Evaluation of Bone Height and Bone Mineral Density Using Cone Beam Computed Tomography After Secondary Bone Graft in Alveolar Cleft

Abstract

The purpose of this study was to assess the optimal timing of subsequent dental implant placement and orthodontics after alveolar bone grafting (ABG) in patients with unilateral complete clefts of the alveolar process. Iliac bone graft surgery was performed on 60 patients. Bone mineral density (BMD) and height of the ABG areas were assessed using cone beam computed tomography at 3 and 6 months postoperatively. The heights of the labial and palatal bone graft areas were classified using the modified Bergland classification. The study found that there was no change in BMD between 3 months (mean ± SD: 406.51 ± 71.28 Hounsfield units [HU]) and 6 months (409.53 ± 46.37 HU; P = 0.381). Significant changes in the distribution of bone height classifications were observed in the labial and palatal sides of the ABG between 3 and 6 months (P = 0.025 for labial bone height, P = 0.008 for palatal bone height). These results indicate that the alveolar density remained stable between 3 and 6 months, whereas bone height level declined during that period after ABG, the latter indicating bone graft absorption over time. It is, therefore, suggested that subsequent orthodontic or dental implants be placed 3 months after ABG rather than at 6 months or later.

Conditions and calibration to obtain comparable grey values between different clinical cone beam computed tomography scanners

“…The anatomical regions investigated in the present study represent clinically important locations to measure BMD for the diagnoses of cervical vertebral maturation (C2), TMJ disorder (RC and LC), dental implantation site and periodontal disease (AB and CB). 20,21,[23][24][25] Alteration of BMD is associated with bone growth, bone disease and post-implantation bone healing. As the CBCT grey value is proportional to BMD, the grey value parameters account for the BMD distribution at the region of interest, which results from bone modelling and remodelling activities observed in clinical settings.…”

Comparison of early and conventional autogenous secondary alveolar bone graft in children with cleft lip and palate: A systematic review

“…Nine studies 22,[26][27][28]30,33,34,36,37 used intraoral radiographs to either evaluate the bone level in the grafted area or the stage of canine eruption. Eight studies 20,21,23,24,31,32,35,38 utilized CT or CBCT images for different reasons: 1. measurement of bone volume and/or height, 2. acquisition of pre-and post-surgical superimpositions, and 3. fabrication of 3D models of the cleft and grafted areas. Although the studies using CT or CBCT considered three-dimensional images to be superior to two-dimensional images, one study 36 found good accuracy with the Bergland and modified Witherow analyses.…”

“…The four articles [21][22][23][24] retrieved during the search update in addition to the ones initially selected 20,[25][26][27][28][29][30][31][32][33][34][35][36][37][38] accounted to a total of 19 eligible articles. [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] An overview of the entire selection process can be found in the PRISMA 39 flow diagram below ( Figure 1). Their data were extracted and scrutinized to determine the risk of bias (Table 2).…”

“…Bone stability after SABG varied from 50% to 88%. [20][21][22][23][26][27][28]30,31,[33][34][35][36][37][38] The following success parameters were observed after SABG:…”

“…better nasal symmetry, 29 decreased number of fistulas, 28 stable mineral density, 23 greater bone volume 21,38 and height. 27 A better outcome was observed in children with UCLP, 25,33,37 when the cleft-side permanent lateral incisor 38 was present and when the graft had been performed before the eruption of the cleft-adjacent permanent canine.…”