Early Alveolar Bone Grafting Research Articles

Alveolar Bone Grafting in Unilateral Cleft Lip and Palate: Impact of Timing on Palatal Shape.

Alveolar bone grafting (ABG) is a critical surgical intervention in patients with a cleft of the alveolus, aimed at reconstructing the alveolar ridge to facilitate proper eruption, periodontal support, and alignment of adjacent permanent teeth. The optimal timing for ABG remains debated, with late secondary ABG between the ages of 9 and 11 being widely adopted. This study compared the palatal shapes of 28 children at a mean age of 9.5 years (SD = 0.7) who underwent early secondary ABG at a mean age of 2.1 years (SD = 0.6) or 33 children at a mean age of 10.8 years (SD = 1.5) who underwent late secondary ABG at a mean age of 8.6 years (SD = 1.3) to 60 non-cleft controls at a mean age of 8.6 years (SD = 1.2). The palatal shapes were captured with 239 landmarks digitized on the palate on a digital model. Utilizing geometric morphometric methods, i.e., generalized Procrustes superimpositions, principal component analysis, and permutation tests, we assessed the impact of ABG timing on palatal morphology. The first five principal components (PCs) explained 64.1% of the total shape variability: PC1 = 26.1%; PC2 = 12%; PC3 = 11.9%; PC4 = 7.8%; and PC5 = 6.4%. The Procrustes distance between both cleft groups and the control group was more than twice as large as the Procrustes distance between the early ABG and late ABG groups. Nonetheless, all intergroup differences were statistically significant. Our findings suggest that early ABG has a limited negative effect on palatal shape, providing comparable outcomes to late ABG. The study highlights the potential suitability of early ABG, challenging conventional practices and encouraging further exploration into its long-term effects on maxillary growth.

Digital impressions from newborns to preschoolers with cleft lip and palate: A two-centers experience

Documenting cleft lip and palate morphology prior to surgery is standard care. Presurgical orthopedic treatment also requires a 3D cleft model. Endangering the airway, conventional impressions require additional safety measures and resources. We investigate the implementation and risks of digital impressions for the youngest patients with orofacial clefts. We report a retrospective cohort study of patients with cleft lip and palate, aged up to 6 years, treated at two cleft centers in Europe (Basel (A), Warsaw (B)). We scanned with the Medit i500 (Medit Corp, Seoul, South Korea). Center A for presurgical orthopedics and prior surgery from June 2020 to March 2022. Center B prior surgery from December 2020 to May 2021. Scanning data were analyzed for adverse events and adverse device effects, scanning duration, and number of images according to cleft type and age. We analyzed 342 digital impressions in 190 patients (center A: 71, B: 119). The median age was 8.7 months with a range from the first day of birth (presurgical orthopedics) to six years of life (early alveolar bone grafting). No adverse events or adverse device effects were observed. The median scan duration was 85.5s for cleft palate and 50s for cleft lip and nose (IQR 56s and 39s, respectively). Digital impressions with intraoral scanners are safe in patients with cleft lip and palate from newborn to preschool age. Given the funding to purchase an intraoral scanner, interfaces to electronic patient records, and point-of-care 3D printing, cleft centers can successfully implement this technology.

Discussion: Early Alveolar Bone Grafting Is Associated with Lower Regraft Rates and Improvements in Long-Term Psychosocial Outcomes

Discussion: Early Alveolar Bone Grafting Is Associated with Lower Regraft Rates and Improvements in Long-Term Psychosocial Outcomes

Facial esthetics in children with unilateral cleft lip and palate 3 years after alveolar bonegrafting combined with rhinoplasty between 2 and 4 years of age

To evaluate facial esthetics in patients with unilateral cleft lip and palate (UCLP) after alveolar bone grafting combined with rhinoplasty between 2 and 4 years of age. Retrospective case-control study. The Department of Pediatric Surgery, Institute of Mother and Child, Warsaw, Poland. Photographs of full faces and cropped images of five nasolabial components: nasal deviation, nasal form, nasal profile, vermillion border, and inferior view were assessed by 5 professional and 14 layraters in 29 children (23 boys and 6 girls; mean age = 5.3 years, SD 0.5; Early-grafted group) and 30 children (20 boys and 10 girls; mean age = 5.5 years, SD 1.0; Non-grafted group) with complete unilateral cleft lip and palate repaired with a one-stage closure. The groups differed regarding the timing of alveolar bone grafting: in the Early-grafted group, alveolar bone grafting in combination with rhinoplasty (ABG-R) was performed between 2 and 4 years of age (mean age = 2.3 years; SD 0.6); in the Non-grafted group, the alveolar defect was grafted after 9 years of age. No primary nose correction was carried out in any group. To rate esthetics, a modified five-grade esthetic index of Asher-McDade was used, where grade 1 means the most esthetic and grade 5 - the least esthetic outcome. Esthetics of full faces and of all nasolabial elements in the Early-grafted group was significantly better than in Non-grafted group. The scores in the Early-grafted group ranged from 2.30 to 2.66 points, whereas in the Non-grafted group ranged from 2.66 to 3.17 points. All intergroup differences were statistically significant (p < 0.05). Three years post-operatively, early alveolar bone grafting combined with rhinoplasty is favorable for facial esthetics in children with UCLP, but a longer follow-up is needed to assess whether the improvement was permanent.

Dental arch relationship in 5‐year‐olds with complete unilateral cleft lip and palate after early alveolar bone grafting

To evaluate dental arch relationship in preschoolers with unilateral cleft lip and palate after early alveolar bone grafting (ABG). Three raters blindly assessed the dental arch relationship with the GOSLON Yardstick (using a 5-point scale, from 1--very good to 5--very poor outcome) in Early-grafted group (27 boys and 15 girls; mean age = 5.2 years, SD 0.5) and Non-grafted group (17 boys and 12 girls; mean age = 5.8 years, SD 0.8). The groups differed regarding the age when ABG was performed: between 2 and 4 years (mean = 2.4, SD 0.6) in the Early-grafted group and after 9 years in the Non-grafted group. The strength of agreement of rating was evaluated with kappa statistics. The intra- and inter-rater agreement was high (κ > 0.800). The mean GOSLON score in the Early-grafted group was 2.72 and in the Non-grafted group -2.64. The distribution of the GOSLON grades in the Early-grafted group was: 54.8% had a score 1 or 2, 23.8%--3, and 21.4%--4 or 5; in the Non-grafted group, 38.0% subjects scored 1 or 2, 41.4%--3, and 20.6%--4 or 5 (p = 0.023). Early alveolar bone grafting carried out between the ages of 2 and 4 years was not found to negatively affect dental arch relationship by the age of 5 years. However, it is possible that such a negative effect could be found if a longer observation period (e.g. at age 10 years or age 15 years) was allowed.

Early alveolar bone grafting has a negative effect on maxillary dental arch dimensions of pre‐school children with complete unilateral cleft lip and palate

To evaluate maxillary dental arch dimensions in pre-school children with a complete unilateral cleft lip and palate (CUCLP) after early alveolar bone grafting. Intercanine and intermolar widths, length of dental arch and mesiopalatal inclination of both maxillary segments were measured directly on the dental casts of 42 children (27 boys and 15 girls; mean age = 5.2 years, SD 0.5; Early-grafted group), 30 children (18 boys and 12 girls; mean age = 5.8 years, SD 0.8; Non-grafted group), and 40 children (25 boys and 15 girls, mean age = 5.8, SD 0.4; non-cleft Control group). Children from Early-grafted and Non-grafted groups had a CUCLP repaired with a one-stage closure of the entire cleft. An alveolar bone grafting was performed in the Early-grafted group between 2 and 4 years (mean = 2.4, SD 0.6). A one-way anova model with post hoc Tukey's multiple comparison procedures were used to identify intergroup differences. The mesiopalatal inclination of the lesser segment in the Early-grafted group was decreased in comparison with the Non-grafted and Control groups. The intercanine width had a tendency to be reduced in the Early-grafted group relative to Non-grafted group. Early bone grafting results in a larger collapse of the lesser segment than bone grafting carried out between 9 and 12 years of age.

唇顎裂症例に対する早期顎裂部骨移植の臨床的評価

AIM: The purpose of this study was to evaluate the effectiveness of early alveolar bone grafting in patients younger than 8 years.MATERIALS AND METHODS: The treated group comprised 15 patients (mean age, 13.2 years; range, 11.4-16.3 years) with cleft lip and alveolus (13 unilateral and 2 bilateral clefts) who underwent alveolar bone grafting at Kitasato University Hospital between July 1999 and January 2004. The mean age at the time of surgery was 6.8 years (range, 5.3 to 7.11) and the mean follow-up period after grafting was 6.6 years (range, 4.8 to 9.1) . We evaluated maxillary growth, bone bridge formation, alveolar bone height and overjet in the cleft area, molar overjet on the cleft side, dental arch width, and basal arch width. The control group comprised 13 patients (mean age, 13.4 years; range, 12.4-14.2) with unilateral cleft lip and alveolus who underwent alveolar bone grafting. The mean age at the time of surgery was 9.2 years (range, 8.0 to 11.4). The Mann-Whitney U-test was used to examine the statistical significance of differences between the two groups in upper jaw growth, dental arch width, and basal arch width.RESULTS: Maxillary growth was not significantly restricted in any of the patients in the treated group, with a mean SNA angle of 82.4° and 81.6° and a mean ANB angle of 7.3° and 6.1° before and after grafting, respectively. After surgery, the mean dental arch width was 44.8 mm, and the mean basal arch width was 48.8 mm. Bone bridge formation in the cleft area was observed in all patients in the treated group, and the alveolar bone height was similar to that on the non-cleft side. A proper overjet was achieved in 14 of the 15 patients by orthodentic treatment after grafting. In the control group, the mean SNA angle was 80.8°, the mean dental arch width was 44.0 mm, and the mean basal arch width was 48.8 mm after bone grafting. There was no significant difference in SNA angle, dental arch width, and basal arch width between the treated and control groups.CONCLUSION: The results suggest that early alveolar bone grafting followed by orthodontic treatment at least does not affect the maxillary growth of patients with cleft lip and alveolus who are younger than 8 years.