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.

scholarly journals A CASE REPORT OF ELIMINATION OF ALVEOLAR DEFECTS BY SECONDARY BONE GRAFTING.

2020 ◽  
Vol 4 (9) ◽  
Author(s):  
Charan Teja Vemagiri ◽  
Damera Srikanth ◽  
Chandrababu V ◽  
Siva Ganesh
Keyword(s):  
Case Report ◽  
Bone Graft ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Iliac Bone Graft ◽  
Alveolar Bone Grafting ◽  
Successful Rehabilitation ◽  
Secondary Alveolar Bone Grafting

The secondary alveolar bone grafting is an integral component of contemporary rehabilitation of the patients with cleft lip and palate with alveolar defects. Iliac bone graft is frequent secondary graft used in the correction of alveolar defects. There is successful rehabilitation of osseous component post operatively.

Effect of Alveolar Bone Grafting in the Mixed Dentition on Maxillary Growth in Complete Unilateral Cleft Lip and Palate Patients

1997 ◽  
Vol 34 (5) ◽  
pp. 455-458 ◽  
Author(s):  
John Daskalogiannakis ◽  
R. Bruce Ross
Keyword(s):  
Bone Graft ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Statistical Significance ◽  
Analysis Of Covariance ◽  
Mixed Dentition ◽  
Research Centre ◽  
Alveolar Bone Grafting

Objective: This study was conducted to evaluate the effects on facial growth of alveolar bone grafting in the mixed dentition for patients with UCLP. Design: Retrospective cephalometric study. Setting: Craniofacial Treatment and Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada. Patients: The 58 patients participating in the study had a history of complete unilateral cleft lip and palate, all of which were repaired by the same plastic surgeon. Interventions: Twenty-one patients received an iliac-crest alveolar bone graft at a mean age of 10.3 years, while 37 did not receive an alveolar bone graft. Lateral cephalometric radiographs were obtained on all patients at two different times: at a mean age of 9.4 years (prior to bone grafting in the grafted group) and at a mean age of 15.2 years. Main Outcome Measures: All radiographs were traced and digitized by the same person, using cephalometric computer software. Superimposition and cephalometric analysis was undertaken to investigate the differences between the two groups in the 5.6-year experimental period. A two-way analysis of covariance was used for evaluation of the statistical significance of the results. Results: No statistically significant differences were found in 14 of the 15 cephalometric measurements performed. Harvold's maxillary unit length was statistically significantly shorter in the grafted group, although a lack of correlation with angular measurements and inherent problems with this specific measurement raise doubts in this finding. Conclusion: Mixed dentition bone grafting does not affect subsequent vertical and A-P development of the maxilla in complete unilateral cleft lip and palate patients during the first several postoperative years.

scholarly journals Secondary alveolar bone graft in incomplete unilateral pre-foramen fissure: case report

2022 ◽  
Vol 11 (1) ◽  
pp. e29111124969
Author(s):  
Luiza Roberta Bin ◽  
Eleonor Álvaro Garbin Júnior ◽  
Geraldo Luiz Griza ◽  
Natasha Magro Érnica ◽  
Mauro Carlos Agner Busato ◽  
...  
Keyword(s):  
Bone Graft ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Clinical Case ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Treatment Protocols ◽  
Alveolar Bone Grafting ◽  
Embryonic Life ◽  
Secondary Alveolar Bone Grafting

Cleft lip and palate is one of the most common facial deformities. During embryonic life, non-fusion of the maxillary and medial nasal plaques leads to cleft lip and palate. Fissures can produce a range of dental problems in terms of number, size, shape, and position, related to deciduous or permanent dentition. Besides this, the teeth most affected are those located in the fissure area. There are numerous treatment protocols, which, despite the lack of a consensus, start as soon as the child is born, going into adulthood, seeking functional and aesthetic rehabilitation. The surgical phases, lip repair, nasal repair, palatoplasty and alveolar bone grafting, are performed according to age. As for the bone graft, the most used option is the secondary graft, with the autogenous one being the most available. Thus, the objective of this work is to present a clinical case of secondary alveolar bone grafting in a 10-year-old female patient with an incomplete unilateral pre-foramen cleft.

scholarly journals Maxillary Canine Impaction and Unilateral Cleft Lip and Palate: A Review of the Current Literature

2018 ◽  
Author(s):  
Ali Alqerban
Keyword(s):  
Bone Graft ◽  
Current Literature ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Dental Anomalies ◽  
Maxillary Canine ◽  
Alveolar Bone Grafting

The present review aims to investigate the effect of alveolar bone grafting in canine impacted unilateral cleft lip and palate patients. The goal of this review is to identify and highlight the factors that may cause maxillary canine impaction, the role of primary and secondary bone graft and dental anomalies that may affect canine impaction in patients with cleft lip and palate.

scholarly journals Effectiveness of Secondary Alveolar Bone Graft on Canine Eruption: Systematic Review

2021 ◽  
Author(s):  
Rogério Lacerda-Santos ◽  
Rhaslla Gonçalves Batista ◽  
Samantha Silva Neves ◽  
José Lucas dos Santos Araújo ◽  
Rayssa Amaral Vieira ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bone Graft ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Risk Of Bias ◽  
Tooth Eruption ◽  
Lateral Incisor ◽  
Alveolar Bone Grafting

Abstract There are controversies related to the effects of bone grafts on tooth eruption and impaction in patients with cleft lip and palate. The aim of this systematic review was to evaluate the effectiveness of bone grafting on eruption of canines in patients with unilateral cleft lip and palate (UCLP). An electronic search was conducted in six electronic databases and gray literature, without limitations on year of publication or language. The primary outcome was the increase in rate of canine eruption; the secondary outcomes were success of the bone graft, canine impaction due to agenesis of the lateral incisor, and effect of orthodontic treatment before and after bone grafting. The risk of bias was analyzed by means of the tool Cochrane risk of bias in nonrandomized controlled trials (NRCTs) of interventions (ROBINS-I). The certainty of the evidence was assessed for outcomes reported through a narrative synthesis using grading of recommendations, assessment, development and evaluation (GRADE) approach. Four NRCTs were included, with a total of 360 patients, 283 UCLP and 77 bilateral cleft lip and palate (BCLP). The studies reported association between the increase in the rate of tooth eruption and bone graft with very low certainty of evidence, and greater experience of surgical success, with low certainty of evidence. The majority of the studies found an association between increase in the rate of canine impaction and agenesis of the lateral incisor, with very low certainty of evidence. There was very low certainty of the efficacy of secondary alveolar bone grafting for increasing the rates of eruption and reducing impaction of the maxillary canine.

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.

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