Cleft Defects Research Articles

Bone marrow aspirate versus two bone autograft types in reconstruction of alveolar cleft: A histomorphometric analysis

Objectives: The aim of this study was to compare histomorphometrically between bone marrow aspirate on a collagen carrier with autogenous bone grafts harvested from two different donor sites in alveolar cleft defect repair.Materials and Methods: eighteen patients with alveoalar cleft defect were included in the study. Twelve out of eighteen patients were reconstructed with auotogenous bone graft; six patients grafted with illium bone graft and six patients grafted with chin bone graft. The remaining patients out of eighteen were reconstructed using bone marrow aspirate implanted on a collagen carrier. Six months after grafting, bone specimens from augmented alveolar ridge sites were retrieved by trephine burs for histomorphometric analysis. Results: Good consolidation of the grafts have been observed, this was demonstrated by intense osteogenesis indicating an active remodeling process. In all groups, the improvement in bone quality of the receptor site was clear with no statistical significance between the groups, however, the autografts presented better bone quality.Conclusions: From this study it was possible to conclude that quality of bone repair using autogenous bone graft is superior to bone marrow aspirate. The time needed for bone maturation is less when chin or iliac autogenous grafts have been used in comparison to the bone marrow aspirate.

Personalized Bioactive Nasal Supports for Postoperative Cleft Rhinoplasty

After cleft lip and palate surgical procedures, patients often need nostril supports to help the reconstructed nostrils retain their shape during healing. Many postoperative nasal stents use a one-size-fits-all approach, in which a standard rubber tube retainer is trimmed and used to support the healing nares. The purpose of this study was to examine photogrammetry and 3-dimensional (3D) printing as a fabrication tool for postoperative patient-specific nasal supports that can be loaded with bioactive agents for localized delivery. A "normal" right nostril injection mold was prepared from a left-sided unilateral cleft defect, and the negative-space impression was modeled using a series of photographs taken at different rotation angles with a commercial mobile phone camera. These images were "stitched" together using photogrammetry software, and the computer-generated models were reflected, joined, and digitally sculpted to generate hollow bilateral supports. Three-dimensional prints were coated with polyvinylpyrrolidone-penicillin and validated for their ability to inhibit Escherichia coli using human blood agar diffusion assays. The results showed that our approach had a high level of contour replication and the antibiotic coating was able to inhibit bacterial growth with a mean zone of inhibition of 15.15±0.99mm (n=9) (P<.0001) in disc diffusion assays. Consumer-grade 3D printing displays potential as a fabrication method for postoperative cleft bilateral nasal supports and may support the surgically reconstructed internal contours. The results of this study suggest that such types of bioactive 3D prints may have potential applications in personalized drug-delivery systems and medical devices.

A Novel Method to Calculate the Volume of Alveolar Cleft Defect Before Surgery.

This study aimed to evaluate a novel subtractive method for the precise calculation of alveolar cleft defect volume before surgery using the three-dimensional imaging software Mimics. Ten patients (3 female, 7 male, age range 8-12 years) with unilateral alveolar cleft were enrolled in the study. Preoperative helical computed tomography scans were performed for all patients. A new subtractive method was introduced to precisely calculate the alveolar cleft defect volume before surgery with the aid of Mimics. The DICOM data of every patient were processed using the subtractive method. Statistical analyses were performed using Pearson's correlation test and t test. The mean volume of the alveolar cleft defect was 1811.97 ± 817.90 mm. The mean time spent to calculate an alveolar cleft defect volume was 60.60 ± 11.67 minutes. The Pearson correlation test (r = 0.38, P = 0.279) indicated a poor correlation between alveolar cleft defect volume and calculation time. Preoperative knowledge of defect volume is crucial in alveolar cleft repair. Accurate estimation of graft volume in alveolar cleft patients can be performed using this new subtractive method. Compared with previous methods, this new subtractive method is time-saving and suitable for both unilateral and bilateral clefts. Surgeons can use this method to design a surgical plan for each patient before surgery within a short time, and with less cost.

Evaluation of osteoinductive calcium phosphate ceramics repairing alveolar cleft defects in dog model.

Alveolar cleft repair is an important step in the sequence of treatments for cleft lip and palate. Intrinsically osteoinductive materials have been the subject of research interest. The aim of this study was to explore the use of osteoinductive biphasic calcium phosphate (BCP) ceramics to repair alveolar cleft defects in dogs. We prepared two kinds of BCP ceramic with different physical characteristics: osteoinductive BCP (OBCP) and non-osteoinductive BCP (NBCP). Bilateral alveolar cleft models were surgically established in dogs. On one side, OBCP was implanted in the defect; on the opposite side NBCP was implanted as a control. The materials were also implanted in the femoral muscles to test their properties at non-osseous sites. The osteogenic ability of materials was evaluated with imaging, spiral CT, histology and fluorescent dye tests. At the muscular implantation sites, new bone formed in all of the OBCP samples, but none in the NBCP samples. Imaging and spiral CT revealed good appearance and continuity of the alveolar cleft postoeration, with normal eruption of the bilateral permanent teeth in the groups. Histological and fluorescent dye testing revealed new bone formation in both groups in situ. However, earlier osteogenesis initiation and bone remodeling were superior with OBCP. Osteogenic process in the intramuscular samples with OBCP was similar to that seen in situ. Our findings indicated that osteoinductive biphasic calcium phosphate ceramics (OBCP) have superior characteristics in alveolar cleft repair compared with non-osteoinductive calcium phosphate ceramics (NBCP).

Noncritical Signaling Role of a Kinase–Receptor Interaction Surface in the Escherichia coli Chemosensory Core Complex

In Escherichia coli chemosensory arrays, transmembrane receptors, a histidine autokinase CheA, and a scaffolding protein CheW interact to form an extended hexagonal lattice of signaling complexes. One interaction, previously assigned a crucial signaling role, occurs between chemoreceptors and the CheW-binding P5 domain of CheA. Structural studies showed a receptor helix fitting into a hydrophobic cleft at the boundary between P5 subdomains. Our work aimed to elucidate the in vivo roles of the receptor–P5 interface, employing as a model the interaction between E. coli CheA and Tsr, the serine chemoreceptor. Crosslinking assays confirmed P5 and Tsr contacts in vivo and their strict dependence on CheW. Moreover, the P5 domain only mediated CheA recruitment to polar receptor clusters if CheW was also present. Amino acid replacements at CheA.P5 cleft residues reduced CheA kinase activity, lowered serine response cooperativity, and partially impaired chemotaxis. Pseudoreversion studies identified suppressors of P5 cleft defects at other P5 groove residues or at surface-exposed residues in P5 subdomain 1, which interacts with CheW in signaling complexes. Our results indicate that a high-affinity P5–receptor binding interaction is not essential for core complex function. Rather, P5 groove residues are probably required for proper cleft structure and/or dynamic behavior, which likely impact conformational communication between P5 subdomains and the strong binding interaction with CheW that is necessary for kinase activation. We propose a model for signal transmission in chemotaxis signaling complexes in which the CheW–receptor interface plays the key role in conveying signaling-related conformational changes from receptors to the CheA kinase.

Perceived and Normative Needs of Facial Cleft Patients Seen in Nigeria

Objective: To evaluate the pattern of presentation and assessing treatment needs of children with facial clefts. Material and Methods: This was a cross sectional study of 49 patients seen at the cleft clinic of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife for a 39-month period of study. Data collected were patient’s bio-data including age, date of birth, sex, social class, age of parents, dental findings, associated malformations, treatment given and referral using an interviewer-administered questionnaire. Data was analyzed using the Statistical Package for Social Sciences. Frequency distributions were carried out for all variables and the Pearson Chi-Square Test was applied to assess the significance of differences between groups at a p value of 0.05. Results: Cleft lip and palate had the highest preponderance 23 (47.0%) followed by cleft lip 14 (28.6%) and cleft palate 12 (24.5%). There were more females 28 (57.14%) than males 21 (42.9%) at male to female ratio of 3: 4, though; it was not statistically significant (p-0.73). Most of the patients (73.5%) belong to the low social class. The high social class had 13 (26.5%) cases. Conclusion: The most important treatment needs of cleft patients in this study were: review/follow-up of treatment protocol, oral hygiene instructions, cleft palate repair, cleft lip repair, and referral to the Orthodontist for treatment of varying degrees of malocclusion in descending order. This trend in the treatment needs arose because most of the patients were still ignorant of the implications of managing facial cleft defects through the multi-disciplinary treatment approach.

Evaluation of the Different Biomaterials Used in Alveolar Cleft Defects in Children.

The aim of this study was to use a literature review to evaluate and compare the different biomaterials used in surgeries for the closure of the palatal and alveolar clefts as alternatives to isolated autografting. For the search strategy, the PubMed and Medline databases were used with the indexing terms “’cleft palate’ (Mesh), ‘biocompatible materials’ (Mesh), and ‘dentistry’ (Mesh).” There was no restriction on language or publication time. After the research, 26 articles were found, and then, only the filter for clinical trials was selected. With this methodology, five articles were selected. The full texts have been carefully evaluated. The main issue among the five selected articles was the closure of a cleft palate and/or alveolar bone with the use of different types of biomaterials (e.g. autogenous bone from the iliac crest and chin, deproteinized bovine bone (DBB), β-tricalcium phosphate (β-TCP), synthetic resorption based on calcium sulfate, and the engineering of bone tissue); they evaluated preoperative and postoperative clinically and through imaging tests. The autogenous bone associated with DBB or β-TCP significantly reduces the amount of autogenous bone harvested from the iliac crest, morbidity, and the hospitalization of the patient, and the isolated use of bovine hydroxyapatite resulted in lower bone density compared to that from autogenous bone.

Bone regeneration using composite non-demineralized xenogenic dentin with beta-tricalcium phosphate in experimental alveolar cleft repair in a rabbit model

BackgroundAlveolar cleft repair is performed via bone grafting procedure to restore the dental arch continuity. A suitable bone substitute materials should possess osteoinductive and osteoconductive properties, to promote new bone formation, along with a slowly resorbable scaffold that is subsequently replaced with functionally viable bone. Calcium phosphate biomaterials have long proved their efficacy as bone replacement materials. Dentin in several forms has also demonstrated its possibility to be used as bone graft replacement material in several studies. The purpose of this study was to evaluate bone regeneration pattern and quantify bone formation after grafting pre-established experimental alveolar clefts defects model in rabbits using composite xenogenic dentin and β-TCP in comparison to β-TCP alone.MethodsUnilateral alveolar cleft defects were created in 16 New Zealand rabbits according to previously described methodology. Alveolar clefts were allowed 8 weeks healing period. 8 defects were filled with β-TCP, whereas 8 defects filled with composite xenogenic dentin with β-TCP. Bone regeneration of the healed defects was compared at the 8 weeks after intervention. Quantification of bone formation was analyzed using micro-computed tomography (µCT) and histomorphometric analysis.ResultsµCT and histomorphometric analysis revealed that defects filled with composite dentin/β-TCP showed statistically higher bone volume fraction, bone mineral density and percentage residual graft volume when compared to β-TCP alone. An improved surgical handling of the composite dentin/β-TCP graft was also noted.ConclusionsComposite xenogenic dentin/β-TCP putty expresses enhanced bone regeneration compared to β-TCP alone in the reconstruction of rabbit alveolar clefts defects.

Current concept in alveolar cleft management

The alveolar cleft is known as the developmental defect of bone in alveolar process of maxillae which occurs in 75% of the cleft lip and palate patients with different types of clinical presentation like unilateral or bilateral and complete or incomplete. Secondary alveolar cleft reconstruction with autogenic spongy bone grafting (osteoplasty) at the stage of mixed dentition is commonly accepted treatment to help in the maintenance of maxillary arch continuity, repairing of oronasal fistula, eruption of the permanent dentition, enhancement of nasal symmetry through providing alar base support and improving speech. As of late, conflicting argument of alveolar cleft management is continuing regarding treatment planning with timing, graft materials, surgical techniques as well as methods of evaluation of the progress of alveolar osteoplasty. Now-a-days, experiments have made for the application of allogeneic bone, artificial bone, and recombinant human bone morphogenetic protein (rhBMP), along with growth factors to diminish the donor-site morbidity associated autogenic bone grafting. The purpose of this review is to discuss about pathogenesis and aetiology of cleft defects, surgical techniques, assessment of progress of alveolar bone graft and proposed future materials for bone graft.

Cryogel scaffolds from patient-specific 3D-printed molds for personalized tissue-engineered bone regeneration in pediatric cleft-craniofacial defects.

Bone defects are extremely common in children with cleft-craniofacial conditions, especially those with alveolar cleft defects and cranial defects. This study used patient-specific 3D-printed molds derived from computed tomography and cryogel scaffold fabrication as a proof of concept for the creation of site-specific implants for bone reconstruction. Cryogel scaffolds are unique tissue-engineered constructs formed at sub-zero temperatures. When thawed, the resulting structure is macroporous, sponge-like, and mechanically durable. Due to these unique properties, cryogels have excellent potential for the treatment of patient-specific bone defects; however, there is little literature on their use in cleft-craniofacial defects. While 3D-printing technology currently lacks the spatial resolution to print the microstructure necessary for bone regeneration, it can be used to create site-specific molds. Thus, it is ideal to integrate these techniques for the fabrication of scaffolds with patient-specific geometry. Overall, all cryogels possessed appropriate geometry to allow for cell infiltration after 28 days. Additionally, suitable mechanical durability was demonstrated where, despite mold geometry, all cryogels could be compressed without exhibiting crack propagation. Such a patient-specific scaffold would be ideal in pediatric cleft-craniofacial defects, as these are complex 3D defects and children have less donor bone availability.

Grafting of Alveolar Cleft Defects in Preparation for Endosseous Dental Implant Placement and Orthodontic Tooth Movement

Prosthodontic rehabilitation of patients with edentulous sites secondary to cleft palate has shown a paradigm shift towards implant placement in skeletally mature patients. Patients with residual alveolar cleft defects after secondary grafting at the optimal age of 8-11 years old have presented with persistent defects precluding implant placement. The purpose of this article is to revisit an approach to augmentation bone grafting of the residual maxillary alveolar cleft defect in preparation for endosseous dental implant placement.

Abstract: Association of Hospital Surgical Volume with Outcomes in Cleft Repair: A Kids’ Inpatient Database Analysis

INTRODUCTION: Cleft defects are among the most common congenital abnormalities in the US.1 Increasing centralization of specialist services, including cleft service delivery, is occurring worldwide, with the aim of improving the provision of cost-efficient, quality services.2,3 The aim of this study is to investigate the impact of hospital volume on complications, charges and length of stay after cleft palate repair in the US. METHODS: A retrospective analysis of the Kids’ Inpatient Database (KID) was undertaken. Children ≤3 years of age undergoing cleft palate repair in 2012 were identified. Hospital volume was categorized by cases per year as low (LV, 0–14), intermediate (IV, 15–46) or high (HV, 47–99); differences in hospital charges and length of stay (LOS) were determined using a gamma log-link generalized linear model. Logistic regression was used to assess hospital volume as a predictor of overall complications. RESULTS: Data for 2,389 children were retrieved: 24.9% (595) of cases were LV, 50.1% (1,196) were IV and 25.0% (596) were HV. There were significant differences in ethnicity (p<0.001), co-morbidity number (p=0.002), hospital bed size (p<0.001) and concomitant procedure performed (cleft lip, p=0.025, or myringotomy, p=0.041) between LV, IV and HV centers. HV centers were more frequently located in the West (71.9%) compared with LV (19.9%) or IV (24.5%) centers (p<0.001 for hospital region). Median household income was more commonly highest quartile in HV centers compared with IV or LV centers (32.3% vs. 21.7% vs. 18.1%) (p<0.001 for household income). There was no significant difference in major complications between different volume centers (p=0.74). Compared to HV centers, there was a significant decrease in mean hospital costs for LV centers ($9,682 vs. $8,378, p<0.001) but no significant difference in cost for IV centers ($9,260, p=0.103). Intermediate and LV centers had a significantly greater LOS when compared with HV centers (1.97 vs. 2.10 vs. 1.74, p<0.001). CONCLUSION: Despite improvement in length of stay in high-volume centers, our findings differ with previous literature demonstrating that concentration of resources in high-volume centers generates cost-savings, as our results do not show a reduction in cost in the high-volume centers. High volume centers may undertake more complex cases, increasing costs, although there was no significant difference in complications between centers of differing volumes. Further research is needed to ensure widespread cost-efficiency. Reference Citations: 1. Parker SE, Mai CT, Canfield MA, Rickard R, Wang Y, Meyer RE, et al. Updated national birth prevalence estimates for selected birth defects in the United States, 2004–2006. Birth Defects Res Part A - Clin Mol Teratol. 2010;88:1008–16. 2. Fitzsimons KJ, Mukarram S, Copley LP, Deacon SA, van der Meulen JH. Centralisation of services for children with cleft lip or palate in England: a study of hospital episode statistics. BMC Health Serv Res[Internet]. BioMed Central; 2012 [cited 2017 Feb 21];12:148. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22682355 3. Aquina CT, Probst CP, Becerra AZ, Iannuzzi JC, Kelly KN, Hensley BJ, et al. High volume improves outcomes: The argument for centralization of rectal cancer surgery. Surgery. 2016;159:736–48.

A systems-level analysis of drug-target-disease associations for drug repositioning.

Drug repositioning is the process of finding new therapeutic uses for existing, approved drugs-a process thathas value when considering the exorbitant costs of novel drug development. Several computational strategies exist as a way to predict these alternative applications. In this study, we used datasets on: (1) human biological drug targets and (2) disease-associated genes and, based on a direct functional interaction between them, searched for potential opportunities for drug repositioning. From the set of 1125 unique drug targets and their 88 490 interactions with disease-associated genes, 30 drug targets were analyzed and (3) discussed in detail for the purpose of this article. The current indications of the drugs thattarget them were validated through the interactions, and new opportunities for repositioning were predicted. Among the set of drugs for potential repositioning werebenzodiazepines for the treatment of autism spectrum disorders; nortriptyline for the treatment of melanoma, glioma and other cancers; and vitamin B6 in prevention of spontaneous abortions and cleft palate birth defects. Special emphasis was also placed on those new potential indications that pertained to orphan diseases-these are diseases whose rarity means that development of novel treatment is not financially viable. This computational drug repositioning approach uses existing information on drugs and drug targets, and insights into the genetic basis of disease, as a means to systematically generate the most probable new uses for the drugs on offer, and in this way harness their true therapeutic power.

Anti-EDAR Agonist Antibody Therapy Resolves Palate Defects in Pax9-/- Mice

To date, surgical interventions are the only means by which craniofacial anomalies can be corrected so that function, esthetics, and the sense of well-being are restored in affected individuals. Unfortunately, for patients with cleft palate—one of the most common of congenital birth defects—treatment following surgery is prolonged over a lifetime and often involves multidisciplinary regimens. Hence, there is a need to understand the molecular pathways that control palatogenesis and to translate such information for the development of noninvasive therapies that can either prevent or correct cleft palates in humans. Here, we use the well-characterized model of the Pax9−/− mouse, which displays a consistent phenotype of a secondary cleft palate, to test a novel therapeutic. Specifically, we demonstrate that the controlled intravenous delivery of a novel mouse monoclonal antibody replacement therapy, which acts as an agonist for the ectodysplasin (Eda) pathway, can resolve cleft palate defects in Pax9−/− embryos in utero. Such pharmacological interventions did not reverse the arrest in tooth, thymus, and parathyroid gland development, suggesting that the relationship of Pax9 to the Eda/Edar pathway is both unique and essential for palatogenesis. Expression analyses and unbiased gene expression profiling studies offer a molecular explanation for the resolution of palatal defects, showing that Eda and Edar-related genes are expressed in normal palatal tissues and that the Eda/Edar signaling pathway is downstream of Pax9 in palatogenesis. Taken together, our data uncover a unique relationship between Pax9 and the Eda/Edar signaling pathway that can be further exploited for the development of noninvasive, safe, and effective therapies for the treatment of cleft palate conditions and other single-gene disorders affecting the craniofacial complex.

A Prospective Study of Chin Bone Graft Harvesting for Unilateral Maxillary Alveolar Cleft During Mixed Dentition

The chin is a common donor site for alveolar cleft bone grafting. The amount of bone available at this site can be limited, because conservative harvesting with mixed dentition must consider the incisive nerve, the unerupted mandibular canine, and the integrity of the inferior mandibular border. Patients with nonsyndromic unilateral alveolar cleft in the mixed dentition stage were selected for this study. The volume of bone obtained from the mandibular symphysis (symphysis menti), degree of alteration in lower lip sensation, anterior tooth vitality, remaining bone in the alveolar cleft, and bone defects at the donor site 1year after surgery were evaluated. Eighteen patients were enrolled in this study. The mean volume of bone harvested from the symphysis was 2.1mL (range, 1.6 to 2.3mL). For all cases, the bone volume harvested from the symphysis was insufficient to fill the alveolar cleft defect, and allograft had to be added to completely fill the cleft. Allograft was admixed in the range of 0.5 to 1mL with autogenous bone harvested from the mandible. Lower lip sensation and vitality of the anterior teeth of the mandible were within the normal range 1year after surgery in all cases. Fourteen of 18 patients (77.8%) had normal bone height or bone height at least three fourths of the expected height in the grafted alveolar cleft after 1year; only 10% of the defect remained in the mandible. The amount of bone yielded by conservative monocortical bone harvest from the mandibular symphysis during the mixed dentition stage for unilateral alveolar cleft bone grafting is not sufficient in volume and should be mixed with allograft. However, donor site morbidity is low with this approach.

Stem cell therapy for reconstruction of alveolar cleft and trauma defects in adults: A randomized controlled, clinical trial

Stem cell therapy with bone marrow-derived mesenchymal stem cells is a promising tissue engineering strategy to promote regeneration of craniofacial bone. To determine whether cell therapy with ex vivo expanded stem cell populations would be safe and efficacious in the regeneration of large alveolar defects in patients with a history of cleft palate or craniofacial trauma. Eighteen patients (10 patients with traumatic injury and 8 patients with cleft palate) presenting with missing teeth associated with horizontal alveolar bone deficiencies were included in this randomized controlled clinical trial. Patients were randomized to receive either conventional autogenous block grafts or stem cell therapy. After a healing period of 4 months the treated sites were re-entered and the bone width re-assessed prior to implant placement. Implant stability was evaluated through torque testing of the implant upon insertion and at 6 months postloading. The mean gain in bone width was 1.5 ± 1.5 mm in the stem cell therapy group and 3.3 ± 1.4 mm in the control group. Overall, bone gain was higher in trauma patients as compared to patients with cleft palate, for both the control and the stem cell therapy groups. Most postoperative complications were wound dehiscences and incision line openings. Implants were placed successfully in 5 out of 10 patients in the stem cell therapy group and in all 8 patients in the control group. One implant from the control/cleft palate group failed before loading, while the rest of the implants were loaded successfully and remained stable at 6 months. The patients who did not receive implants were re-treated with autogenous block bone graft. The ability of stem cells to treat large alveolar defects is safe, yet, their ability to completely reconstitute large alveolar defects is limited. This approach requires further optimization to meet the outcomes seen using current methods to treat large defects, particularly those resultant of cleft palate.

CT Imaging in Congenitally Healed Microform of Primary Cleft Palate

Diagnostic radiology is essential in the planning of multidisciplinary treatment for cleft defects. The aim of this study is to present the merits of performing computed tomography in the case of a patient with a suspected cleft defect on the left side and its spontaneous healing in intrauterine life. This paper describes the case of a patient with a visible scar suggesting a left-sided cleft lip. Anamnestic examination ruled out any surgical correction, although the scar was already evident at birth.

Evaluation of graft uptake from the iliac crest in secondary alveolar bone grafting: Bergland’s criteria revisited

Back groundThe secondary alveolar grafting is an integral part in the management of alveolar cleft defect. Particulate cancellous bone and marrow (PCBM) graft obtained from iliac crest are considered as the gold standard. AimAim of the study was to evaluate the graft uptake clinically and radiologically using the Bergland’s radiographic scale. Material and methodsA longitudinal descriptive study was conducted on twenty patients of unilateral CLP in the age group of 6–13 years, presenting with residual/secondary alveolar cleft defect with unerupted maxillary lateral incisor/canine adjacent to the defect. Autologous PCBM graft obtained from iliac crest was used in all cases. Post operative clinical and radiological evaluation was carried out using the Bergland’s radiographic scale at intervals of 1 week, 1 month and 6 months. Data collection and resultClinical evaluation consisted of assessment for infection, exposure of graft, rejection of graft, wound dehiscence and status of oronasal communication. A four-point Bergland’s radiographic scale was used to compare the interdental height of the bone graft with unaffected side and categorized from grade I to IV. After six months, 6 cases were graded as grade I, 11 cases as grade II and 2 cases were grade III. Only one case deteriorated to grade IV which is considered as failure. Summary and conclusionSatisfactory results were obtained in 95% cases. Bergland’s radiographic assessment scale is a valuable, easily available and inexpensive diagnostic tool to assess the condition of the grafted bone in SABG.

Repairing alveolar cleft defect using autologous concentrated bone marrow derived mesenchymal stem cells: a preliminary study

Repairing alveolar cleft defect using autologous concentrated bone marrow derived mesenchymal stem cells: a preliminary study

A rabbit model for experimental alveolar cleft grafting

ObjectivesThe purpose of the present study was to develop an animal model for creating alveolar cleft defects with properly simulated clinical defect environment for tissue-engineered bone-substitute materials testing without compromising the health of the animal. Cleft creation surgery was aimed at creating a complete alveolar cleft with a wide bone defect with an epithelial lining (oral mucosa) overlying the cleft defect.MethodsA postmortem skull of a New Zealand White (NZW) rabbit skull (Oryctolagus cuniculus) underwent an osteological and imaging survey. A pilot postmortem surgery was conducted to confirm the feasability of a surgical procedure and the defect was also radiologically confirmed and illustrated with micro-computed tomography. Then, a surgical in vivo model was tested and evaluated in 16 (n = 16) 8-week-old NZW rabbits to create in vivo alveolar cleft creation surgery.ResultsClinical examination and imaging analysis 8 weeks after cleft creation surgery revealed the establishment of a wide skeletal defect extending to the nasal mucosa simulating alveolar clefts in all of the rabbits.ConclusionsOur surgical technique was successful in creating a sizable and predictable model for bone grafting material testing. The model allows for simulating the cleft site environment and can be used to evaluate various bone grafting materials in regard to efficacy of osteogenesis and healing potential without compromising the health of the animal.