Does Early Secondary Alveolar Bone Grafting Influence Need for Additional Maxillary Advancement Procedures in Cleft Lip and Palate?

Objective To determine if secondary alveolar bone grafting (SABG) timing in patients with cleft lip and palate (CLP) influences the future need for additional maxillary advancement procedures, particularly Le Fort I osteotomy with rigid external distraction (RED). Design Retrospective cohort study. Groups were separated by SABG timing: early mixed dentition (ages 68 years) or late mixed dentition (ages 9-11 years). The criterion for RED was negative overjet ≥8 mm, and sufficient dental development for RED. Setting Single tertiary care institution. Patients Patients with CLP that underwent SABG from 2010 to 2015. Exclusion criteria included syndromic conditions, SABG surgery at age >12 years, current age <12 years, and <2 years follow-up. 104 patients were included. Main outcome measures The number of RED candidates and treated patients. Results There was no statistical difference in the number of RED candidates ( P = .0718) nor treated patients ( P = .2716) based on SABG timing; stratification by laterality was also insignificant. Early SABG is associated with higher odds of being a RED candidate (pooled, unilateral, bilateral) and treated patient (pooled and unilateral); however, there were no statistically significant associations between SABG timing and the number of RED candidates and treated patients as determined by logistic regression models. Conclusion There is no statistically significant association between SABG timing and the odds of being a RED candidate or treated patient. Future prospective studies are recommended to assess the relationship between SABG timing and maxillary growth in patients with CLP.

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Surgical Outcomes of Secondary Alveolar Bone Grafting and Extensive Gingivoperiosteoplasty Performed at Mixed Dentition Stage in Unilateral Complete Cleft Lip and Palate

Journal of Clinical Medicine ◽

10.3390/jcm9020576 ◽

2020 ◽

Vol 9 (2) ◽

pp. 576

Author(s):

Yu-Ying Chu ◽

Frank Chun-Shin Chang ◽

Ting-Chen Lu ◽

Che-Hsiung Lee ◽

Philip Kuo-Ting Chen

Keyword(s):

Bone Grafting ◽

Orthodontic Treatment ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Alveolar Bone ◽

Prospective Trial ◽

Mixed Dentition ◽

Alveolar Bone Grafting ◽

Significant Difference ◽

Secondary Alveolar Bone Grafting

Secondary alveolar bone grafting (SABG) is associated with donor site morbidities. We aimed to compare the outcomes of SABG and extensive gingivoperiosteoplasty (EGPP) at the mixed dentition stage. This single-blinded, randomized, prospective trial enrolled 50 consecutive patients with unilateral complete cleft lip and palate who had residual alveolar bone cleft, of which 44 (19 SABG, 25 EGPP) completed the study. Bone volumes before surgery, 6 months postoperatively, and 1-year postoperatively were compared using computed tomography. The Bergland scale score was recorded at 6 months postoperatively. Both groups had the same preoperative alveolar cleft volume. On the Bergland scale, 21, 3, and 1 patient in the EGPP group and 16, 2, and 1 patient in the SABG group were classified as types I, II, and IV, respectively, which did not show significant difference. With perioperative orthodontic treatment, the 1-year residual bone defect volume in both groups did not show significant difference (SABG 0.12 cm3 vs. EGPP at 0.14 cm3, p > 0.05). The study was not able to reveal much difference between SABG and EGPP combined with perioperative orthodontic treatment.

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Premaxillary Osteotomy and Guided Tissue Regeneration in Secondary Bone Grafting in Children with Bilateral Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1597/06-032.1 ◽

2007 ◽

Vol 44 (5) ◽

pp. 469-475 ◽

Cited By ~ 24

Author(s):

Julia K. Scott ◽

Roger M. Webb ◽

Timothy R. Flood

Keyword(s):

Tissue Regeneration ◽

Bone Grafting ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Alveolar Bone ◽

Guided Tissue Regeneration ◽

Mixed Dentition ◽

Collagen Membrane ◽

Alveolar Bone Grafting ◽

Secondary Alveolar Bone Grafting

Objective: To introduce a surgical technique for secondary alveolar bone grafting performed in conjunction with premaxillary osteotomy and guided tissue regeneration in children with bilateral clefts. This paper also looks at the outcomes of this surgery in a series of 15 consecutive patients. Methods: Secondary alveolar bone grafting (with a premaxillary osteotomy and guided tissue regeneration with a collagen membrane) is usually carried out in the mixed dentition stage. This retrospective study used patients’ medical records, radiographs, and clinical examination to assess the outcome of the surgery. Patients were followed up for an average of 3 years. Results: Bone grafting was successful in all cases. No premaxillae were lost and there was no long-term morbidity of the donor site. Radiographic assessment of the bone heights showed an average of 94% retention, 3 months postoperatively. Preliminary assessment of maxillary canine eruption is encouraging, with 79% being fully erupted in those patients who are at least 3 years post–bone grafting. Conclusion: Premaxillary osteotomy allows repositioning of the premaxilla to its optimal preplanned position and successful closure of all fistulae. We have found that use of a collagen membrane is a useful adjunct.

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Maxillofacial morphology in post-pubertal patients with unilateral cleft lip and palate following early vs. late secondary alveolar bone grafting

Journal of Cranio-Maxillofacial Surgery ◽

10.1016/j.jcms.2021.04.012 ◽

2021 ◽

Author(s):

Andrzej Brudnicki ◽

Ewa Sawicka ◽

Piotr Stanisław Fudalej

Keyword(s):

Bone Grafting ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Alveolar Bone ◽

Alveolar Bone Grafting ◽

Secondary Alveolar Bone Grafting

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

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211002689 ◽

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.

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Permanent maxillary central incisor and first molar rotations in the mixed dentition in repaired complete unilateral cleft lip and palate and their relationship with absence of teeth in their vicinity

The Angle Orthodontist ◽

10.2319/121117-856.1 ◽

2018 ◽

Vol 88 (5) ◽

pp. 567-574

Author(s):

Sunjay Suri ◽

Suteeta Disthaporn ◽

Bruce Ross ◽

Bryan Tompson ◽

Diogenes Baena ◽

...

Keyword(s):

Bone Grafting ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Alveolar Bone ◽

Permanent Tooth ◽

Mixed Dentition ◽

Central Incisor ◽

Maxillary Central Incisor ◽

Anterior Teeth ◽

Alveolar Bone Grafting

ABSTRACT Objectives: To describe qualitatively and quantitatively the directions and magnitudes of rotations of permanent maxillary central incisors and first molars in the mixed dentition in repaired complete unilateral cleft lip and palate (UCLP) and study their associations with absence of teeth in their vicinity. Materials and Methods: Dental casts and orthodontic records taken prior to orthodontic preparation for alveolar bone grafting of 74 children with repaired UCLP (53 male, 21 female; aged 8.9 ± 1.0 years) were studied. Directions and magnitudes of permanent maxillary central incisor and first molar rotations were recorded. Tooth absence was confirmed from longitudinal radiographic records. Incisor and molar rotations were analyzed in relation to the absence of teeth in their vicinity. Results: Distolabial rotation of the permanent maxillary central incisor was noted in 77.14% on the cleft side, while distopalatal rotation was noted in 82.19% on the noncleft side. Incisor rotation was greater when a permanent tooth was present distal to the cleft side central incisor, in the greater segment. The permanent maxillary first molar showed mesiopalatal rotation, which was greater on the cleft side and when there was absence of one or more teeth in the buccal segment. Conclusions: Presence and absence of teeth were associated with the severity of incisor and molar rotations in UCLP. Crowding of anterior teeth in the greater segment was associated with a greater magnitude of rotation of the cleft side permanent central incisor. Absence of one or more buccal segment teeth was associated with greater magnitude of rotation of the molar.

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Radiographic Assessment of Secondary Autogenous Alveolar Bone Grafting in Cleft Lip and Palate Patients

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1997_034_0195_raosaa_2.3.co_2 ◽

1997 ◽

Vol 34 (3) ◽

pp. 195-198 ◽

Cited By ~ 33

Author(s):

Jeremy D. Kindelan ◽

Robert R. Nashed ◽

Michael R. Bromige

Keyword(s):

Bone Grafting ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Alveolar Bone ◽

Kappa Statistic ◽

Observer Agreement ◽

Point Scale ◽

Alveolar Bone Grafting ◽

Grade 3 ◽

Secondary Alveolar Bone Grafting

Objective To assess if a 4-point, radiographically based scale could be used between operators to reliably assess the success of secondary alveolar bone grafting. Design The study was retrospective with the clinicians blind to patient identity. Radiographs were examined twice by two clinicians with 1 week between assessments. Setting The research was carried out in a hospital-based orthodontic/oral and maxillofacial unit. Patients All patients who had secondary alveolar bone grafting in this unit between February 1992 and March 1995 were included In this study. There were 38 patients with a total of 48 grafted sites. Interventions The bone graft site was radiographed following orthodontic expansion prior to grafting. The radiograph was repeated postoperatively at a mean of 4 months after surgery. Main Outcome Measure The degree of bony fill in the cleft area was assessed using a 4-point scale: Grade 1 >75% bony fill; Grade 2 50–75% bony fill; Grade 3 < 50% bony fill; Grade 4 no complete bony bridge. Results Overall, 50% of grafts achieved grade 1, 23% were grade 2, 22% grade 3, and 5% grade 4. Levels of intra- and inter-observer agreement were highly variable (.33 to .72 kappa statistic). Conclusions The 4-point scale described could be used to assess the success of autogenous secondary alveolar bone grafting. It showed moderate to substantial intra-observer agreement, and fair-to-moderate inter-observer agreement.

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