bone Grafting Affect Nasal Width More on the Cleft Side?

PurposeMaxillary expansion is often required in patients with cleft lip and alveolus/palate prior to alveolar cleft bone grafting (ABG) to align maxillary segments and provide space for closure of an oronasal fistula (ONF). There is limited information on how maxillary expansion affects the nasal skeleton in patients with unilateral cleft lip and alveolus/palate (UCLA/P). The purpose of this study was to compare changes in width between the cleft and non-cleft sides after maxillary expansion at the widest part of the nasal pyriform and at the level of the inferior turbinates. Patients and methodsThis is a retrospective case series of patients with UCLA/P who had maxillary expansion prior to alveolar bone grafting by the author (BLP) at Boston Children's Hospital from 2015 through 2020. Patients were included if they had maxillary expansion prior to ABG and had CBCT before and after expansion. Linear measurements at the widest aspect of the nasal pyriform and the most superior position of the inferior turbinate were recorded for both the cleft and non-cleft sides. Patients were excluded if they did not have maxillary expansion, if the CBCT data did not include all relevant landmarks, or the scans were greater than 4 years apart. Twenty patients with UCLP who underwent ABG without expansion during the same time period were used as a control group. A paired sample T-test was used to compare the cleft vs. the non-cleft side in the expansion group. The same test was used to compare the non-expanded control group to those who underwent maxillary expansion. ResultsA total of 119 patients with UCLA/P had maxillary expansion prior to ABG, but only 41 (61.0% male, mean age at ABG 10.1 years) had adequate pre- and post-expansion CBCT and were included in the study. Patients with UCLA/P who underwent maxillary expansion showed greater increase in width at the nasal pyriform and inferior turbinate levels on the cleft side compared to the non-cleft side (P < .001). When compared to the non-expanded control group of patients with UCLA/P, the percent increase at the nasal pyriform and inferior turbinate on both the cleft and non-cleft sides were statistically greater for those who underwent maxillary expansion (P < .001, P = .01 at inferior turbinate on the non-cleft side). ConclusionPatients with UCLA/P who undergo maxillary expansion prior to alveolar bone grafting have greater dimensional change of the anterior nasal skeleton on the side of the cleft.

Clinical, volumetric and densitometric evaluation of tissue engineered constructs for secondary alveolar cleft reconstruction: A randomized clinical trial

The objective of this study was to assess the efficacy of tissue engineered (TE) constructs compared to the standard autogenous anterior iliac crest (AIC) bone graft in secondary maxillary alveolar cleft reconstruction.This clinical trial was registered on (clinical trials.gov); the trial registry number is: NCT03563495. Patients with unilateral alveolar clefts were allocated on the basis of simple randomization. Selected patients were randomly divided into two equal groups: the AIC group (control) received autogenous particulate bone graft from anterior iliac crest, whereas the TE group received tissue engineered construct. Assessment included the newly formed bone volume and density at the grafted cleft sites, which were measured immediately, 6 and 12 months postoperatively on axial computed tomograms.The study population included 10 patients; each group comprised 5 patients. There was no statistically significant difference between the 2 groups regarding the mean volume of the newly formed bone (p = 0.91 at 6 months, p = 0.994 at 1 year) and the mean density of the newly formed bone (p = 0.364 at 6 months, p = 0.073 at 1 year). However, there was a significant increase of TE graft density from 6 months to 1 year (p = 0.048).Within the limitations of the study it seems that the tissue engineered construct (collagen/osteogenically differentiated bone marrow−derived mesenchymal stem cells) might be an alternative to autogenous bone for unilateral secondary alveolar cleftgrafting.

Day Care Surgery for Unilateral Alveolar Bone Grafting of Residual Clefts With Mandibular Symphyseal Bone-A Prospective Questionnaire Study.

To evaluate patients' experiences of shortened hospitalization in relation to bone grafting of unilateral alveolar clefts with mandibular symphyseal bone grafts. Prospective cohort questionnaire study. Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Denmark. Thirty-nine (male n = 26, female n = 13) patients with unilateral residual clefts after primary reconstruction, mean age 10.4 years. All patients underwent a standardized procedure with closure of the alveolar defect using mandibular symphyseal bone grafts. Patients were discharged within a day after surgery. Within 24 hours after discharge from surgery, patients and their parents filled in a 14-item psychometric questionnaire assessing the quality of their recovery. For all questions, a visual analogue scale (VAS) (0-10) was used. Patients' experience of shortened hospitalization in relation to secondary bone grafting of alveolar defects. Factors influencing the overall experience were measured using a VAS scale. A significant correlation between "Information from the hospital" and feeling worried and anxious was found (P = .04). Additionally, the ability to sleep correlated with pain (P = .003) and with nausea (P = .001). Although this study included a limited number of patients, the findings suggest that treatment of alveolar residual cleft with bone grafting from the mandibular symphyseal region in a day care surgery setting is characterized by very high patient satisfaction.

Tessier cleft type 5 craniofacial anomaly – A rare oblique facial cleft

One of the rarest types of craniofacial malformations is Tessier cleft type 5. These are oblique facial clefts with bony defect representing an alveolar cleft in the premolar region. This extends to the lateral surface of the maxilla up to the infraorbital rim and orbital floor. The cleft begins in the upper lip, just medial to the commissure, and extends up to the eyelid. They may also show deficient maxillary growth on the side of the cleft, clinically represented as constriction in the maxilla and occlusal cant. It becomes very challenging to treat such cases and requires a team approach. The goals of such cases include surgical repair of the lower eyelid and outer canthus, expansion of the arch and alignment, Bone grafting for the alveolar cleft, zygomatic region, and orbital rim to restore the continuity. The following is a case report of Tessier type 5 facial cleft describing the clinical features, diagnosis, and treatment approach for the case.

Alveolar cleft bone grafting: factors affecting case prognosis.

ObjectivesThe goal of this retrospective study was to determine the significance and impact of several factors on the alveolar cleft bone grafting procedure.Materials and MethodsThe medical records were reviewed. In addition, x-rays were checked. The size of every cleft was measured in this retrospective study. The analyzed factors included sex, age, type of cleft, size of the cleft, and the type of flap used in surgery. The patients were characterized into group A (no complications, Bergland scale 1 or 2), group B (complications or Bergland scale 3), or group C (failure cases). Statistical analysis was performed with a P-value set at 0.05.ResultsThere were 32 cases in group A, 26 in group B, and 9 in group C. Multinomial logistic regression showed an association between the type of the cleft and the size of the cleft, with the presence of complications, or achieving type 3 on the Bergland scale, with odds ratios of 5.118 and 6.000, respectively. The type of cleft was related to failure with an odds ratio of 4.833. Given a small sample, statistical analysis could not be performed to evaluate the relationship between the size of the cleft and group C. Age, sex, and the type of the flap were not significant factors.ConclusionThe cleft size of more than 10 mm and bilateral clefts were listed regarding their effect on the procedure. Clinicians should not overlook these factors. In addition, patients must be informed of any risks that are present.

The use of various types of autografts in the bone grafting of the alveolar process

Relevance. Fixing a cleft alveolar process is one of the most complicated problems in pediatric maxillofacial surgery. The difficulty lies in the fact that bone grafting of the alveolar process directly affects the growth of the upper jaw, the difficulty of performing surgery, as well as trying to form a sufficient amount of bone regenerate, while it is necessary to restore the anatomical integrity of the alveolar process for subsequent orthodontic treatment or dental implantation. Purpose: To review the literature on the use of autografts from various donor areas in patients with congenital cleft upper lip, alveolar process, hard and soft palate. Materials and methods: A literature review of the data was carried out using the electronic databases “Medline”, “Pubmed”, “Kibeleninka”. The key words in the search were: bone plastic, cleft alveolar process. The selection criteria were the articles in English and Russian containing clinical studies on the use of various types of grafts in bone grafting of the alveolar process cleft. Results: The sources of literature on the use of various autografts for bone grafting of the alveolar outgrowth in children with cleft lip and palate were analyzed. Currently, most authors are inclined to use an iliac crest autograft in surgery. Conclusion: Although more than a century has passed since the first alveolar cleft bone graft surgery was performed, the choice of bone material is still unresolved - due to the severity of complications, the impossibility of taking a sufficient amount of bone material, as well as a high percentage of material resorption, because even with the use of iliac crest bone, the volume of transplant resorption can be over 40%.

The Efficacy of Xenograft Polymerized with Platelet Rich Fibrin Versus Autogenous Graft During the Secondary Alveolar Bone Grafting Of Alveolar Clefts: A Randomized Controlled Clinical Trial

The Efficacy of Xenograft Polymerized with Platelet Rich Fibrin Versus Autogenous Graft During the Secondary Alveolar Bone Grafting Of Alveolar Clefts: A Randomized Controlled Clinical Trial