Bone fill following secondary alveolar bone grafting for children with cleft of the alveolus in New Zealand

Abstract

Structured Abstract Objective To investigate the amount of bone fill post‐secondary alveolar bone grafting for children with cleft in New Zealand. Settings and Sample Population Retrospective analysis of post‐operative intra‐oral periapical and upper anterior occlusal radiographs of 45 grafted sites where all grafting was undertaken within the New Zealand public hospital service. Materials and Methods A modified Kindelan Index and a 100 mm visual analogue scale (VAS) were used to assess the amount of bone fill using intra‐oral radiographs by 4 orthodontists experienced in cleft care and who were blind to the patient's identity. Fourteen duplicated radiographs were randomly selected and added to the sample for reliability assessment. Results The Kindelan Index rated 37.8% Grade 1 (Good), 31.1% rated Grade 2 (Satisfactory), 22.2% rated Grade 3 (Unsatisfactory) and 8.9% Grade 4 (Failure), a combined unsatisfactory/failure rate of 31.1%. The average VAS score was 50 mm ± 24 mm, and there was a strong relationship between Kindelan and VAS assessments. Those patients aged 10‐11 years had significantly better outcomes using both assessments compared to those aged <10 and >11. The VAS assessment found that higher caseload surgeons had better outcomes, although the difference was of borderline statistical significance (mean VAS 56 mm vs 44 mm P = 0.07). Conclusions Contemporary secondary alveolar bone grafting bone fill outcomes in New Zealand are poor when compared to contemporary international studies. These findings indicate a review of secondary bone grafting is required to improve outcomes for New Zealand children with cleft.

Radiographic outcome of secondary alveolar bone grafting in patients with alveolar clefts

“…There is some variation in what is considered a late graft, however, for patients undergoing SABG after the age of 11 the overall success rate was not reduced but there was a reduction in the proportion of grade 1 outcomes, albeit not to a statistically significant extent. This trend is consistent with previous reports in the literature 23‐25 . As this study was primarily conducted for audit purposes, we did not seek to examine other indicators of success which could provide a more holistic measure of SABG outcome.…”

“…This trend is consistent with previous reports in the literature. [23][24][25] As this study was primarily conducted for audit purposes, decisions to proceed with grafting were a deviation from the ideal protocol. Some patients underwent later SABG due to delayed dental development or other medical concerns (n = 13).…”

“…The Kindelan bone-fill index is an inherently subjective assessment tool and attempts to increase sensitivity have included modification with a visual analogue scale. 23 Radiographic indices of this kind all have seemingly comparable reproducibility 27 but in future, three-dimensional imaging modalities may be used more widely as radiation doses reduce. 11 It has been suggested that the SWAG scale may overcome some of the deficiencies of the Kindelan index by localizing any residual alveolar defects.…”

Behavioral Outcomes in Children With an Orofacial Cleft in a National Study in New Zealand

“…The assessment of behavior and QoL in children with OFC was undertaken as part of a broader research program of cleft outcomes in NZ. A more detailed description of other aspects of the study is available in previous publications (Fowler, Al-Ani et al, 2019;Fowler, Keall et al, 2019;Fowler, Wholley et al, 2019;Thompson et al, 2019;Fowler et al, 2020). Eligibility included all children with OFC considered to be nonsyndromic and born after January 1, 2000.…”

Quality of Life Using General Population Validated Questionnaires in Children With Cleft Lip and/or Palate in New Zealand

“…The New Zealand Cleft Outcomes Study is a cross sectional study including children born with an OFC in New Zealand from January 1, 2000, and having their primary surgery carried out at 1 of the 5 centers repairing clefts in New Zealand. This QoL analysis is part of a wider outcomes study, details of which have been previously published (Fowler, Al-Ani et al, 2019; Fowler, Keall et al, 2019; Thompson et al, 2019; Fowler et al, 2020; Fowler, Wholley et al, 2019). Families were asked to fill out questionnaires related to QoL when they attended appointments as part of their standard cleft clinic follow up appointments.…”