Reduced Need for Alveolar Bone Grafting by Presurgical Orthopedics and Primary Gingivoperiosteoplasty

1998 ◽  
Vol 35 (1) ◽  
pp. 77-80 ◽  
Author(s):  
Pedro E. Santiago ◽  
Barry H. Grayson ◽  
Court B. Cutting ◽  
Mark P. Gianoutsos ◽  
Lawrence E. Brecht ◽  
...  
Keyword(s):  
Bone Graft ◽  
Bone Grafting ◽  
Alveolar Bone ◽  
Mixed Dentition ◽  
Primary Study ◽  
Control Group ◽  
Dental Ct ◽  
Alveolar Cleft ◽  
Alveolar Bone Grafting ◽  
Presurgical Orthopedics

Objective The purpose of this study was to evaluate if narrowing and approximation of the alveolar cleft through presurgical alveolar molding followed by gingivoperiosteoplasty (GPP) at the time of lip repair reduces the need for a bone-grafting procedure. Design This was a retrospective blind study of patients with unilateral or bilateral alveolar clefts who underwent presurgical infant alveolar molding and GPP by a single surgeon. Alveolar bone formation was assessed prior to the eruption of the maxillary lateral incisor or canine by clinical examination, panoramic and periapical radiographs, and/or a dental CT scan. The criterion for bone grafting was inadequate bone stock to permit the eruption and maintenance of the permanent dentition. Setting This study was performed at the Institute of Reconstructive Plastic Surgery by the members of the Cleft Palate Team. Patients All patients with unilateral (n = 16) or bilateral (n = 2) alveolar clefts who underwent presurgical infant alveolar molding and GPP by a single surgeon from 1985 to 1988 were studied. The control population consisted of all alveolar cleft patients (n = 14) who did not undergo alveolar modeling or GPP during the same time period. Interventions Presurgical alveolar modeling was performed with an intraoral acrylic molding plate. This plate was modified on a weekly basis to align the alveolar segments and close the alveolar gap. The surgical intervention consisted of a modified Millard GPP. Main outcome Measures The primary study outcome measure was the elimination of the need for a secondary bone graft in patients who underwent presurgical alveolar molding and GPP. Results Of the 20 sites in the 18 patients who underwent GPP, 12 sites did not require an alveolar bone graft. Of the 8 sites requiring a bone graft, 4 presented minimal bony defects. All 14 patients in the control group required bone grafts. Conclusions In this series of 20 alveolar cleft sites treated with presurgical orthopedics and GPP, 60% did not need a secondary alveolar bone graft in the mixed dentition.

Alveolar Bone Grafting

2019 ◽  
pp. 95-98
Author(s):  
Raj M. Vyas ◽  
Gennaya L. Mattison
Keyword(s):  
Cleft Palate ◽  
Bone Graft ◽  
Bone Grafting ◽  
Crucial Role ◽  
Cleft Lip ◽  
Alveolar Bone ◽  
Mixed Dentition ◽  
Maxillary Expansion ◽  
Alveolar Bone Grafting ◽  
Cleft Lip Repair

Alveolar bone grafting plays a crucial role in cleft reconstruction. When neonatal presurgical orthodontia is successful in aligning the cleft segments, alveolar reconstruction can be initiated as a gingivoperiosteoplasty during primary cleft lip repair. In children with cleft palate, alveolar bone grafting is usually done after transverse maxillary expansion with a palatal expander. Exact timing of bone grafting is controversial; most centers initiate orthodontic evaluation/expansion between ages 7 and 8 years (beginning of mixed dentition) with an aim to bone graft before age 10 in order to allow osteogenic incorporation prior to eruption of the permanent canine teeth.

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 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

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.

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

2021 ◽  
pp. 105566562110427
Author(s):  
Kathlyn K. Powell ◽  
Paul Lewis ◽  
Rae Sesanto ◽  
Peter D. Waite
Keyword(s):  
Bone Grafting ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Treated Patient ◽  
Tertiary Care ◽  
Mixed Dentition ◽  
Maxillary Advancement ◽  
Alveolar Bone Grafting ◽  
Secondary Alveolar Bone Grafting

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.

Segment Distraction to Reduce a Wide Alveolar Cleft Before Alveolar Bone Grafting

2003 ◽  
Vol 40 (6) ◽  
pp. 561-565 ◽  
Author(s):  
Thomas Binger ◽  
Christos Katsaros ◽  
Martin Rücker ◽  
Wolfgang J. Spitzer
Keyword(s):  
Bone Grafting ◽  
Alveolar Bone ◽  
Alveolar Cleft ◽  
Alveolar Bone Grafting

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.

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

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.

Alveolar Bone Grafting for Patients with Unilateral Complete Alveolar and Palatal Clefts Improves the Bony Structure of the Nose

2009 ◽  
Vol 46 (1) ◽  
pp. 9-18 ◽  
Author(s):  
Tomohisa Nagasao ◽  
Hisao Ogata ◽  
Junpei Miyamoto ◽  
Hua Jiang ◽  
Tsuyoshi Kaneko ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Alveolar Bone ◽  
Morphological Changes ◽  
Control Group ◽  
Tomographic Images ◽  
Bony Structure ◽  
Nasal Bones ◽  
External Nose ◽  
Alveolar Bone Grafting ◽  
Frontal Process

Objective: This is a retrospective study regarding the effect of alveolar bone grafting (ABG) on morphological changes in the bony structure of the nose in alveolar and palatal cleft patients. Methods: Sixty-five randomly selected adults were included in the present study. Of the 65 subjects, 21 had no congenital anomaly and were designated as the control group (n  =  21; mean age 22.4 ± 4.3 years). Forty-four had unilateral complete clefts of the alveolus and palate on the left side. The patients with clefts were further divided into two subgroups based on presence or absence of ABG in their histories. These groups were termed the ABG(+) group (n  =  24; mean age 20.3 ± 2.5 years) and the ABG(−) group (n  =  20; mean age 32 ± 4.5 years), respectively. An anatomical structure that constitutes the bony component of the nose was defined. This structure, composed of the nasal bones and part of the frontal process of the maxilla, was termed the BSEN (bony structure of the external nose). The symmetry of the BSEN was assessed quantitatively by performing morphological measurements on computerized tomographic images of each patient's skull, and these measurements were compared among the control, ABG(+), and ABG(−) groups. Results: The BSEN presented more symmetric features in the ABG(+) group patients than in the ABG(−) group patients. Conclusion: ABG improves symmetry of the BSEN. This finding justifies ABG in terms of cosmetic improvement of the external nose in patients with unilateral complete alveolar and palatal clefts.

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