Alveolar Cleft Research Articles

Postoperative Assessment of Secondary Alveolar Bone Grafting Using a Combination of β-Tricalcium Phosphate and Chin Bone for Patients With Unilateral Cleft Alveolus.

Secondary alveolar bone grafting (sABG) is crucial for the treatment of alveolar clefts. However, postoperative bone formation using a graft material comprising a mixture of beta-tricalcium phosphate (β-TCP) and chin bone has been previously evaluated only 2-dimensionally, using plain radiographic images. In this study, the authors aimed to retrospectively and 3-dimensionally assess bone formation following sABG in patients with an alveolar cleft, using a mixture of β-TCP and chin bone. Thirty-eight patients with unilateral cleft lip and alveolus (CLA, n=13) or unilateral cleft lip and palate (CLP, n=25) who underwent sABG at our hospital were recruited. The grafted material was replaced with normal bone structure within 6 months postsurgery. The authors conducted a 3-dimensional evaluation utilizing cone-beam computed tomography images taken before surgery and at 1 week, 6 months, and 12 months postsurgery. Bone survival rates inside and outside the dental arch were 56.3% and 4.6%, respectively. No patients exhibited complete resorption of the material. This combination of β-TCP and chin bone demonstrated favorable bone formation following sABG in patients with unilateral CLA and CLP.

Effect of symmetrical bone repair of nasal alar base on nasal deformity after unilateral cleft lip surgery.

This study aimed to compare the impacts of undertaking symmetrical bone repair of the nasal alar base combined with nasolabial deformity repair versus nasolabial deformity repair alone on the improvement in nasal deformity of patients with unilateral cleft lip and alveolar cleft. Fifty patients presenting with unilateral cleft lip and alveolar cleft were evaluated. Among them, 20 underwent nasolabial deformity repair solely (non-bone grafting group), whereas 30 patients received bone repair in conjunction with nasolabial deformity repair (bone-repair group). Preoperative measurements and one-year follow-up results were assessed through photographic anthropometric analysis. According to the Farkas anthropometric standard, the nasal anatomic landmarks were located, and 10 nostril indicators were measured. The operative effects of two groups were compared. In contrast to the non-bone-grafting group, the nasal deformity of patients in the bone-repair group demonstrated significant improvement one year post-operation. The symmetry parameters of the nasal columella more closely approximated 1, the columella deviation angle more closely approached 90°, and the sub-alare inclination angle and the inclination angle of the nasal alar were smaller (P<0.05). The accomplishment of symmetrical bone repair of the nasal alar base is conducive to enhancing nasal deformity after cleft-lip surgery in patients with unilateral cleft lip and alveolar cleft. This strategy has a positive influence on nasal symmetry, the morphology of the nasal alar, and nasal base deformity.

Cleft Palate and Presurgical Orthopedics: A Systematic Review and Meta-Analysis of Intra-Arch Dimensions During the First Year of Life

Background: This systematic review and meta-analysis aimed to investigate the effects of presurgical orthopedics (PSO) on maxillary arch dimensions in infants with cleft lip and palate during the first year of life. Methods: The review was conducted following PRISMA guidelines. A comprehensive electronic search was performed in MEDLINE, Embase, Cochrane, Scopus, and Google Scholar databases, supplemented by manual searching. Two reviewers independently conducted study selection, data extraction, quality assessment, and risk of bias evaluation. Results: Five studies were included in the meta-analysis. Quantitative analysis was performed based on the primary outcomes. The estimate was calculated using a random-effects model and z distribution (95% confidence interval (CI)). The results showed similar alveolar cleft widths (mean difference, −3.06; 95% CI, −8.03 to 2.70, p = 0.30, I2 = 99%) with clinical differences in favor of PSO, and comparable posterior cleft widths (mean difference, −0.88; 95% CI, −2.06 to 0.30, p = 0.14, I2 = 89%) with and without PSO in CLP babies. Conclusions: This meta-analysis found no statistically significant effects of presurgical orthopedic treatment on maxillary arch dimensions in infants with cleft lip and palate during the first year of life. Further high-quality randomized controlled trials are needed to definitively establish the efficacy of PSO.

Enhancing Effective Scanning Techniques for Digital Impression in Neonates with Cleft Lip and/or Palate: A Laboratory Study Investigating the Impact of Different Scanners, Scanning Tip Sizes, and Strategies

Background/Objectives: Digital impressions are increasingly used to manage Cleft lip and/or palate (CL/P), potentially offering advantages over traditional methods. This laboratory investigation sought to evaluate the impact of scanning tip sizes, different scanners, and scanning strategies on intraoral scanning in neonates with CL/P. Methods: Ten soft acrylic models were used to simulate the oral anatomy of neonates with CL/P, evaluating parameters such as the ability of different scanning tips to capture alveolar cleft depth, scanning time, number of scan stops, and scan quality. The study utilised various scanning tips, including the Carestream normal tip, Carestream side tip, and Trios 4 scanner tip to assess the alveolar cleft depth measurements. The Trios 4, Carestream, and iTero scanners were evaluated for the time taken, number of scan stops during cleft-unobstructed scanning and cleft-obstructed scanning. The quality of all scanned images was analysed. Results: The findings showed comparable accuracy in capturing alveolar cleft depth with the three-scanning tip (p &gt; 0.05). Scanning time and the number of scan stops did not significantly differ across the three scanners and various scanning strategies employed (p &gt; 0.05). However, scanning with the cleft obstructed required less time and resulted in fewer scan stops compared to cleft -unobstructed scanning. Despite these results, all scanners failed to record the deepest part of the alveolar cleft, highlighting a limitation in current scanning technology for neonates with CL/P. Conclusions: The study recommends enhancing intraoral scanning in this population by adjusting tip size, improving clinician training, optimizing protocols, and conducting further research to improve techniques.

Alveolar Bone Graft Supplemented With Stromal Vascular Fraction in Patients With Permanent Dentition: A Randomized Study.

To evaluate bone development in patients with alveolar clefts and permanent dentition treated with alveolar bone graft supplemented with stromal vascular fraction (SVF). Clinical, prospective, randomized. Single tertiary care institution. Eighteen participants with unilateral alveolar cleft and permanent dentition were included. Patients with other comorbidities were excluded. The control group underwent alveolar bone grafting (ABG) using iliac crest bone, while the experimental group underwent the same treatment, supplemented with SVF. Adipose tissue was collected by abdominal liposuction, and the SVF was processed using mechanical methods (decantation, microfragmentation, and filtration). Bone formation and bone graft integration rate in alveolar cleft at 6 months postsurgery using 3-dimensional tomographic methods and density measurements. The amount of bone graft correlated with an improvement in the relationship between the cleft and noncleft sides (R = 0.78, P < .001) and an improvement in alveolar cleft density (R = 0.69, P = .005), but did not correlate with the graft integration rate. The experimental group showed larger cleft sizes (0.83 × 1.74 cm3, P = .021) and older patients (17.35 × 27.6 years, P = .002), and did not differ in terms of bone development variables when compared to the control group. ABG supplemented with SVF showed statistically similar bone development results, but with a better trend than conventional ABG. Additionally, the studied groups had asymmetric pre-existing characteristics, with greater severity in the experimental group. A larger study will be necessary to mitigate preoperative characteristic differences and to more accurately compare the results between the methods.

The Pattern of Maxillary Cleft Alveolus in Patients from Khyber College of Dentistry, Peshawar, Pakistan: A Cross-Sectional Study

The Pattern of Maxillary Cleft Alveolus in Patients from Khyber College of Dentistry, Peshawar, Pakistan: A Cross-Sectional Study

Patterns of Congenital Tooth Agenesis and Crown Width in Patients with Alveolar Clefts in Guizhou, China: A Retrospective Study

Objective This study aimed to investigate the prevalent pattern of congenital tooth agenesis and the development of crown width in patients with alveolar clefts in Guizhou, China. Methods The imaging data and complete medical record information of 222 patients who met the criteria were studied. The rate of tooth agenesis, tooth agenesis patterns, type of cleft, gender, and crown width in patients with alveolar cleft were counted. Results Twenty-two congenital tooth agenesis patterns were statistically identified in patients with alveolar clefts by the tooth agenesis code method. The rate of congenital tooth agenesis in patients with alveolar cleft was 72.5%, and the most common missing teeth were lateral incisors. The rate of tooth agenesis was higher in bilateral alveolar cleft (87.1%) than in unilateral alveolar cleft (67.4%). No correlation was found between gender and tooth agenesis patterns, tooth agenesis rate, or number of missing teeth. Crown width in patients with alveolar clefts is less than normal. No correlation was found between the number of missing teeth and crown width. Conclusions The congenital tooth agenesis patterns and tooth agenesis rates in patients with alveolar clefts in Guizhou, China, were related to the type of cleft, independent of gender. The crown widths in patients with alveolar clefts were smaller than normal, irrespective of the number of tooth agenesis.

A Two-Stage Approach to Alveolar Clefts Repair with Combined Cortical and Cancellous Bone Grafting

Background: Achieving optimal efficacy in secondary alveolar bone grafting (SABG) poses a considerable challenge for patients with alveolar clefts post-canine eruption. This study introduces a novel technique called the "two-stage SABG" to improve the treatment outcomes for patients who have missed the optimal timing for bone grafting. Methods: Patients aged 12 and above, presenting with unilateral, complete alveolar clefts after canine eruption, were divided into two cohorts: conventional and two-stage groups. The two-stage group underwent oronasal fistula closure and mucoperiosteal sealing during the initial stage, followed by particulate cancellous bone marrow (PCBM) and mandibular cortical bone grafting in the second stage after a three-month interval. Six months after surgery, the SABG was evaluated quantitatively and qualitatively using computed tomography (CT). Results: A total of 81 patients (median age: 14 years; male/female: 49/32) were included in the conventional group, while the two-stage group consisted of 33 patients (19 years; 20/13). The two-stage group exhibited significantly superior outcomes (P &lt; 0.01) in terms of radiographic healing rate (&gt; 4 points) (96.97% vs. 55.56%), bone bridge height (12.17mm, IQRs=4.26mm), bone bridge width (9.09mm, IQRs=2.74mm), bone formation rate (69.73%, IQRs=22.73%), and bone resorption rate (48.85%, IQRs=22.57%). Additionally, the average three-dimensional deviations greater than 3.5mm at the affected piriform aperture margin. Conclusions: The novel two-stage SABG approach demonstrates significant benefits in the repair of alveolar clefts and pyriform foramen deformities through combined cortical and cancellous bone grafting.

Low-Dose Cone-Beam Computed Tomography in Swedish Pediatric Patients With Alveolar Clefts Following Alveolar Bone Grafting-A Clinical Study.

The aim of this study was to investigate whether a low-dose cone-beam computed tomography (CBCT) protocol provides diagnostically acceptable image quality for assessing bone healing after alveolar bone grafting. The study cohort comprised 11 patients (aged 7-14 years) with orofacial clefts who had undergone alveolar bone grafting at Skåne University Hospital in Malmö, Sweden. During the postsurgical follow-up at 6 months, each patient was assessed twice: once with a standard-dose CBCT protocol and once with a low-dose CBCT protocol, which in total corresponds to one CBCT examination made with the exposure settings recommended by the manufacturer. Among others, the assessed parameters included subjective image quality, as well as bone graft height, thickness, and integration. No significant differences were found between the standard- and low-dose protocols for most parameters (p > 0.05). Exceptions included subjective image quality (one observer, p = 0.05) and confidence levels during the assessment (three observers, p = 0.01, 0.01, 0.02). The low-dose protocol yielded adequate image quality for postoperative CBCT healing assessment in patients who have undergone alveolar bone grafting. However, the confidence level of observers during the assessment with the low-dose protocol was reduced. This study is registered on ClinicalTrials.gov (NCT06395077). This study is registered on ClinicalTrials.gov (NCT06395077).

Comparing Three-dimensional Radiologic Outcomes Between Early Versus Late Secondary Alveolar Bone Grafting.

Secondary alveolar bone grafting (SABG) during mixed dentition is the standard of care for patients with complete cleft of lip and palate. Early SABG (E-SABG; 4 to 7y) occurs before the eruption of lateral incisors, whereas late SABG (L-SABG; 8 to 12y) occurs before the eruption of maxillary permanent canines. This study compares outcomes of E-SABG versus L-SABG among patients with unilateral cleft of lip and palate (UCLP). A prospective cohort study was conducted evaluating nonsyndromic patients with UCLP who underwent SABG from April 2018 to January 2020, 48 consecutive patients with UCLP were included. Preoperative and 6 to 10-month postoperative cone beam computed tomography imaging were obtained to assess graft and periodontal outcomes. Among 48 patients with UCLP, of which 21 were in the E-SABG group (6.9 ± 1.1y), and 28 were in the L-SABG cohort (10.4 ± 1.6y). The initial alveolar cleft width is significantly smaller in the E-SABG cohort compared with the L-SABG cohort (5.1 ± 1.5 versus 6.5 ± 2.0mm, P = 0.008). Compared with the L-SABG cohort, the E-SABG cohort had higher rates of bony bridge formation (77.3% versus 65.4%, P= 0.367), thicker bony bridges (5.7 ± 2.1 versus 3.9 ± 1.5mm, P= 0.004), lower Bergland scores [1.5 (interquartile range: 1 to 2) versus 2.25 (interquartile range: 1.5 to 3.5), P= 0.026], and greater alveolar bone coverage (79.8 ± 16.7% versus 67.9 ± 18.1%, 0.024). The authors' findings suggest that patients who undergo E-SABG at ∼7 years may have better graft outcomes and benefits to the periodontal bone support on cleft-adjacent incisor compared with L-SABG at 11 years.

Three-Dimensional Changes of Alveolar Ridges and Nasolabial Structures Following a Digital Nasoalveolar Molding Therapy With a Novel Nasal Stent Activation Protocol

Digital orthodontics has been integrated into NasoAlveolar Molding (NAM) therapy to overcome challenges in the conventional NAM method. This study introduced an individualized Digital NAM (iDNAM) and evaluated the changes in the alveolar ridges and nasolabial morphology after iDNAM treatment. Prospective data were collected from 15 infants with complete unilateral cleft lip and palate who underwent iDNAM therapy. An intraoral-and-nasolabial scan was used to create a virtual setup model and plate generation. A total of 2 plates were required under the iDNAM treatment protocol. The first iDNAM plate has a specific interior and exterior design to allow continuous force application with minimal plate adjustment. After an intermediate scan, a nasal stent was meticulously incorporated into the second plate for nasal molding. To activate the nasal stent, a silicone molding extension was used instead of manually adding acrylic. The alveolar cleft gap was significantly reduced by 7.48 ± 2.06 mm. On the cleft side, statistically significant increases occurred in nostril height, columellar length, and nasal base–columellar angle (2.08 ± 0.63 mm, 2.58 ± 0.28 mm, and 22.29 ± 0.88 degrees, respectively). By using 2 serial plates, iDNAM improved the alveolar cleft gap and the nasal morphology in complete unilateral cleft lip and palate. An addition of a nasal extension to the second iDNAM plate presents a challenge as accurate positioning is required for appropriate activation force. The iDNAM plate design and nasal activation protocol reduce the need for chairside adjustment and the number of appointments.

Long-Term Three-Dimensional Morphometric Outcome Study of Nasal Bone in Cleft Patients.

Cleft lip nose deformities are characterized by underlying features in the bony skeleton as well as the soft tissues; however, no previous study has focused on the evaluation of the nasal bone. The aim of this study was to compare nasal bone features among adult patients with unilateral cleft lip with or without cleft palate, those with bilateral cleft lip and palate, and controls. Included in this retrospective study were patients aged ≥16 years with nonsyndromic cleft who underwent long-term orthodontic treatment and controls aged 18-45 years who underwent surgery for jaw deformities at Keio University Hospital. Piriform width, nasal width, and nasomaxillary angle values measured on CT were compared among the groups using the Wilcoxon rank sum test. Nine patients had unilateral cleft lip and alveolar cleft, 19 had unilateral cleft lip and cleft palate, and 14 had bilateral cleft lip and palate (BCLCP). There were 18 controls. Mean piriform width and mean nasomaxillary angle were significantly greater in the BCLCP group than the control group (20.1±2.54mm versus 18.8±1.35mm, P<0.05; and 105.8±8.13 degrees versus 100.4±7.95 degrees, P<0.05, respectively). There was no significant difference in mean nasal width among the groups. Nasal bone morphology was not affected by initial cleft lip alone or by the presence or absence of cleft palate. Patients with bilateral cleft lip and palate have a wider and lower nose than those without cleft deformity and might benefit more from reduction of the bony nasal width than from treatment of the soft tissues.

Evaluation of the Regenerative Capacity of Demineralized Bone Matrix vs Fat Graft in Alveolar Cleft Model in Albino Rats.

This study was performed to evaluate the regenerative capacity of demineralized bone matrix vs fat graft, both guided by pericardium membrane in alveolar cleft model in albino rats. A total of 72 rats were required in this study. A surgical bone defect with a 7 mm length × 4 mm width × 3 mm depth was created as a model of an alveolar cleft, then the rats were divided randomly into four equal groups each group contained 18 rats: control group (defect only), the membrane group (the defect was covered by the pericardium membrane), the demineralized bone matrix (DBM) group (the defect was filled with DBM guided by pericardium membrane) and fat group (the defect was filled with a fat graft guided by the pericardium membrane). Around 6 rats from each group were euthanized after 2, 4, and 8 weeks. Skulls were scanned with cone beam computed tomography (CBCT) and harvested for histological evaluation with routine H&E immunohistochemical stains (Anti-osteocalcin and Anti-Wnt5a). The data was recorded and statistically analyzed by a two-way ANOVA. The study showed a notable formation of new bone, and expression of OCN and Wnt5a were notably increased by time in the fat group. However, the density of bone grafts and OCN and Wnt5a expression decreased with time in the DBM group. Control and membrane groups showed negative OCN and Wnt5a immune-reactivity in the cleft site. Fat graft results were superior to DBM results with regard to mucosal closure and accelerated bone regeneration, and may represent an effective treatment for alveolar cleft reconstruction. Finding an inexpensive, accessible, biocompatible and easily manipulated treatment for craniofacial reconstruction and fat graft fulfilled the desired aims. Further investigations with prolonged evaluation periods are needed. How to cite this article: Abdel Raouf E, Elsherbini AM, Abdel Salam Yousef Y, et al. Evaluation of the Regenerative Capacity of Demineralized Bone Matrix vs Fat Graft in Alveolar Cleft Model in Albino Rats. J Contemp Dent Pract 2024;25(6):554-562.

Analysis of the Complications of Mandibular Cortical Bone with/without Particulate Artificial Bone Graft for Alveolar Cleft Reconstruction: A Retrospective Study

Analysis of the Complications of Mandibular Cortical Bone with/without Particulate Artificial Bone Graft for Alveolar Cleft Reconstruction: A Retrospective Study

Effect of Surgical Timing to Dental Health in Secondary Alveolar Bone Grafting: Three-Dimensional Outcomes.

There are various opinions on the optimal timing for performing secondary alveolar bone grafting (SABG). This study compared dental health and 3-dimensional outcomes according to the timing of SABG surgery. A retrospective chart review was performed in patients who underwent SABG between January 1996 and October 2020. Patients were divided into early SABG (6-8y old) and traditional SABG (9-13y old) groups. The final dental survival of the lateral incisor and canine teeth, survival of the bone graft, and maxillary growth were analyzed using plain radiographs and computed tomography with a 3-dimensional volumetric analysis tool. Thirty-six patients were divided into an early group (15 patients) and a traditional group (21 patients). Five patients had bilateral cleft lip, and 26 patients had unilateral cleft lip and palate; therefore, 36 alveolar clefts were analyzed in this study. Lateral incisor survival was significantly greater in the early group than in the traditional group (60% vs. 23.5%; P<0.05). Compared with that in the traditional group, graft success in the early group was greater (80% vs. 57.1%; P<0.05). Three-dimensional volumetric analysis revealed superior bone graft efficiency in the early group compared with the traditional group (55.2 vs. 38.5%; P<0.05). There was no significant difference in maxillary growth between the 2 groups. In our study, superior dental and clinical outcomes were observed in the early SABG group without any long-term complications or maxillary retrusion. Our institution cautiously indicated that SABG could be performed at an age earlier than the existing SABG performed after 9 years old.

Early functional restoration in cleft patients by presurgical infantile orthopedics with follow up

Cleft lip and palate present significant surgical challenges, particularly in cases of extensive clefts associated with severe nasolabial deformities. This case series focuses on the role of presurgical naso alveolar molding (PNAM) in improving surgical outcomes by reducing cleft deformities and enhancing facial symmetry. PNAM, combined with nasal stenting and presurgical orthopedics, aids in aligning the segments of the alveolar cleft and correcting nasal cartilage asymmetry. The study involved bilateral and unilateral cleft repairs, utilizing the Randall's modification of tennison triangular flap for unilateral cases and the Millard-Mulliken procedure for bilateral full clefts. Precise preoperative marking, meticulous tissue rearrangement, and multi-layer closure were key to achieving optimal results. Postoperative care included close monitoring, with skin sutures removed on the fifth day. The results align with existing literature, demonstrating the effectiveness of PNAM in narrowing the cleft and achieving nasal symmetry. This case series highlights the importance of early intervention and the application of PNAM plates in the comprehensive treatment of cleft lip and palate, contributing to favorable outcomes in reconstructive surgery.

Outcomes of Xenograft with Platelet-rich Fibrin versus Autogenous Bone in Alveolar Cleft Grafting.

The use of a suitable graft material helps with sufficient osseointegration. The aim of this study was to compare the clinical and radiographic outcomes of two types of alveolar bone graft materials, xenografts with platelet-rich fibrin (PRF) and autogenous grafts, in patients with alveolar clefts. Thirty-six patients with alveolar clefts were enrolled in this study. Those patients were randomly divided into two groups: group A, where the autogenous iliac bone graft was used to fill the alveolar defect, and group B, where the xenograft with PRF was used to fill the alveolar defect. After 6 months of grafting, patients were assessed in terms of pain, duration of hospital stay, and donor site morbidity associated with iliac crest harvesting, while bone formation was evaluated radiographically using cone beam computed tomography. The results showed no statistical differences as regards baseline and perioperative data. Operative duration was significantly lower among xenograft with PRF patients. Both groups had comparable postoperative success scores, and total failure was reported in a total of three patients (one patient in group A and two patients in group B). With no potential donor site morbidities, xenograft with PRF is an equivalent bone transplant replacement to the autologous iliac bone graft. Additionally, it is associated with a significant success rate, and a significant decrease in operative time and hospital stay. Many future studies are warranted to draw firm conclusions.

Periodontal health and oral hygiene of children with orofacial clefts in Eastern China.

To comparatively assess the periodontal condition and oral hygiene of children and adolescents at different ages presenting with different types of orofacial clefts (OFCs). A total of 1608 patients aged 6-18 years who had not previously undergone periodontal treatment were enrolled in this study. Participants were categorized into two age groups: 6-12 years (Group I) and 13-18 years (Group II). Participants in both age groups were further classified into one of the three OFC-type subgroups: cleft lip only (without or with alveolar cleft), cleft lip and cleft palate, and cleft palate only. Periodontal health was determined by evaluating plaque formation and gingival status with reference to the Silness and Loe plaque index (PI), Loe gingival index (GI), and community periodontal index (CPI). Periodontal health and oral hygiene were not significantly different between Groups I and II for cleft type (p > 0.05). A significant difference was not observed in PI for cleft type among the groups (p > 0.05). In Group II, GI and CPI were significantly higher than in Group I (p < 0.05). According to our results, cleft type does not influence periodontal health of children and adolescents with OFCs. Age, however, influences periodontal diseases' prevalence and severity.

Effect of “platelet rich” fibrin with bone marrow aspirate on the regenerative capacity of alveolar bone grafting with iliac bone graft: A randomized controlled trial

Objectives of the Study: (1) To evaluate the effect of platelet-rich fibrin (PRF) with bone marrow aspirate on regenerative capacity in patients undergoing iliac bone grafting for secondary alveolar bone grafting. (2) and to compare it with group 2 where only bone marrow aspirate was used along with iliac bone graft in secondary alveolar bone grafting. Materials and Methods: A prospective study on patients with cleft alveolus, requiring bone grafting and reporting to our unit from October 2018 to October 2020 was included in this study. Group 1 (bone marrow aspirate with PRF along with cancellous iliac bone graft) and Group 2 (bone marrow aspirate concentrate and cancellous Iliac bone graft without PRF). Computerized tomography (CT) scan was done to assess the volume of defect at the following intervals: Pre-op, immediate post-op, and 12 months. The outcome is assessed using a CT scan by statistical analysis. Results: Mean cleft alveolus volume measured preoperatively in group 1 was 2.5cc, post-operatively measured immediately was 3.2cc, and 12 months post-operative was 2.2cc. Mean volume defect in group 2 is 2.3cc, post-operatively measured immediately was 2.6 cc, and 12 months post-operative was 1.9cc. The average resorption rate at immediate post-op to 12 months interval in group 1 was 25% and in group 2 was 30%. The overall percentage of regenerated bone in group 1 was 75% whereas in group 2 it was 70%. Conclusion: Platelet-rich fibrin in combination with bone marrow aspirate and autogenous bone was beneficial in improving the volume of newly formed bone in the reconstruction of the cleft defect and also results in greater osteogenic effect which increases new bone regeneration and better wound healing.

A Novel Technique for Repairing Alveolar Clefts: Computer-Assisted Design With Posterior of Mandible Block Bone Grafts

Objective: Iliac cancellous bone graft is the gold standard for the treatment of alveolar clefts. However, the resorption rate of iliac cancellous bone is generally high. In this study, the authors propose a new method for repairing alveolar clefts using block bone grafts in the posterior region of the mandibular molar and the anterior margin of the ascending branch. Methods: Ten patients with a diagnosis of unilateral or bilateral alveolar cleft were collected. Block bone grafting between the posterior mandibular molar region and the inner and outer oblique lines of the anterior margin of the ascending branch was used to treat the alveolar synostosis. Preoperative, 1-week postoperative, and 6-month postoperative multislice spiral computed tomography scans of the patients were collected and analyzed for preoperative design and postoperative graft bone morphology using computer-assisted software tools, which were also required to measure the changes in the bone tissue density in the posterior mandibular bone extraction area. Results: At 6 months postoperatively, the mean bone resorption rate of the posterior mandibular bone grafts for cleft alveolar processes was 33.96% ± 11.23%. Bone tissue density in the posterior mandibular bone grafting area recovered to near preoperative levels at 6 months postoperatively. Conclusion: The novel method of bone grafting for the cleft alveolar process used in this paper is really effective. Postoperative posterior mandibular bone extraction did not cause sequelae such as mandibular bone defects or poor morphology in the patients. Computer-assisted design and three-dimensional printing technology helped to improve intraoperative bone grafting accuracy and postoperative assessment.