Long-Term Postoperative Cone-Beam Computed Tomography Analysis of Secondary Bone Grafting in 79 Patients With Unrepaired Alveolar Clefts

Abstract

This study used cone-beam computed tomography (CBCT) analysis to assess the long-term radiographic outcomes of early secondary alveolar bone grafting.Patients and Methods: The most recent postoperative CBCT scans of 79 alveolar cleft patients who underwent anterior iliac crest bone grafting by a single surgeon over a 6-year period and met all inclusion criteria were analyzed using a modified assessment tool. Clefts were measured vertically, horizontally, and superiorly in terms of nasal support and then assigned corresponding scores of 0 to 4 to help determine radiographic success. The sites were deemed poor (score of 0 or 1), acceptable (score $ 2), or favorable (score $ 3). Similarly, overall clefts (vertical plus horizontal scores) were classified as poor (score of 0 to 3), acceptable (score $ 4), or favorable (score $ 5). Statistical analysis was used to characterize patient demographic characteristics, to perform subgroup comparisons, and to identify factors specifically predictive of favorable outcomes.Results: The study included 79 patients with a total of 105 clefts. Male patients comprised 60.8% of patients, and 32.9% of patients had a bilateral cleft. The average age at the time of surgery was 8 years 0 months, and the average time until the most recent postoperative CBCT scan was 2 years 8 months. The average scores were as follows: vertical, 2.9 (maximum score possible, 4); horizontal, 3.1 (maximum score possible, 4); nasal support, 2.7 (maximum score possible, 4); and overall cleft, 6.0 (maximum score possible, 8). All 79 patients were discharged on postoperative day 1, and the regraft rate was 0%. Multivariate analysis showed that younger patients had a significantly higher chance of achieving favorable results in terms of vertical scores (P = .0081) and overall cleft scores (P = .0204). The association between younger age and horizontal scores was marginally significant (P = .0667), but no significant association was found between age and nasal support.Conclusions: Younger patients have improved long-term radiographic success with grafted alveolar clefts. This finding supports performing anterior iliac crest bone grafting at a younger age in cleft lip patients.

Comparative Assessment of Autogenous Cancellous Bone Graft and Bovine-Derived Demineralized Bone Matrix for Secondary Alveolar Bone Grafting in Patients With Unilateral Cleft Lip and Palate

“…However, in our study, the number of patients ( 9) with 75% to 100% horizontal bone growth was higher. Considering long-term follow-up, mean values for both horizontal and vertical bone growth in both the groups were in accordance to those reported by Anver et al (2020), who conducted retrospective study on patients with CLP treated with iliac bone graft and observed the radiographic changes in the bone formed over 6 years. Trindade et al (2012) reported more than 75% growth in height of interdental bone in about 70% to 80% patients with 4-year follow-up using Bergland scale; whereas in our study, only 4 cases had more than 75% vertical growth at the final follow-up.…”

Residents’ Commentary for “Long-Term Postoperative Cone-Beam Computed Tomography Analysis of Secondary Bone Grafting in 79 Patients with Unrepaired Alveolar Clefts”

“…They should also be aware that variability in timing exists across treatment centers. Although the value of alveolar grafts is recognized, the results presented by Alver et al, 1 determined from analyzed radiographic data, support early grafting for younger patients and should be considered when planning treatment for patients with cleft.…”

“…Additionally, more favorable radiographic findings have not been shown to better predict for clinical success in these patients, although their system provides an objective metric by which to measure outcomes. 1 Supported by their findings, the surgical protocol preferred by Anver et al 1 is to extract teeth adjacent to the cleft 1 to 2 months before grafting to preserve the keratinized tissue and graft just before the upper central incisors erupt. This idea is in line with the 2009 study by Precious, 4 who concluded that the optimum time to perform alveolar bone grafting is when the patient is 5.5 to 6 years old, when the permanent central incisor is just beginning to erupt.…”

“…The study by Anver et al 1 was a retrospective cohort study that examined the follow-up CBCT imaging studies of a cohort of 79 patients treated by a single surgeon for alveolar cleft bone grafting using an anterior iliac bone graft. The patients had undergone grafting at the early secondary, late secondary, and late stages, at 5 years, 10 months to 14 years, 4 months of age (mean, 96.3 months; median, 90.0 months).…”

“…The adjusted odds ratios for age showed that younger children had a statistically significant greater chance of achieving favorable results in the vertical and overall cleft scores. 1 However, the proposed scoring system has not been validated. Additionally, more favorable radiographic findings have not been shown to better predict for clinical success in these patients, although their system provides an objective metric by which to measure outcomes.…”