Cleft Alveolar Bone Graft Materials: Literature Review

2021 ◽  
pp. 105566562110076
Author(s):  
Caroline Dissaux ◽  
Laetitia Ruffenach ◽  
Catherine Bruant-Rodier ◽  
Daniel George ◽  
Frédéric Bodin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cell Therapy ◽  
Bone Graft ◽  
Cancellous Bone ◽  
Gold Standard ◽  
Alveolar Bone ◽  
Bone Substitutes ◽  
Comparable Efficacy ◽  
Alveolar Bone Grafting ◽  
Supplementary Material

Introduction: Since the early stages of alveolar bone grafting development, multiple types of materials have been used. Iliac cancellous bone graft (ICBG) remains the gold standard. Design/Methods: A review of literature is conducted in order to describe the different bone filling possibilities, autologous or not, and to assess their effectiveness compared to ICBG. This review focused on studies reporting volumetric assessment of the alveolar cleft graft result (by computed tomography scan or cone beam computed tomography). Results: Grafting materials fall into 3 types: autologous bone grafts, ICBG supplementary material, and bone substitutes. Among autologous materials, no study showed the superiority of any other bone origin over iliac cancellous bone. Yet ICBG gives inconsistent results and presents donor site morbidity. Concerning supplementary material, only 3 studies could show a benefit of adding platelet-rich fibrin (1 study) or platelet-rich plasma (2 studies) to ICBG, which remains controversial in most studies. There is a lack of 3-dimensional (3D) assessment in most articles concerning the use of scaffolds. Only one study showed graft improvement when adding acellular dermal matrix to ICBG. Looking at bone substitutes highlights failures among bioceramics alone, side-effects with bone morphogenetic protein-2 composite materials, and difficulties in cell therapy setup. Studies assessing cell therapy–based substitutes show comparable efficacy with ICBG but remain too few. Conclusion: This review highlights the lack of 3D assessments in the alveolar bone graft materials field. Nothing dethroned ICBG from its position as the gold standard treatment at this time.

scholarly journals Cancellous Bone Versus Tricalcium Phospate (TCP) For Bone Grafting: A Literature Review And Case Report Of Alveolar Bone Grafting In Cipto Mangunkusumo Hospital

2018 ◽  
Vol 4 (2) ◽  
pp. 124-130
Author(s):  
Muhammad Iqbal Maulana ◽  
Akmal Primadian ◽  
Julieta Pancawati ◽  
Kristaninta Bangun
Keyword(s):  
Bone Graft ◽  
Cancellous Bone ◽  
Bone Grafting ◽  
English Language ◽  
Alveolar Bone ◽  
Inclusion Criteria ◽  
Hydroxy Apatite ◽  
Synthetic Materials ◽  
Surgical Methods ◽  
Alveolar Bone Grafting

Background: In the last decade, there are various methods of bone grafting in plastic surgery. Cancellous bone is more often used as bone graft than cortical bone due to its high osteoconductivity and osteogenic capability. The synthetic materials for bone graft such as tricalcium phospate (TCP) and hydroxy-apatite can be use as new alternative for bone grafting surgery. Methods: The PubMed®  databases were searched using the terms: ‘bone graft OR bone grafting’ AND ‘cancellous bone OR iliac crest OR tibia’ AND ‘tricalcium phospate OR tricalciumphospate OR tri calcium phospate’, restricted to English language, and to a publication period from January 2010 to January 2017. The inclusion criteria were any kind of research paper that compared the utility of TCP synthetic graft and autograft as a bone graft. Results: Out of 139 selected studies, only 8 met the inclusion criteria.  In 6 publications TCP graft has similar outcome and in 1 publication have a better result in reducing post operative complication.  Conclusion: TCP graft can be used as substitution for autograft in particular clinical conditions and surgical methods.

Mind the Gap: Alveolar Bone Graft Revision in the Era of Computed Tomography

2021 ◽  
pp. 105566562110026
Author(s):  
Ema Zubovic ◽  
Gary B. Skolnick ◽  
Abdullah M. Said ◽  
Richard J. Nissen ◽  
Alison K. Snyder-Warwick ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Tertiary Care ◽  
Radiographic Examination ◽  
Graft Take ◽  
Alveolar Bone Grafting ◽  
Ct Evaluation

Objective: To determine the rate of revision alveolar bone grafting (ABG) in patients with cleft lip and palate (CLP) before and after the introduction of postoperative computed tomography (CT). Design: Retrospective case–control study analyzing the incidence of revision ABG in patients with and without postoperative CT scans for graft success evaluation. Setting: Academic tertiary care pediatric hospital. Patients: Eighty-seven patients with CLP or cleft lip and alveolus treated with autologous iliac crest bone grafting for alveolar clefts over a 10-year period (January 2009 to March 2019) with minimum 6-month follow-up. Fifty patients had postoperative CT evaluation; 37 did not. Interventions: Postoperative CT to determine ABG success, versus standard clinical examination and 2-dimensional radiographs. Main Outcome Measures: Requirement for revision ABG, defined as failure of the original graft by clinical or radiographic examination. Results: Fifty-eight percent of patients underwent a postoperative CT scan at median interval of 10 months after surgery. Patients with postoperative CT evaluation had a 44% rate of revision ABG (22/50) for inadequate graft take, compared to 5% (2/37) in patients without postoperative CT ( P < .001; 95% CT, 31%-58% in the CT group, 1%-16% in the non-CT group). Conclusions: Computed tomography evaluation after ABG is associated with a significantly increased revision rate for inadequate graft take. The presence of a secondary palatal fistula at the time of original ABG is not associated with revision requirement. Lack of standardized dental and orthodontic records complicates the study of ABG outcomes and presents an area for systems-based improvement.

scholarly journals Alveolar bone heights of maxillary central incisors in unilateral cleft lip and palate patients using cone-beam computed tomography evaluation

2021 ◽  
Author(s):  
Marcin Stasiak ◽  
Anna Wojtaszek-Słomińska ◽  
Bogna Racka-Pilszak
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Contralateral Side ◽  
Cone Beam ◽  
Rank Test ◽  
Cross Sectional ◽  
Alveolar Bone Grafting

Abstract Purpose The aims of this retrospective cross-sectional study were to measure and compare labial and palatal alveolar bone heights of maxillary central incisors in unilateral cleft lip and palate patients, following STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Patients and methods The study group consisted of 21 patients with a mean age of 16 years. High-resolution cone-beam computed tomography was performed at least one year after secondary alveolar bone grafting. The experimental side was the cleft side and the contralateral side without congenital cleft was the control. Measurements were performed on incisors’ midsagittal cross-sections. The Wilcoxon signed-rank test was used for intergroup comparisons. Results The labial and palatal distances between alveolar bone crests and cementoenamel junctions were significantly greater on the cleft side than on the noncleft side. Mean differences were 0.75 and 1.41 mm, respectively. The prevalence of dehiscences at the cleft side maxillary central incisors was 52% on the labial surface and 43% on the palatal surface. In the controls, it was 19% and 14%, respectively. Conclusion The cleft-adjacent maxillary central incisors had more apically displaced alveolar bone crests on the labial and palatal sides of the roots than the controls. Higher prevalence of dehiscences was found on the cleft side. Bone margin differences predispose to gingival height differences of the central incisors. These differences could increase the demands of patients to obtain more esthetic treatment results with orthodontic extrusion and periodontal intervention on the cleft side.

The Effects of Secondary Cleft Procedures on Alar Base Position and Nostril Morphology in Patients with Unilateral Clefts

2017 ◽  
Vol 54 (4) ◽  
pp. 431-435 ◽  
Author(s):  
Stephanie M. Power ◽  
Damir B. Matic
Keyword(s):  
Bone Graft ◽  
Cleft Lip ◽  
Alveolar Bone ◽  
Nonparametric Tests ◽  
Single Stage ◽  
Base Position ◽  
Alar Base ◽  
Alveolar Bone Grafting ◽  
Tertiary Center ◽  
Long Term Follow Up

Objective To compare effects of secondary cleft procedures on alar base position and nostril morphology. Design Retrospective review. Setting Multidisciplinary cleft clinic at tertiary center. Patients, Participants Seventy consecutive patients with unilateral clefts were grouped according to secondary procedure. Interventions Alveolar bone graft versus total lip takedown with anatomic muscle repair versus single-stage total lip with cleft septorhinoplasty (nose-lip) versus rhinoplasty alone. Main Outcome Measures Anthropometric measurements were recorded from pre- and postoperative photographs. Ratios of cleft to noncleft side were compared within and across groups pre- and postoperatively using parametric and nonparametric tests. Results Within the bone graft group, no differences were seen postoperatively in alar base position in long-term follow-up. The total lip group demonstrated greater symmetry at the alar base ( P < .001), increased vertical lip dimension ( P < .001), and decreased nostril height ( P = .004) postoperatively. Within the nose-lip group, increased vertical dimension and alar base support ( P < .001) were also seen postoperatively. Across groups, the single-stage nose-lip group demonstrated greatest alar base symmetry on worm's-eye view ( P < .04). Conclusions Alar base asymmetry in patients with unilateral clefts may be related to soft tissue deficiency and was not affected by alveolar bone grafting. Total lip takedown with anatomic muscle reapproximation was associated with increased alar base symmetry and vertical lip dimension on cleft to noncleft side. Greatest symmetry at the alar base was seen following single-stage nose-lip reconstruction, which may be an effective technique for correcting the secondary cleft lip nasal deformity.

Racial Disparities Affect Timing of Alveolar Bone Grafting for Patients With Cleft Lip and Palate: An Analysis of the 2012 Kids’ Inpatient Database

FACE ◽  
2021 ◽  
pp. 273250162110485
Author(s):  
Alfredo Cepeda ◽  
Mary T. Austin ◽  
Phuong D. Nguyen ◽  
John F. Teichgraeber ◽  
Matthew R. Greives
Keyword(s):  
Bone Graft ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Sociodemographic Factors ◽  
Alveolar Bone Grafting ◽  
Income Quartile ◽  
Inpatient Database

Objective: The timing of alveolar bone graft (ABG) for patients with cleft lip and palate is critical to the success of the operation. Sociodemographic factors have been implicated in delaying surgery for other diagnoses but their impact on patients undergoing ABG is unknown. The purpose of this study is to examine the association of sociodemographic factors on the age of patients undergoing ABG. Methods: The Kids’ Inpatient Database (KID) from 2012 was used to define a cohort of patients with cleft lip and/or palate between the ages of 5 and 14. Patients were selected using ICD-9 procedure codes for repair of oronasal fistula and bone graft. Gender, race, income quartile, hospital region, and type of insurance were used as independent variables. Time to ABG was then calculated as hazard ratios (HR) of having surgery using Cox regression models with 95% confidence intervals. Results: A cohort of 395 patients was identified. Median age at ABG was 9 ± 0.15 years. On univariate analysis, Non-Hispanic Black (NHB) patients underwent surgery later than Non-Hispanic White (NHW) patients (11.13 ± 0.44 years vs 9.67 ± 0.19 years, P = .0026). Patients in the higher 2 income quartiles were more likely to have an early surgery as compared to those in the lowest quartile (9.16 ± 0.43 and 9.32 ± 0.43 years vs 10.20 ± 0.33, P = .016 and 0.043 respectively). No factor was significant on multivariate analysis. Conclusions: Patients who are NHB are associated with delayed time to ABG as compared to NHW. Conversely, those in the upper income quartile by zip code underwent surgery at an earlier age. While this study identifies demographic factors associated with delay of ABG, more research is needed to understand the direct causal effects for this delay in surgery and its implication for future growth and need for orthognathic surgery.

Cleft Width and Secondary Alveolar Bone Graft Success

1995 ◽  
Vol 32 (5) ◽  
pp. 420-427 ◽  
Author(s):  
Ross E. Long ◽  
Barbara E. Spangler ◽  
Mimi Yow
Keyword(s):  
Bone Graft ◽  
Root Length ◽  
Bone Grafting ◽  
Alveolar Bone ◽  
Distal Segment ◽  
Distortion Correction ◽  
Distal Margin ◽  
Maxillary Central Incisor ◽  
Alveolar Bone Grafting ◽  
Graft Success

Fifty-six cleft sites were reviewed prior to alveolar bone grafting and subsequently evaluated for graft success using study models, periapical and occlusal radiographs from the Lancaster Cleft Palate Clinic. All patients in this sample had presurgical orthodontics to expand and align the maxillary arch prior to alveolar bone grafting. Ninety-five percent of the grafts were done using iliac crest, the remaining 5% were cranial grafts. The alveolar bone grafting technique used was as described by Boyne and Sands (1972, 1976). Cleft width was measured on a radiograph taken no more than 1 month preoperatively, following the completion of all orthodontic expansion. Cleft width was determined by inspection at its narrowest point. A distortion correction was attempted by determining the ratio of the radiographic width of the maxillary central incisor adjacent to the cleft compared with the actual width of this tooth measured on study models. The radiographic cleft width was then multiplied by this factor to approximate true cleft width. Alveolar contour was measured at least 6 months postoperatively using ratios of actual bone heights measured at the mesial, middle, and distal margin of the previous cleft compared with root length of adjacent teeth. This was to eliminate the radiographic distortion factors of foreshortening and elongation. Regression analysis was carried out to see if there was a correlation between preoperative cleft width and eventual success of the graft as measured on postsurgical radiographs. The success rate for achieving a bony bridge across the cleft was 91%. Mean alveolar crest height achieved was 93% of the anatomic root length of the tooth in the proximal segment and 96% of the anatomic root length of the tooth in the distal segment. There was significant, but low, negative correlation between presurgical cleft width and alveolar bone attachment of teeth adjacent to the grafted cleft site, after a mean radiographic follow-up of 3.1 years. Notching of the alveolar ridge in the region of the bone graft had a statistically significant low positive correlation with differing cleft widths.

A Comparison of Shepard's Osteotome versus Trapdoor Flap Technique to Harvest Iliac Crest Bone for Secondary Alveolar Bone Grafting

2008 ◽  
Vol 45 (4) ◽  
pp. 347-352 ◽  
Author(s):  
J. Constantinides ◽  
P. Chhabra ◽  
P. J. Turner ◽  
B. Richard
Keyword(s):  
Bone Graft ◽  
Iliac Crest ◽  
Alveolar Bone ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Iliac Crest Bone Graft ◽  
Open Technique ◽  
Flap Technique ◽  
Graft Harvest ◽  
Alveolar Bone Grafting

Objective: To compare the postoperative donor site morbidity and alveolar bone graft results following two different techniques for iliac crest bone graft harvest: a closed (Shepard's osteotome) and an open (trapdoor flap) technique. Design: A retrospective review of two cohorts of alveolar bone grafts performed from 1998 to 2004 in Birmingham Children's Hospital by two surgeons using different harvest techniques. Medical and nursing anesthetic notes and medication charts were reviewed. Alveolar bone graft results were assessed using preoperative and postoperative radiographic studies. Patients: A total of 137 patients underwent an operation. Of these, 109 patients were compatible with the inclusion criteria (data available, first operation, no multiple comorbidities). Sixty-four patients had iliac bone harvested using the open trapdoor technique, while 45 had the same procedure using the closed osteotomy technique. Results: Maximum bone graft volumes harvested were similar with both techniques. The mean length of hospital stay was 50.9 hours for the osteotome and 75.5 hours for the open technique group (p < .0001). The postoperative analgesia requirement was higher and the postoperative mobilization was delayed and more difficult for the open technique patients (p < .0005). Kindelan scores performed by two independent orthodontists were similar for both techniques. Conclusion: The findings demonstrate that harvesting bone from the iliac crest using an osteotome technique reduces time in hospital, analgesia requirements, and postoperative donor site morbidity with no detrimental outcome.

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