Progressive Comparison of Density Assessment of Alveolar Bone Graft in Patients with Unilateral and Bilateral Cleft

Abstract

(1) Background: Continuing to observe the grafted bone mineral density (BMD) is essential to ensure the success of alveolar bone grafting (ABG) in patients with cleft lip and palate. This study elaborates on three methods that can be used to evaluate the progressive BMD. (2) Methods: Forty patients with unilateral or bilateral clefts receiving ABG were enrolled. Cone beam computed tomography (CBCT) scans were taken at 6 months (T1) and 2 years (T2) postoperatively. In CBCT, measurements were obtained on three different planes using the circle located 1 mm from the adjacent teeth (Method A), the largest circle within the defect (Method B), or the central circle with a diameter of 2 mm (Method C). The BMD was the average density of the three planes and was adjusted by pogonion density. Bland–Altman plots were used to evaluate the agreement of each method. Inter-rater reliability was confirmed by the intraclass correlation coefficient (ICC). (3) Results: For Method A, B, and C, the mean-adjusted BMD (BMD/pogonion density, BMDa) was 17.44%, 17.88%, and 17.69%, respectively, at T1 (p = 0.495), and 22.51%, 22.87%, and 22.74%, respectively, at T2 (p = 0.690); the density enhancement rates were 40.54%, 38.92%, and 43.15% (p = 0.382). Significant differences between the BMDa at T1 and T2 were observed (p < 0.001, <0.001, and 0.001, for Method A, B, and C, respectively). The volume of the grafted tissue remained stable during T1 and T2, and no significant correlation between density enhancement rate and volume loss was observed. (4) Conclusions: A significant increase in the BMD of grafted tissue was observed in the 2-year postoperative follow-up. The three methods for measuring BMDa via CBCT can be applied in post-ABG evaluations.

Effectiveness of pre‐alveolar bone graft orthodontics for patients with non‐syndromic complete unilateral cleft lip, alveolus and palate: A systematic review and meta‐analysis

“…This is not surprising as we know that orthodontic treatment aims to increase the cleft width to give better access for surgeons and to increase the volume of bone filled in the cleft site. The bone volume at 6 months post‐ABG reported in the present review showed similar results to previous studies 13–15 …”

Three-dimensional comparative changes in the pharyngeal airway of patients with cleft after two-jaw orthognathic surgery

“…27,28 However, scarring from lip repair, palatoplasty, and even alveolar bone grafting may limit development of the midface. 5–8 Despite the high success rate of alveolar bone grafting at our center, 29,30 a certain percentage of patients present with midface retrusion and require OGS on maturity. 3 The average alveolar defect is approximately twice as large among patients with bilateral cleft compared with that among patients with unilateral cleft.…”

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.…”