Alveolar Volume Following Different Timings of Secondary Bone Grafting in Patients with Unilateral Cleft Lip and Palate. A Pilot Study

Abstract

This study was intended to evaluate the relationship between secondary alveolar bone grafting (SABG) timing and the alveolar volume in patients with unilateral cleft lip and palate (UCLP). The material consisted of CTs of 35 patients (17 males, 18 females) with UCLP who underwent a one-stage primary cleft repair at a mean age of 8.4 months and SABG at different timings ranges of 1.8–18.8 years. The mean age at CT was 17.2 years. The relative coefficient (Ꞷ) which was independent from factors such as individual maxillary size, gender or age at the CT was introduced in order to compare volumes of the cleft-side in relation to the non-cleft-side alveolus. Pearson correlation coefficient r between Ꞷ coefficient and SABG timing was weak negative (r = −0.34, p = 0.045). The multiple regression analysis implied that the dependent variable-Ꞷ coefficient was associated with independent variables (cleft repair and SABG timings and age at CT) with r2 = 0.228. Only patient’s age at SABG explained the dependent variable (p = 0.003). The study cautiously indicates a tendency to larger alveolar volume following earlier timing of SABG. Nevertheless, the further research on a larger group of patients should be performed before formulating any clinical indications.

Correlation between alveolar cleft morphology and the outcome of secondary alveolar bone grafting for unilateral cleft lip and palate

“…It is possible that the age range of our material was too narrow (8–18 years at the procedure) to register any statistically significant results. Hence, it does not seem to be in contradiction to the studies registering age-related correlation with the SABG outcome [ 15 , 44 ]. If the initial cleft size is relatively large, distraction osteogenesis may be an alternative [ 11 ].…”

“…Brudnicki et al analysed the location and morphology of bone resorption after SABG [ 13 ]. However, there are several limitations to former studies: morphology was described based on cephalometric variables and 2D evaluation and although 3D assessment has already been conducted [ 15 ], there was no relevant research focused on the preoperative morphology of the cleft defect, no certain morphological description had been summarized, and whether there was a correlation between the cleft morphology and SABG outcomes remain unknown.…”

Machine learning in 3D auto-filling alveolar cleft of CT images to assess the influence of alveolar bone grafting on the development of maxilla

“…Brudnicki showed in the latest papers that SABG indeed increased the volume of alveolars but had an adverse effect on the maxilla growth, although might be limited and regardless of timing [ 7 , 8 , 13 ]. Combined with the results of this study, we further speculated that on one hand, SABG increased the volume and length of the maxilla, especially on the cleft sides; on the other hand, the transversal growth of the maxilla on the cleft sides was more negatively affected by SABG than the non-cleft sides.…”

Bone Morphogenetic Protein-, Antimicrobial Agent-, and Analgesic-Incorporated Nanofibrous Scaffolds for the Therapy of Alveolar Clefts

“…Considering reconstructed 3D images of cavity defects, studies have recommended (1) for 1.5-mL iliac bone grafts to be harvested to meet the demand for defect repair among patients with unilateral alveolar cleft and (2) for 2.5 mL iliac bone graft to be prepared for cases of bilateral alveolar cleft [2]. However, greater amounts of required bone graft equate to greater morbidity at the donor site, as indicated by increases in blood loss, rate of wound infection, and length of hospitalization [3,4]. Therefore, an alternative biomaterial substitute should be developed to mimic the characteristics of iliac bone grafts to enhance bone formation, without the morbidities experienced at the donor harvesting site.…”

“…The optimal time for alveolar cleft repair is at primary school age, when the patient's permanent teeth are beginning to erupt [2]. In the literature, autologous iliac bone graft remains the most practical material to facilitate maxillary bone development for tooth eruption [3,4]. However, for patients with failed bone grafting or patients with a bilateral alveolar cleft, the alternative treatment wherein optimal bone grafting material is used for alveolar cleft reconstruction should be considered when the volume of cancellous bone grafts is limited or not adequate for the procedure.…”