Monocortical mandibular bone grafting for reconstruction of alveolar cleft

Abstract

A monocortical mandibular bone grafting procedure for reconstruction of alveolar cleft was developed and assessed prospectively. The procedure was performed by harvesting lateral cortical bone plates from the symphysis and/or mandibular body and then placing these plates on the labial and palatal openings of the alveolar process defect. No particulate bone grafts were packed into the bony cavity. Based on CT findings at 6 months postoperatively, 58 of 70 clefts(82.9 ％) , including immature bony bridge cases, showed sufficient bone formation at the cleft site in the labio-palatal direction to facilitate migration of the permanent canines and/or lateral incisors. From periapical radiographic findings at the time of last follow-up, 54 of 62 clefts(87.1 ％) , except nonclassified 8 clefts in which cleft-related teeth were erupting showed ＞ − 75 ％ of the root surface of cleft-adjacent teeth was covered with spanning bone. In addition, canines had erupted spontaneously through grafted bone in occlusion for 27 of 29 clefts(93.1 ％)in which the cleft-adjacent canine was uncovered with bone during follow-up. Packing of particulate bone grafts in a secondary bone grafting procedure is clearly not a prerequisite for sufficient bone bridge formation and facilitation of teeth eruption, and placement of walls of cortical bone to enclose the defect is adequate for successful secondary alveolar bone grafting in the mixed dentition. Our procedure has advantages in reducing the quantity of bone required per unit volume of cleft defect, and thus could be applicable to larger cleft defects.

A New Technique in Alveolar Cleft Bone Grafting for Dental Implant Placement in Patients With Cleft Lip and Palate

“…Despite the various donor sites described in the literature, including the tibia (Chen et al, 2006), rib, calvarium (Amanat and Langdon, 1991;Cohen et al, 1991;Denny et al, 1999;Kline and Wolfe, 1995), and mandibular symphysis (Booij et al, 2005;Bukhari et al, 2009;Mikoya et al, 2010), the iliac crest is the most preferred (Canady et al, 1993;Murthy and Lehman, 2005). In a survey of 110 centers with 240 American Cleft Palate-Craniofacial Association teams, Murthy and Lehman (2005) reported that 92 (83%), 9 (8%), 3 (2.7%), 2 (1.8%), and 5 (4.5%) centers used the iliac crest, calvarium, rib, tibia, and other bones as donor sites for alveolar bone grafting (Murthy and Lehman, 2005).…”

“…Its aims are to (1) allow spontaneous eruption or orthodontic movement of the canine or lateral incisor into the cleft area (Dempf et al 2002;Takahashi et al, 2011); (2) maintain bony support of teeth adjacent to the cleft and prevent collapse of alveolar segments (Cho-Lee et al, 2013); (3) enable oronasal fistula closure (Cho-Lee et al, 2013;Takahashi et al, 2011); (4) support the alar base and nose (Cho-Lee et al, 2013); (5) improve speech, articulation, and nasality (Bureau et al, 2001); and (6) facilitate dental implant placement (Takahashi et al, 2011). The reported techniques include autogenous cancellous bone grafted with a sutured nasal flap (Feichtinger et al, 2007;Kindelan et al, 1997;Long et al, 2000), pyramidal iliac corticocancellous block grafted with the cortical surface contacting the nasal mucosa and interspaced with cancellous chips (Cho-Lee et al, 2013), autogenous iliac particulate bone grafted along with a resorbable or nonresorbable membrane (Peled et al, 2005) or titanium mesh and screw fixation (Takahashi et al, 2011), iliac cortex bone plate grafted into the palatal deficiency and particulate marrow and cancellous bone (PMCB) packed between the cortical bone and the reconstructed nasal flap (Ishii et al, 2002), and 2 lateral cortical bone plates from the mandibular symphysis grafted against the labial and palatal cleft margins without screw fixation or intervening particulate bone (Mikoya et al, 2010).…”

Accuracy of both virtual and printed 3-dimensional models for volumetric measurement of alveolar clefts before grafting with alveolar bone compared with a validated algorithm: a preliminary investigation

“…1 Where tooth movement is precluded due to the dimensions of the cleft, alveolar bone grafting (ABG) is an integral component of treatment for patients with alveolar clefts. 2 During bone graft surgery, the alveolar defect is firmly packed with cancellous bone chips to reconstruct the alveolar crest height from donor sites including the anterior iliac crest, 2 tibia 3 and mandibular symphysis 4 or recombinant human bone morphogenetic protein [rhBMP-2 (an osteoinductive cytokine)]. 5 Bone is packed under the alar base to ensure good nasal symmetry.…”

Comparison of 2- and 3-dimensional radiologic evaluation of secondary alveolar bone grafting of clefts: a systematic review

“…Despite the fact that redundant x-ray exposure is not justified, it is understandable that 2-D images are made to serve as a comparison for 3-D evaluations. [19][20][21] No systematic review has yet compared the 2-D and 3-D results; the authenticity and reliability of both data sets remain controversial. No optimal 3-D evaluation method has been identified.…”