Unilateral Cleft Alveolus Research Articles

The impact of zygomatic buttress bone graft on nasal floor augmentation in unilateral alveolar cleft patients with late referral: A case series

PurposeThis preliminary study aimed to assess the efficacy of zygomatic buttress bone grafting for nasal floor augmentation in patients with a unilateral alveolar cleft who were referred after the optimal timetable for this surgery had elapsed. Case seriesFive patients, aged 12–18 years, with unilateral alveolar clefts were treated at Qaem Hospital, Mashhad, Iran. Initially, a mucous layer was established on the side of the cleft nose, followed by forming a bony bridge between the defect's sides through a bone graft derived from the zygomatic buttress and xenograft bone powder. Subsequently, the grafted region was covered with an absorbable collagen membrane, and the oral-side flap was sealed. Post-operative follow-ups occurred at 1 week, 1 month, and 3 months, and cone beam computed tomography (CBCT) was performed 6 months post-treatment. Discrepancy between the anterior edge height of the pyriform aperture on the healthy and cleft sides post-grafting was assessed. The average disparity between the height of the anterior edge of the pyriform aperture on the healthy side and the peak height achieved post-grafting on the cleft side was 1.90 ± 2.82 mm. ConclusionWithin the limitations of the study, it seems that zygomatic buttress is applicable for late unilateral alveolar bone grafting as an intraoral source, and is helpful in symmetric bony nasal floor reconstruction, with a good success rate.

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

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

Validation and comparison of 2D grading scales and 3D volumetric measurements for outcome assessment of bone-grafted alveolar clefts in children.

Several methods have been proposed to assess outcome of bone-grafted alveolar clefts on cone beam computed tomography (CBCT), but so far these methods have not been compared and clinically validated. To validate and compare methods for outcome assessment of bone-grafted clefts with CBCT and provide recommendations for follow-up. In this observational follow-up study, two grading scales (Suomalainen; Liu) and the volumetric bone fill (BF) were used to assess the outcome of 23 autogenous bone-grafted unilateral alveolar clefts. The mean age at bone grafting was 9 years. The volumetric BF was assessed in five vertical sections. The bone-grafted cleft outcome was based on a binary coding (success or regraft) on a clinical multidisciplinary expert consensus meeting. Grading scales and volumetric assessment were compared in relation to the bone-grafted cleft outcome (success or regraft). Reliability for the different outcome variables was analyzed with intra-class correlation and by calculating kappa values. The study had a limited sample size. Clinical CBCT acquisitions had a varying tube current and exposure time. Volumetric 3D measurements allowed for outcome assessment of bone-grafted alveolar clefts with high reliability and validity. The two grading scales showed highly reliable outcomes, yet the validity was high for the Suomalainen grading scale but low for the Liu grading scale. Volumetric 3D measurement as well as the Suomalainen grading can be recommended for outcome assessment of the bone-grafted cleft. Yet, one must always make a patient-specific assessment if there is a need to regraft.

Bone grafting with PRP and dental implantation for unilateral alveolar cleft patients

Bone grafting with PRP and dental implantation for unilateral alveolar cleft patients

Impact of Unilateral Alveolar Bone Grafting on Nasal Volume and Nasolabial Surface: A 3D Analysis.

To determine possible effects of unilateral alveolar cleft closure on internal nasal volume and external nasolabial surface. Retrospective, single-arm, cohort study. Institutional, tertiary care. Patients with complete unilateral cleft lip, alveolus, and palate (CUCLAP), who underwent closure of the alveolar cleft with autologous bone graft (ABG) at the age of 9-11 years, with cone beam computed tomography (CBCT) and/or three-dimensional (3D) stereophotogrammetry images taken before and one year after the ABG procedure. ABG-pocedure in patients with CUCLAP. The influence of ABG on the internal and external nasal morphology. A total of 28 patients (21M/7F, 14R/14L) were divided into internal (CBCT) and external (3D-stereophotogrammetry) measurement subgroups. The external nasolabial surface showed a significant decrease of the angle alar curvature right-subnasale-alar curvature left (-1.99°; P = .02; 95% CI -2.61, -0.36) and an increase of the linear measurement between these points (+1.01 mm; P = .03; 95% CI: 0.11, 1.91). No significant differences were found when comparing the distance maps of the affected side with the non-affected side (P = .50, 95% CI: -0.20, 0.29). Closure of the alveolar cleft in CUCLAP patients with ABG did not affect the internal nasal volume, but significantly affected the external nasal surface. The procedure resulted in the nose becoming wider because both alar curvatures moved caudally and laterally relative to the subnasale.

Alveolar cleft reconstruction using iliac bone graft: a clinical case report

Introduction and importance: Alveolar clefts are frequently occurring congenital anomalies that can significantly impact both the functional and aesthetic aspects of an individual’s life. Thus, reducing the quality of life. These clefts can give rise to difficulties in feeding, speech, and dental development. Furthermore, the presence of a gap in the alveolar ridge can disrupt the proper alignment and eruption of permanent teeth. Various techniques have been developed to effectively repair these defects and restore oral function and rehabilitation. Case presentation: An 18-year-old girl is presented with unilateral alveolar cleft which was successfully repaired by utilizing iliac bone grafting and augmenting the defect to restore proper bone architecture and gain suitable support for dental prostheses. Therefore, enhancing oral health by closing the oronasal fistula and improving aesthetics and functional abilities including speech. Clinical discussion: Having an alveolar cleft can lead to challenges which may require a multidisciplinary approach, including surgical intervention, orthodontic treatment, and dental rehabilitation. The primary goal is to close the cleft, restore normal speech and feeding functions, and promote proper dental development. Conclusion: Patients who suffer from alveolar clefts need appropriate treatment. This case report suggests a surgical technique of utilizing the combination of hard and soft tissue management to fix the problem for such individuals and achieve improved oral health, speech, and overall enhancement in quality of life.

Alveolar cleft reconstruction using bone marrow aspirate concentrate and iliac cancellous bone: A 12-month randomized clinical study

ObjectiveThis study aimed to compare the bone density and volume in patients with alveolar cleft reconstructions utilizing bone marrow aspirate concentrate with iliac graft versus iliac graft alone.Material and methodsThirty-six patients with unilateral alveolar cleft were randomly allocated into either an intervention group receiving an iliac bone graft mixed with bone marrow concentrate or a control group receiving an iliac bone graft. Cone beam CT was obtained preoperative, 6 and 12 months postoperatively to assess the bone density of the graft and bone volume of the alveolar defect, and then, the bone loss ratio was calculated.ResultsBone volume and bone density demonstrated a statistically significant increase in the intervention group at 6 and 12 months. In contrast, the bone loss ratio decreased significantly in the intervention group throughout the follow-up period.ConclusionA combination of bone marrow concentrate and iliac cancellous bone in alveolar cleft reconstruction may improve bone densities and volume in addition to decreasing graft loss rate.Clinical significanceUsing of bone marrow aspirate concentrate will decrease the amount of the graft needed and decrease the ratio of bone loss at the grafted site by the time.Trial registration ClinicalTrials.org (NCT04414423) 4/6/2020

Using the Dermal Fat Graft as a Barrier Membrane in Unilateral Alveolar Cleft Grafting: A Randomized Clinical Trial.

Alveolar cleft grafting is a surgical procedure that usually suffers from inferior results. The patients were divided into 2 groups; study and control. In the study group, the grafted site was covered with a dermal fat graft. Showed that the bone fill percentage (Bergland Scale) recorded in the study was significantly better ( P =0.03); the study group had 14 successful cases out of 18 compared with the control, which had only 9 out of 20. The study group significantly ( P = 0.002) better bone fill (71%±32%) compared with the control (46%±33%). There was a significant reduction in dehiscence in the study compared with the control ( P =0.02); the study group had no dehiscence compared with the control, which had 5 dehiscence. The dermal fat graft use as a barrier membrane was successful in improving alveolar cleft grafting.

Influence of osseous structure characteristics of unilateral alveolar cleft on outcomes of alveolar bone grafting: a retrospective study

To enhance the success rate of alveolar bone grafting, it is crucial to identify the factors that may influence the postoperative bone formation. This study aimed to investigate the impact of various osseous structure characteristics of alveolar clefts on the survival ratio of autogenous cancellous bone particle grafts. A retrospective study was conducted on 60 patients who underwent surgery performed by the same surgeon between 2016 and 2022. Two researchers measured and recorded the bone defect volume (DV), postoperative bone formation volume at 1 year, contact area between the graft and the bone surface within the cleft (S), cleft width (CW), osseous occlusion relationships, and presence of a cleft palate and initial bone bridge within the cleft for each patient. Pearson correlation analysis, Spearman's correlation analysis, and multiple linear regression analysis were performed. The analysis results revealed statistical correlations between DV, CW, ratio of S to DV, cleft palate, initial bone bridge presence, and occlusion relationships with the survival rate. Multiple linear regression analysis showed that initial bone bridge and occlusion relationships affected the graft survival rate. Based on the presence of initial bone bridges and occlusions, we can make a rough estimate of the postoperative bone formation outcome in patients. However, the underlying mechanisms by which these two factors influence the bone formation require further investigation. In addition, preoperative orthodontic treatment to improve occlusal relationships may improve the postoperative bone formation outcomes in alveolar bone grafting.

An easy-to-use semi-automatic volumetric evaluation for secondary bone grafting in patients with unilateral alveolar cleft.

Surgical intervention for alveolar bone formation is important in patients with alveolar cleft; however, the treatment methods and materials are still controversial. A precise evaluation method for postoperative bone formation is important for comparing outcomes and establishing the best treatment protocol. The purpose of this study is to establish a new method of evaluating surgical outcomes for patients with alveolar cleft. Computed tomography datasets from 20 patients who underwent secondary alveolar bone grafting were obtained before and 1 year after surgery. Six anatomical landmarks were used to superimpose the preoperative and mirrored preoperative volume and postoperative volume data. The cleft region was segmented by subtracting the preoperative from mirrored preoperative volume data, and the failed osteogenesis region was segmented by subtracting the postoperative volume data from the cleft region; subsequently, the bone formation ratio was calculated. Two observers performed this method using a free software 3D slicer and the average evaluation times were 12.7 and 13.2 min for observers 1 and 2, respectively. Method reliability was determined by evaluating intraclass correlation coefficients. The intra-observer intraclass correlation coefficients were 0.97 and 0.96 for observers 1 and 2, respectively. The inter-observer intraclass correlation coefficient was 0.97. Our method is practical for assessing bone formation after treatment, which does not require specific knowledge or software and can be used by ordinary physicians.

Orthodontic-prosthetic rehabilitation of alveolar cleft

ABSTRACT This case report presents the treatment of an 18-year-old girl with a unilateral alveolar cleft and impacted deciduous teeth. The patient had a gap in her upper front teeth and sought treatment for the alveolar defect. The initial treatment plan included alveolar bone grafting, fixed mechanotherapy, and prosthetic rehabilitation. However, the patient declined the bone grafting surgery. To address the issue, orthodontic treatment began with the extraction of a lower incisor to correct the overjet and the removal of over-retained deciduous teeth and a resorbed lateral incisor. The impacted lateral incisor was brought into the arch to stimulate bone formation. The treatment lasted 21 months, and an interim prosthetic rehabilitation with a natural tooth pontic was placed before the final rehabilitation using a Maryland bridge. The outcome of the treatment showed improved dental esthetics, harmonious soft-tissue profile, and parallel roots. This case highlights the importance of early intervention for alveolar clefts and the collaborative effort required for comprehensive oral rehabilitation in cleft lip and palate patients.

A Comparative Evaluation of Iliac Crest Cortical-Cancellous Bone Blocks Graft With and Without Concentrated Growth Factors (CGFs) in Secondary Alveolar Bone Grafting: A Retrospective Study.

The purpose of this study was to investigate the clinical effect and bone resorption of iliac crest cortical-cancellous bone block grafts combined with concentrated growth factor (CGF) compared with iliac crest cortical-cancellous bone block grafts only in secondary alveolar bone grafting. Eighty-six patients (43 in the CGF group and 43 in the non-CGF group) with unilateral alveolar clefts were examined. Patients (17 in the CGF group and 17 in the non-CGF group) were randomly chosen for radiologic evaluation. Quantitative evaluation of the bone resorption rate was made with cone-beam computed tomography and Mimics 19.0 software at 1 week and 12 months after surgery. The success rate of bone grafting was 95.3% and 79.1% in the CGF and non-CGF groups, respectively ( P =0.025). The mean bone resorption rate at 12 months postoperatively was 35.66±15.80% and 41.39±19.57% in the CGF and non-CGF groups, respectively ( P =0.355). The bone resorption patterns of the 2 groups were similar on the labial, alveolar process, and palatal sides, and there was no obvious bone resorption on the labial side in either group. Nasal side bone resorption in the CGF group was significantly less than that in the non-CGF group ( P =0.047). Cortical-cancellous bone block grafts reduce labial bone resorption, while CGF reduces nasal bone resorption and improves the success rate. The combination of bone block and CGF in secondary alveolar bone grafting is worthy of further clinical application.

Unilateral alveolar cleft size on prenatal 2-D ultrasonography predicts cleft of the secondary palate in fetal unilateral cleft lip: A Pilot Study.

Prenatal diagnosis of cleft palate (CP) is challenging. The current study's objective was to investigate if prenatal alveolar cleft width is associated with the likelihood of a cleft of the secondary palate in unilateral cleft lip (CL). The authors reviewed 2D US images in fetuses with unilateral CL from 1/2012-2/2016. Images of the fetal face were obtained with a linear and/or curved probe in the axial and coronal planes. Measurements of the alveolar ridge gap were taken by the senior radiologist. Post-natal phenotype findings were compared with prenatal findings. Thirty patients with unilateral CL met inclusion criteria; average gestational age was 26.67 ± 5.11 weeks (range 20.71, 36.57 weeks). Ten fetuses were found to have an intact alveolar ridge by prenatal US; postnatal exam confirmed intact secondary palate in all. Small alveolar defects <4 mm were noted in 3 fetuses; postnatal examination documented CP in a single patient. CP was confirmed in 15 of the remaining 17 fetuses who had alveolar cleft width >4 mm. An alveolar defect ≥ 4 mm on prenatal US was associated with greater likelihood of a cleft of the secondary palate (c 2 (2, n=30) = 20.23, p<.001). In the setting of unilateral CL, prenatal US documentation of alveolar defects ≥4 mm are highly predictive of the presence of a cleft of the secondary palate. Conversely, an intact alveolar ridge is associated with an intact secondary palate.

Volumetric Analysis of Unilateral Alveolar Bone Defect Using Modified Subtraction in Older Chinese Patients.

A large number of older patients (≥13y old) with alveolar clefts missed the optimal alveolar bone grafting time period in China. This study aimed to determine the accuracy and repeatability of modified computer-aided engineering subtraction for volumetric measurement of these patients. In addition, the study aimed to determine whether the volume of defect is correlated with cleft type (cleft lip and alveolus, cleft lip and palate), cleft location, age, and sex. Preoperative computed tomography data from 100 patients of unilateral alveolar cleft patients without secondary alveolar bone grafting were measured using 2 methods. The maxillary resin model around the alveolar cleft was printed using the 3-dimensional (D) printing method, and the volume of the defect was measured using the drainage method. In the modified subtraction method, Mimics software was used to simulate fracture filling by layer drawing, and the defect volume was determined by subtracting the preoperative fracture template from the filled 3D skull template. The mean time taken to calculate an alveolar cleft defect volume by modified subtraction method was 3.2 minutes. The average defect volume measured using the 3D printing and modified subtraction methods were 1.58±0.41 and 1.55±0.42cm 3 , respectively. Findings suggest that cleft location and age do not affect the defect volume of older patients with alveolar cleft, unlike cleft type and sex. The modified computer-aided subtraction method provides good accuracy, consistency, and reproducibility in measuring alveolar ridge defect volume. Moreover, this method is more efficient and cost-effective than the 3D-printed model method.

Imaging Factors Affecting Prenatal Counseling in Orofacial Clefts

Introduction: We aim to correlate pre- and postnatal data regarding the cleft type and surgical prognostic factors associated to orofacial clefts. Methods: Retrospective study concerning all cases of orofacial cleft evaluated prenatally (US+/−MRI) between 2015 and 2020 with available postnatal outcomes. We compared prenatal imaging (cleft type and surgical prognostic factors) with postnatal findings. Results: 48 fetuses were included. Median gestational age at first US/MRI examination: 29+2 WG and 31+6 WG, respectively. The prenatal diagnosis was in accordance with postnatal findings with regard to the cleft type in 88% of the cases (n = 42/48) for US and/or MRI, 84% (n = 38/45) for US only, and 90% (n = 37/41) for MRI only. The nasal septum deviation and nostril collapse were underestimated by prenatal US in 48% (n = 12/25) and 44% (n = 11/25) of cases, respectively (Cohen’s kappa of 0.22 and 0.32, respectively). Pre- and postnatal examinations were in accordance with 75% of cases (n = 8) regarding evaluation of anteroposterior maxillary shift in case of unilateral alveolar cleft and in 90% and 80% of cases (n = 10) regarding the degree of protrusion/deviation of the premaxillary protrusion in case of bilateral cleft, respectively. Conclusion: Prenatal imaging can accurately assess the type of orofacial cleft and evaluate maxillary shift and deviation of the premaxilla. It underestimates the nose deformity.

Detection of unilateral and bilateral cleft alveolus on panoramic radiographs using a deep-learning system.

The purpose of this study was to evaluate the difference in performance of deep-learning (DL) models with respect to the image classes and amount of training data to create an effective DL model for detecting both unilateral cleft alveoli (UCAs) and bilateral cleft alveoli (BCAs) on panoramic radiographs. Model U was created using UCA and normal images, and Model B was created using BCA and normal images. Models C1 and C2 were created using the combined data of UCA, BCA, and normal images. The same number of CAs was used for training Models U, B, and C1, whereas Model C2 was created with a larger amount of data. The performance of all four models was evaluated with the same test data and compared with those of two human observers. The recall values were 0.60, 0.73, 0.80, and 0.88 for Models A, B, C1, and C2, respectively. The results of Model C2 were highest in precision and F-measure (0.98 and 0.92) and almost the same as those of human observers. Significant differences were found in the ratios of detected to undetected CAs of Models U and C1 (p = 0.01), Models U and C2 (p < 0.001), and Models B and C2 (p = 0.036). The DL models trained using both UCA and BCA data (Models C1 and C2) achieved high detection performance. Moreover, the performance of a DL model may depend on the amount of training data.

Investigation of the effect of fibrin glue as a sealant in the unilateral alveolar bone grafting successes

Background: Bone grafting is the primary treatment for the alveolar cleft. Due to the reduced complications by the sealant materials, this study aimed to evaluate fibrin glue's effect on the success rate of unilateral alveolar bone grafting.Materials and Methods: This study was a single-blind clinical trial performed on 20 patients with a unilateral alveolar cleft. Patients were randomly divided into groups: group A patients as a control group underwent bone grafting without fibrin glue, and in Group B, patients were grafted using fibrin glue. The subject was followed up through routine examination and the cone-beam computed tomography systems technique for up to 4 months. Paired t-test and Chi-square tests were used to analyze the data and the P < 0.05 was considered the significance threshold.Results: The mean age, gender, and cleft side distribution did not represent significant differences. Before surgery, the average alveolar cleft volume in Group A and B patients was 0.95 ± 0.25 cm3 and 0.99 ± 0.22 cm3, respectively, which was not statistically different. After the surgery procedure, the alveolar cleft volume in Group A and B patients was determined to be 0.31 ± 0.10 cm3 and 0.23 ± 0.11 cm3, which represented 66.7% ± 8.9% cm3 and 76.2 ± 11.4 cm3 bone formation, respectively, with no remarkable difference. Our examination did not reveal any necrosis and infection in both groups. However, despite no dehiscence observation in fibrin glue treatment patients, one subject showed dehiscence complication in the control group.Conclusion: According to results, fibrin glue may increase the percentage of bone volume formed and prevent dehiscence.

Evaluation of the Efficacy of Platelet Rich Fibrin with Bone Graft in the Reconstruction of Unilateral Alveolar Cleft

Evaluation of the Efficacy of Platelet Rich Fibrin with Bone Graft in the Reconstruction of Unilateral Alveolar Cleft

Differences in the panoramic appearance of cleft alveolus patients with or without a cleft palate.

The purpose of this study was to clarify the panoramic image differences of cleft alveolus patients with or without a cleft palate, with emphases on the visibility of the line formed by the junction between the nasal septum and nasal floor (the upper line) and the appearances of the maxillary lateral incisor. Panoramic radiographs of 238 patients with cleft alveolus were analyzed for the visibility of the upper line, including clear, obscure or invisible, and the appearances of the maxillary lateral incisor, regarding congenital absence, incomplete growth, delayed eruption and medial inclination. Differences in the distribution ratio of these visibility and appearances were verified between the patients with and without a cleft palate using the chi-square test. There was a significant difference in the visibility distribution of the upper line between the patients with and without a cleft palate (p<0.05). In most of the patients with a cleft palate, the upper line was not observed. In the unilateral cleft alveolus patients, the medial inclination of the maxillary lateral incisor was more frequently observed in patients with a cleft palate than in patients without a cleft palate. Two differences were identified in panoramic appearances. The first was the disappearance (invisible appearance) of the upper line in patients with a cleft palate, and the second was a change in the medial inclination on the affected side maxillary lateral incisor in unilateral cleft alveolus patients with a cleft palate.

Erratum.

Figures 1 and 2 were inadvertently switched and printed with the wrong legends in “Does absence of maxillary lateral incisor affect the status of maxillary canine before and after secondary alveolar bone grafting in patients with unilateral alveolar cleft?,” by Hyunseung Hong, Il-Hyung Yang, Jin-Young Choi, Jong-Ho Lee, Jee Hyeok Chung, Sukwha Kim, and Seung-Hak Baek.Angle Orthod.2022;92:683– 690. These have been corrected in the online version.