Conventional Bone Grafting Research Articles

Single tooth osteotomy and distraction in the treatment of an ankylosed central incisor — a case report

Abstract Introduction Clinical practice encounters the unfortunate consequences of dental trauma. The avulsion of permanent teeth is seen in 0.5–3% of all dental traumatic injuries, and when re-implanted, a tooth can undergo ankylosis in the form of replacement resorption. When ankylosis of a maxillary incisor occurs in a pre-adolescent, the affected tooth gradually becomes infra-occluded with time, which results in severe local dentoalveolar disturbances in normal growth and development, along with aesthetic concerns that challenge orthodontic management. To achieve an ideal dental outcome, an interdisciplinary approach is often required. Aim To detail a case report of an infra-occluded ankylosed central incisor successfully treated with a single tooth osteotomy and distraction osteogenesis in conjunction with mechanotherapy to correct the osseous and gingival margins. Methods This combined orthodontic/surgical case report was completed in stages by (1) pre-surgical orthodontics to diverge the roots of the adjacent teeth from the surgical site, (2) a single tooth osteotomy followed by distraction osteogenesis, (3) postsurgery orthodontics, and (4) retention. Consent and complete records were obtained, including pre-treatment photographs, radiographs and cephalometric superimpositions over an eight-year period from initial presentation until retention. Results Distraction osteogenesis in combination with orthodontics successfully managed the dentoalveolar and soft tissue defect. If tooth replacement is eventually needed, donor site morbidity associated with conventional bone and soft tissue grafting procedures may be eliminated. Conclusion This combined interdisciplinary treatment is an effective alternative to bony and soft tissue augmentation procedures that may not be as predictable in restoring vertical and horizontal osseous and soft tissue defects resulting from severe infraocclusion of anterior teeth.

Prognostic factors in the treatment of carpal scaphoid non-unions.

In this literature review, the authors analyse the prognostic factors in the curative treatment of scaphoid non-unions. The main negative prognostic factors are smoking, the time elapsed since the fracture, and avascular necrosis of the proximal fragment. If the latter is present, the revascularization by a pedicle or microsurgical bone autograft is probably the treatment of choice. In non-unions without evidence of osteonecrosis, vascularized bone grafts are probably not superior to conventional bone grafts, which can presently be performed under arthroscopic control, with minimal morbidity.

Arterialized Venous Bone Flaps: An Experimental Investigation.

In arterialized venous flaps (AVFs) the venous network is used to revascularize the flap. While the feasibility of AVFs in soft tissues has been reported there is no study on osseous AVFs. In this study we aim to assess the flap survival of osseous AVFs in a pig model. Medial femoral condyle flaps were elevated in 18 pigs. Three groups were created: AVF (n = 6), conventional arterial flap (cAF, n = 6) and bone graft (BG, n = 6). The AVFs were created by anastomosis of genicular artery with one vena comitans while leaving one efferent vein for drainage. After 6 months the specimens were harvested. The histology and histomorphometry of of the bone in cAF and AVF was significantly superior to bone grafts with a higher bone volume in AVFs (p = 0.01). This study demonstrates that osseous free flaps may be supported and survive using the technique of arterialization of the venous network. The concept of AVFs in osseous flaps may be feasible for revascularization of free flaps with an inadequate artery but well developed veins. Further experimental and clinical studies are needed to assess the feasibility of clinical use of arterialized venous bone flaps.

Bone regenerative effect of recombinant human bone morphogenetic protein-2 after cyst enucleation.

BackgroundThe aim of this study is to quantitatively evaluate the effect of rhBMP-2 for repair of bone defects after cyst enucleation using the osteogenesis index (OI).MethodsUnder general anesthesia, 10 patients (12 lesions) underwent oral or maxillofacial surgery for cyst enucleation. Postoperatively, 12 lesions were divided into two groups: group A (six lesions) was treated with absorbable collagen sponge (ACS) in combination with rhBMP-2, and group B (six lesions) was treated with ACS alone. After 3 months, cone-beam computed tomographic scans were obtained to measure changes in the volume of the lesions. We then calculated the OI of each group at two different Hounsfield units to determine any statistically significant difference between these two groups (Mann–Whitney U test).ResultsAs tested at the level of new bone, the mean OI was 72.37 % in group A and 55.08 % in group B —a statistically significant difference (p = 0.041). As tested at the level of mature bone, the mean OI was 27.47 % in group A and 18.88 % in group B, but the difference was not statistically significant (p = 0.394).ConclusionsThe application of rhBMP-2 after maxillofacial cyst enucleation accelerated new bone formation in the bone defects. Thus, the use of rhBMP-2 in combination with ACS may be considered an alternative to conventional bone grafting in some patients with postoperative bone defects.Electronic supplementary materialThe online version of this article (doi:10.1186/s40902-016-0070-4) contains supplementary material, which is available to authorized users.

Osteogenesis effect of guided bone regeneration combined with alveolar cleft grafting: assessment by cone beam computed tomography

Cone beam computed tomography (CBCT) allows for a significantly lower radiation dose than conventional computed tomography (CT) scans and provides accurate images of the alveolar cleft area. The osteogenic effect of guided bone regeneration (GBR) vs. conventional alveolar bone grafting alone for alveolar cleft defects was evaluated in this study. Sixty alveolar cleft patients were divided randomly into two groups. One group underwent GBR using acellular dermal matrix film combined with alveolar bone grafting using iliac crest bone grafts (GBR group), while the other group underwent alveolar bone grafting only (non-GBR group). CBCT images were obtained at 1 week and at 3 months following the procedure. Using Simplant 11.04 software, the bone resorption rate was calculated and compared between the two groups. The bone resorption rate from 1 week to 3 months following bone grafting without the GBR technique was 36.50±5.04%, whereas the bone resorption rate using the GBR technique was 31.69±5.50% (P=0.017). The application of autogenous iliac bone combined with the GBR technique for alveolar bone grafting of alveolar cleft patients can reduce bone resorption and result in better osteogenesis.

Tantalum coating of porous carbon scaffold supplemented with autologous bone marrow stromal stem cells for bone regeneration invitro and invivo.

Porous tantalum metal with low elastic modulus is similar to cancellous bone. Reticulated vitreous carbon (RVC) can provide three-dimensional pore structure and serves as the ideal scaffold of tantalum coating. In this study, the biocompatibility of domestic porous tantalum was first successfully tested with bone marrow stromal stem cells (BMSCs) invitro and for bone tissue repair invivo. We evaluated cytotoxicity of RVC scaffold and tantalum coating using BMSCs. The morphology, adhesion, and proliferation of BMSCs were observed via laser scanning confocal microscope and scanning electron microscopy. In addition, porous tantalum rods with or without autologous BMSCs were implanted on hind legs in dogs, respectively. The osteogenic potential was observed by hard tissue slice examination. At three weeks and six weeks following implantation, new osteoblasts and new bone were observed at the tantalum-host bone interface and pores. At 12 weeks postporous tantalum with autologous BMSCs implantation, regenerated trabecular equivalent to mature bone was found in the pore of tantalum rods. Our results suggested that domestic porous tantalum had excellent biocompatibility and could promote new bone formation invivo. Meanwhile, the osteogenesis of porous tantalum associated with autologous BMSCs was more excellent than only tantalum implantation. Future clinical studies are warranted to verify the clinical efficacy of combined implantation of this domestic porous tantalum associated with autologous BMSCs implantation and compare their efficacy with conventional autologous bone grafting carrying blood vessel in patients needing bone repairing.

Alveolar ridge preservation using autogenous tooth graft versus beta-tricalcium phosphate alloplast: A randomized, controlled, prospective, clinical pilot study.

Background:A randomized, prospective clinical, radiographical, and histological study was conducted to evaluate healing after alveolar ridge preservation technique using two different graft materials, namely, a novel autogenous graft material i. e., autogenous tooth graft (ATG) and beta-tricalcium phosphate (β-TCP) alloplast.Materials and Methods:Fifteen patients undergoing extraction of at least three teeth were selected. Atraumatic extractions were performed. Of the three extraction sockets, one was grafted with ATG, other with β-TCP, and the third was left ungrafted. Cone-beam computed tomography scans were taken immediately after grafting and 4 months postoperatively to check the changes in alveolar crest height and width at all the sites. Three patients in whom implant placement was done after complete healing; bone samples were harvested using a 3 mm diameter trephine during osteotomy preparation from both the ridge preserved sites and studied histologically.Results:There was a statistically significant difference when the changes in width and height of alveolar crest were compared within all the three groups (P < 0.05). Among three sites, ATG-grafted sites showed the most superior results with a minimal reduction in alveolar crest height and width. Histological analysis also showed the same trend with more new bone formation at ATG-grafted sites as compared to β-TCP-grafted sites.Conclusion:Postextraction, ridge preservation leads to more predictable maintenance of alveolar ridge height and width. ATG as compared to β-TCP provided superior results. Based on this, we conclude that ATG material can serve as a better alternative to conventional bone graft materials.

Tooth Derived Bone Graft Material

ABSTRACT Alveolar bone deficiency is a major postoperative complication in the treatment of traumatic injuries, periodontal diseases and likewise. Hence, alveolar bone repair remains a major hurdle in tissue engineering. Autogenous bone can be wellthought- of as benchmark for bone grafting sans its limitations and complications. In order to overcome these limitations, there is an increased demand of bone graft materials that led to numerous studies on different techniques and materials for bone regeneration over the years. Dentin and bone having same biochemical similarities led to the idea of using it as a bone regenerative material. Demineralized dentin matrix (DDM), an organic material obtained from dentin has been shown to possess osteogenic capacity. Demineralized dentin matrix may prosper in future endodontic world as an apexification material and as a permanent root canal filling material as well. Quick in bone forming as compared to conventional bone graft, this material is a boon to the dental world in this era. This manuscript reviews various studies on different types of DDM as a bone grafting material, and also summarizes the suggested pathway of bone regeneration. How to cite this article Bhattacharjya C, Gadicherla S, Kamath AT, Smriti K, Pentapati KC. Tooth Derived Bone Graft Material. World J Dent 2016;7(1):32-35.

Recombinant human bone morphogenetic protein 2 outcomes for maxillary sinus floor augmentation: a systematic review and meta-analysis.

To study the effect of the recombinant human bone morphogenetic protein 2 (rhBMP-2) on sinus volumetric and histometric changes after sinus floor augmentation compared to a conventional approach of non-biologic bone grafting materials. An electronic search of 4 databases (January 1990-February 2015), including PubMed/MEDLINE, EMBASE, Web of Science and Cochrane Central, and a hand search of peer-reviewed journals for relevant articles were performed. Human clinical trials with data on comparison of sinus volumetric and/or histometric outcomes with and without the use of rhBMP-2 in sinus grafting procedures, with ≥10 augmentation sites in each study group, and with a follow-up period of at least 6months, were included. Random-effects meta-analyses were performed to analyze weighted mean difference (WMD) and confidence interval (CI) for the recorded variables according to PRISMA guidelines. Six randomized controlled trials (RCTs) were included. The results of the meta-analyses showed that the WMD of vertical bone height gain was -0.14mm (95% CI=-1.91 to 1.62mm, P=0.87), the WMD of bone density was -142.42mg/cm3 (95% CI=-310.62-25.78mg/cm3 , P=0.10), the WMD of the percentage of vital bone was -4.59% (95% CI=-11.73-2.56%, P=0.21), and the WMD of the percentage of residual bone grafting materials was -9.90% (95% CI=-26.38-6.58%, P=0.21). The comparison of implant survival rate presented an overall risk ratio of 1.00 (95% CI=0.94-1.07). The two approaches (conventional bone grafting compared to BMPs) demonstrated comparable effectiveness for both clinical and histomorphometric measures. This systematic review revealed that the use of rhBMP-2 in maxillary sinus floor augmentation achieved similar clinical and histometric outcomes when compared to conventional sinus grafting procedures after a healing period of 6-9months. However, previous studies showed the morbidity and other patient-reported outcomes were improved in rhBMP-2 approaches as compared to bone autograft procedures (both intraoral and extraoral bone harvesting because no donor site is required). Long-term studies are required to determine the cost-benefit of sinus floor augmentation procedures for patients requiring implant reconstruction.

A Compaction Bone Grafting Technique Leads to Early Bone Fusion in Cases of Posterior Lumbar Interbody Fusion.

The impaction bone grafting technique is a popular approach for achieving complete bone fusion during hip surgery or total knee arthroplasty. We hypothesized that compaction bone grafting (CBG), a modified version of impaction bone grafting, could be applied to lumbar fusion surgery. To compare the bone fusion rates and durations achieved using the CBG technique and a conventional loose bone grafting technique. We retrospectively reviewed 89 patients who underwent single-level posterior lumbar interbody fusion at the university hospital; 35 other posterior lumbar interbody fusion recipients were excluded due to undergoing multilevel fusion, prior lumbar surgery, trauma, infection, or inadequate computed tomographic data. Computed tomographic-based bone fusion assessments were obtained using the Brantigan, Steffee, and Fraser criteria at 1 and 2 years after surgery. The baseline characteristics of the CBG (n = 42) and loose bone grafting (n = 47) groups did not significantly differ. Fusion assessments indicated that significantly superior bone fusion rates were achieved at 1 year after surgery in the CBG group than in the loose bone grafting group (P = .04, χ2 test). However, the bone fusion rates of the 2 groups at 2 years after surgery did not significantly differ (P = .3). A nonsymptomatic surgical complication occurred in the CBG group when a spacer was inserted into the intervertebral space; specifically, the spacer slipped out of the right psoas muscle because a large quantity of compaction bone grafts disrupted the cage's pathway. In posterior lumbar interbody fusion surgeries, bone fusion was achieved more quickly with the CBG technique than with the conventional technique.

Stem cell origin differently affects bone tissue engineering strategies.

Bone tissue engineering approaches are encouraging for the improvement of conventional bone grafting technique drawbacks. Thanks to their self-renewal and multi-lineage differentiation ability, stem cells are one of the major actors in tissue engineering approaches, and among these adult mesenchymal stem cells (MSCs) hold a great promise for regenerative medicine strategies. Bone marrow MSCs (BM-MSCs) are the first- identified and well-recognized stem cell population used in bone tissue engineering. Nevertheless, several factors hamper BM-MSC clinical application and subsequently, new stem cell sources have been investigated for these purposes. The fruitful selection and combination of tissue engineered scaffold, progenitor cells, and physiologic signaling molecules allowed the surgeon to reconstruct the missing natural tissue. On the basis of these considerations, we analyzed the capability of two different scaffolds, planned for osteochondral tissue regeneration, to modulate differentiation of adult stem cells of dissimilar local sources (i.e., periodontal ligament, maxillary periosteum) as well as adipose-derived stem cells (ASCs), in view of possible craniofacial tissue engineering strategies. We demonstrated that cells are differently committed toward the osteoblastic phenotype and therefore, taking into account their specific features, they could be intriguing cell sources in different stem cell-based bone/periodontal tissue regeneration approaches.

The use of pedicled vascularized bone graft from the dorsum of distal radius for the treatment of scaphoid nonunion

Background The use of vascularized bone grafts from the dorsum of the distal radius for the treatment of scaphoid nonunion. Poor reduction or neglect of an unstable carpal scaphoid fracture may lead to scaphoid nonunion with or without avascular necrosis. When preoperative suggestion of avascular necrosis of the proximal pole is confirmed with intraoperative evaluation, conventional bone graft is not enough and a vascularized bone graft is strongly recommended. Patients and methods From May 2011 to September 2014, 12 patients with nonunited fracture of the scaphoid were treated with pedicled vascularized bone graft from the dorsum of the distal radius using of the 1,2 intercompartmental supraretinacular artery. Presurgical and postsurgical clinical evaluation included pain, range of motion, and grip strength. Radiographic evaluation included plain radiographs and MRI. The average follow-up period was 26 months (range = 12-40 months). Results At a mean follow-up period of 26 months, all patients clinically improved. Nine patients (75%) reported the absence of any discomfort, two patients (16%) reported slight discomfort after hard work, and only one case (8%) reported pain with light work. The wrist range of motion improved significantly, and the hand grip strength also improved. According to the modified Mayo wrist scoring chart, clinical results were rated as excellent in eight cases, good in three cases, and fair in one case. Radiographically, in eight of the 12 patients, union was achieved within 12 weeks after surgery, and in the other four patients trabecular bridging of the scaphoid fracture was achieved 16 weeks after the procedure. Conclusion 1,2 Intercompartmental supraretinacular artery is superficial to the extensor retinaculum and is a proper pedicle of vascularized bone graft due to the ease of visibility and dissection. The functional results and union rates were satisfactory in our study.

Fixed Partial Denture Treatment With Mini Dental Implants

Fixed Partial Denture Treatment With Mini Dental Implants

The Effect of Decortication for Periosteal Expansion Osteogenesis Using Shape Memory Alloy Mesh Device.

In conventional bone grafting technique, decortication procedure enhances the healing process and bone regeneration to reach the grafted site more readily. This study evaluates to improve periosteal expansion osteogenesis (PEO) using a shape memory alloy mesh (SMA) device with decortication in a rabbit model. The SMA device was inserted under the periosteum at the forehead and pushed, bent, and attached to the bone surface and fixed with a titanium screw. Twelve rabbits were divided into two groups: PEO without decortication (P group) and with decortication (D group). After 2 weeks, the screw was removed, and the mesh was activated by its own elasticity. Rabbits were sacrificed 5 (P1/D1) and 8 (P2/D2) weeks after operation and histologically and radiographically evaluated. The mean activation height was 2.9 ± 0.5 mm. The ratio of new bone volume in the elevated volume was 17.6% in P1, 59.8% in D1 33.4% in P2, and 65.1% in D2. D group had a statistically higher volume of new bone than P group during each period (p < .05). PEO with decortication appears to be a promising clinical alternative for bone augmentation and introduces the new concept of "dynamic graft and guided bone regeneration (GBR)."

Expanding the utility of modified vascularized femoral periosteal bone-flaps: An analysis of its form and a comparison with a conventional-bone-graft.

Vascularized medial femoral condyle (MFC) corticoperiosteal bone-flap is a well-accepted technique when dealing with tissue defects or infection. Its role in refractory conditions and in the possible use for options concerning modifications of this bone-flap compared to a conventional iliac bone graft (conventional-graft) are rarely discussed. We reviewed 21 consecutive cases concerning alternatives with some modifications of original MFC bone-flap surgery used to treat refractory conditions with bone defects, necrosis, or infection in the extremities. We present our devised approaches for this boneflap, and especially modifications of the grafted bone (including strut bone, perforator to the vastus medialis muscle, and the use of one vascular pedicle for some bone flaps) as well as the combined use of artificial bone as hybrid bone transplantation. We also compared the clinical results of 21 cases that received a conventional-graft. Following flap placement, 100% of the nonunion sites healed in an average of 2 months, which was significantly shorter than 5.5 months for the conventional-graft. The results showed the expanding possibility for options with regard to the form and options of this bone-flap as well as the shortening the duration of treatment, especially at the site of an infected distal tibia, insertion of the Achilles tendon on the posterior aspect of calcaneal osteomyelitis, distal end of the clavicle, clavicle or forearm with a bone defect, small bones with refractory conditions, and a femur without implant failure. However, it was not efficient for treating a forearm without bone defect.

Vascularized fibular grafting for reconstruction of bone defect of the radius

BackgroundThe vascularized bone graft is indicated in patients where conventional bone grafting has failed or long bone defects, exceeding 6 cm, are observed in the radius. Fibular grafts allow the use of a segment of diaphyseal bone that is structurally similar to the radius and of sufficient length to reconstruct most defects of the radius.Patients and methodsBetween 2005 and 2008, seven patients with segmental bone defects of the radius were managed with vascularized fibular grafts: six females and one male, aged 12 years on average (range, 3-21 years). The length of bone defect was 7.5 cm on average (range, 4-13 cm). In six cases, the fibular graft was harvested as a vascularized osseous flap and in one case, as an osteoseptocutaneous flap. To achieve fixation of the grafted fibula, intramedullary Kirschner wires were used in six cases and plate in one case. The follow-up period ranged from 4 to 39 months.ResultsAll flaps were successful. Four patients required secondary procedures in the form of revision of internal fixation, iliac bone grafting, and ulnar shorting. The mean period to radiographic bone union was 4.8 months (range, 2.5-8 months).ConclusionVascularized fibular graft is a reliable technique for reconstruction of bone defects of the radius even in the presence of infection.Level of evidenceLevel IV, therapeutic case series.

Free Vascularized Fibular Transfer With Langenskiöld Procedure for the Treatment of Congenital Pseudarthrosis of the Forearm

Congenital pseudarthrosis of the radius or ulna is a rare entity. It is associated with neurofibromatosis, but occurs much less commonly than congenital pseudarthrosis of the tibia. Pseudarthrosis of the forearm can lead to pain, deformity, and limited forearm rotation. Nonsurgical management leads to poor results, as do surgical treatments such as open reduction internal fixation and conventional bone grafting. The transfer of a free vascularized fibula to the forearm pseudarthrosis has been more successful, and it is our preferred method of treatment for children with this condition. Because the transfer is often performed in young children, there is the potential for valgus deformity at the ankle after the fibula is removed. We describe here our technique for the transfer, including the technique for distal tibiofibular fusion (Langenskiöld procedure) after removal of the fibular graft. In addition, we present the results of 5 patients who have undergone this combination of procedures for pseudarthrosis of the forearm at our institution.

Mesenchymal stem cells in oral reconstructive surgery: a systematic review of the literature

This study evaluated clinical outcomes following intraoperative use of adult mesenchymal stem cells (MSCs) in various oral reconstructive procedures. PubMed was searched without language restrictions from 2000 to 2011 using the search words stem cell, oral surgery, tissue engineering, sinus lift, bone regeneration and combinations of these. Inclusion criteria were intraoperative use of MSCs in the study design. Reference lists of the articles found were searched for other related studies. Eighteen clinical trials using MSCs for sinus augmentation were found: five case reports on the repair of large bony defects and six studies on ridge augmentation and healing of alveolar sockets after third molar extraction. The findings suggest that MSCs are capable of producing in vivo bone, re-establishing lost tissue and facilitating placement of dental implants. Use of MSCs would reduce patient morbidity because of a less stressful harvesting technique than that of autogenous bone. The majority of clinical trials indicate that MSCs can produce bone in vivo. However, a satisfactory outcome was not seen in all studies, and due to the diversity of study designs, a 'golden approach' cannot be determined. Before use of MSCs can be considered as a first-choice treatment, more predictable outcomes and better long-term prognoses need to be established. Conventional bone grafting remains the gold standard.

Applications of the Medial Femoral Condyle Free Flap for Foot and Ankle Reconstruction

Avascular necrosis (AVN) or persistent nonunion occurs in situations of poor vascular supply. Some specific situations that plague the foot and ankle surgeon are talus nonunion, talus AVN, navicular AVN, and failed ankle arthrodesis with bone loss. The medial femoral condyle (MFC) flap has emerged as a popular source of vascularized corticocancelous bone. We present a series of cases demonstrating the versatility of the MFC flap in complex foot and ankle pathology. A retrospective review was completed of all MFC flaps used in the foot and ankle over the past 5 years. Five patients were identified (average age 48). Surgical indications included talar AVN and ankle arthritis, talar nonunion, and navicular AVN. All patients had undergone conventional bone grafting techniques, which failed, prior to being treated with a MFC free flap; this series of patients did not possess significant medical comorbidities. Fixation techniques included compression screw fixation, plate osteosynthesis, or fine wire external fixation. The average follow-up was 20 months (range 8 to 40 months). There was a 100% flap success rate with no returns to the operating room for thrombosis. The volume of the bone flaps was 5.6 cm(3) (range 1 cm(3) to 12 cm(3)). The average follow-up time was 20 months (range 8 to 40 months). All cases resulted in union, and full weight bearing status was achieved at a mean of 23.8 weeks (range 10 to 52 weeks) postoperatively. Vascularized bone transfer in the form of the MFC free flap was a valuable method for foot and ankle reconstruction. The MFC flap provided an alternative for those defects that were smaller then 3 cm in length. In our experience, for small bone defects requiring vascularized bone, the MFC flap is currently the ideal donor location supplanting the iliac crest. Level IV, retrospective case series.

Treatment algorithm for bilateral alveolar cleft based on the position of the premaxilla and the width of the alveolar gap

The efficacy of conventional secondary bone grafting is limited in instances of a bilateral alveolar cleft with a wide cleft gap and malpositioning of the premaxilla. The purpose of this study is to suggest a systematic algorithm to guide individualised treatment of a bilateral alveolar cleft according to the position of the premaxilla and the width of the alveolar gap. A total of 51 patients with bilateral alveolar clefts were investigated between January 2000 and February 2008. The average age was 9.2 years, and the mean follow-up period was 47 months. Conventional alveolar bone grafting (ABG) was performed for patients with both a narrow cleft gap and acceptable position of the premaxilla. Patients with both a wide cleft gap and acceptable premaxilla position were initially managed by interdental distraction osteogenesis. Premaxilla repositioning was indicated in patients with both sagittally and/or vertically unfavoured positioning of the premaxilla. The extent of bone resorption following bone grafting was evaluated using the Abyhölm criteria. Of 102 grafts, 98 grafts (96.1%) showed satisfactory bony take (Grade I-II). Only four grafts (3.9%) exhibited a poor outcome, with more than 50% bony resorption (Grade III-IV). The average hospital stay was 5.7 days and no serious complications were observed. Our approach resulted in satisfactory surgical outcomes. This suggests the feasibility of a standardised approach for the correction of a bilateral alveolar cleft. Our algorithm should be helpful for systematic and coordinated team approaches to rectify bilateral alveolar clefts.