Alveolar Bone Graft: Clinical Profile and Risk Factors for Complications in Oral Cleft Patients

Pessoa, Erica Alexandra Macedo; Braune, Andre; Casado, Priscila Ladeira; Tannure, Patrícia Nivoloni

doi:10.1597/16-028

Cited by 10 publications

(4 citation statements)

References 20 publications

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“…This is due to secondary deformations, malocclusion, bone loss induced by improper orthodontic treatment based on teeth and maxilla expansion leading to the formation of critical size defects and oro-nasal fistulas that cannot be reconstructed by simple grafting or augmentation procedures. The lack of bone support, scar tissue, inadequate amount of soft tissues and poor vascular sealing make dental implant treatment of the cleft maxilla almost impossible[ 19 , 20 ]. For critical size defects that also include soft tissue deficiencies and/or cases that require significant reconstruction of the jawbone, 3D-VSP supported microsurgical reconstruction is indicated.…”

Section: Discussionmentioning

confidence: 99%

Protocol and Evaluation of 3D-Planned Microsurgical and Dental Implant Reconstruction of Maxillary Cleft Critical Size Defects in Adolescents and Young Adults

Dowgierd

Pokrowiecki²,

Borowiec³

et al. 2021

JCM

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Functional and esthetic final reconstruction of the cleft maxilla is still challenging. Current reconstructive and augmentation techniques do not provide sufficient bone and soft tissue support for the predictable rehabilitation with dental implants due to presence of maxillary bone critical size defects and soft tissue deficiency, scaring and poor vascularity. In this article the protocol for the use of 3D virtual surgical planning and microvascular tissue transfers for the reconstruction and rehabilitation of cleft maxilla is presented. Twenty-five patients (8 male/17 female) aged 14–41 years old with cleft-associated critical size defects were treated by 3D-virtual planned microvascular tissue transfers taken either from fibula, iliac crest, radial forearm, or medial femoral condyle. Follow-up lasted 1–5 years. No significant bone resorption (p > 0.005) nor volume loss of the graft was observed (p = 0.645). Patients received final permanent prosthetic reconstruction of the anterior maxilla based on 2–5 dental implants, depending on the defect severity. This is the first study presenting the use of virtual planning in the final restoration of the cleft maxilla with microvascular tissue transfers and dental implants. Presented protocol provide highly functional and aesthetic results.

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Section: Discussionmentioning

confidence: 99%

Protocol and Evaluation of 3D-Planned Microsurgical and Dental Implant Reconstruction of Maxillary Cleft Critical Size Defects in Adolescents and Young Adults

Dowgierd

Pokrowiecki²,

Borowiec³

et al. 2021

JCM

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“…Also, orthodontic space closure may be possible in 100% of cases when the bone graft is performed to facilitate the eruption of lateral incisor 7 , 8 . Additionally, individuals older than 12 years are four times more likely to present postoperative complications after alveolar bone graft 13 . Recently, the accomplishment of alveolar graft before eruption of the lateral incisor reduced the frequency of permanent canine impaction.…”

Section: Discussionmentioning

confidence: 99%

“…The treatment of alveolar defects usually requires alveolar bone graft 21 . Even though the alveolar bone graft is widely accepted by professionals for cleft treatment, there is still no consensus concerning the technique, timing and donor site 13 . This procedure was used in the 1960s in an early and primary manner, aiming to stabilize the premaxilla, allow tooth eruption in the cleft area and increase the alar base 18 .…”

Section: Introductionmentioning

confidence: 99%

The maxillary lateral incisor in the rehabilitation of cleft lip and palate

et al. 2018

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ObjectiveThis study analyzed the maintenance of lateral incisors in the dental rehabilitation of individuals with cleft lip and palate.Material and MethodsThe study was conducted on a tertiary craniofacial center and comprised retrospective analysis of panoramic and periapical radiographs of Caucasoid individuals with non-syndromic complete unilateral cleft lip and palate, analyzing all radiographs available on the records of each individual, from the first to the last up to 12 years of age. Overall, 2,826 records were reviewed to achieve a sample of 1,000 individuals. Among these, 487 individuals presented the permanent lateral incisors on both cleft and non-cleft sides, which were included in this study.ResultsThe results were evaluated in percentages and by descriptive statistics. The association between maintenance of the lateral incisor and timing of alveolar bone graft were analyzed by the t test. Among the 487 individuals, 265 had not completed treatment, 62 presented insufficient information, and 44 concluded the treatment elsewhere. Among the remaining 116 individuals, the lateral incisor was extracted from 88 (75.86%) of them on the cleft side (CS) and from 23 (19.83%) people on the non-cleft side (NCS). The age at accomplishment of alveolar bone graft was significantly associated with maintenance of the lateral incisor on the cleft side (p<0.01). Most extractions were indicated because of the inadequate positioning on the CS and for midline correction on the NCS. Rehabilitation was primarily completed by orthodontic movement (53 individuals on the CS and 13 individuals on the NCS).ConclusionIn conclusion, the lateral incisor on the cleft side was not maintained in most individuals. Positive relationship was observed between extraction of the lateral incisor and age at accomplishment of the alveolar bone graft, suggesting the need to anticipate the initial radiographic evaluation to enhance its maintenance and reduce the procedures required for rehabilitation.

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“…The origin of the autogenous bone graft depends on numerous factors, namely, the surgeon's experience, the volume of alveolar defect, and the morbidity of the harvest area [16]. Typically, an autologous bone graft from the iliac crest (ICBG) is the conventional donor site [17]. However, others with less morbidity and lower bone resorption rate have been suggested, such as cranial bone, mandibular symphysis and tibia [18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Regenerative Strategies in Cleft Palate: An Umbrella Review

et al. 2021

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(1) Background: Alveolar bone defects or decreased alveolar bone height and width may have different causes, such as cleft palate. Regenerative procedures in oro-dental defects are challenging due to anatomical factors and the distinct cell populations involved. The iliac crest bone graft remains the gold-standard for cleft palate closure. However, tissue regeneration approaches have been employed and their outcome reviewed, but no conclusions have been made about which one is the gold-standard. (2) Methods: this umbrella review aims to critically appraise the effectiveness of the current approaches in bone defects regeneration in non-syndromic patients with cleft palate. A search was performed in PubMed, Cochrane Library, Scopus, Web of Science and EMBASE databases. (3) Results: Systematic reviews of randomized and non-randomized controlled trials with or without meta-analysis were included. Nine articles were included in the qualitative analysis and five in the quantitative one. The included studies quality was evaluated with AMSTAR2. (4) Conclusions: The use of new regenerative strategies, such as bone morphogenic protein 2, appears to provide similar results regarding bone volume, filling, and height to the standard technique with the iliac crest bone graft.

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Alveolar Bone Graft: Clinical Profile and Risk Factors for Complications in Oral Cleft Patients

Abstract: Patients with cleft lip and palate who were 12 years or older had a greater chance of developing complications after grafting the alveolar bone. Furthermore, particulate alveolar graft from iliac crest had significantly better outcomes.

Cited by 10 publications

References 20 publications

Protocol and Evaluation of 3D-Planned Microsurgical and Dental Implant Reconstruction of Maxillary Cleft Critical Size Defects in Adolescents and Young Adults

Protocol and Evaluation of 3D-Planned Microsurgical and Dental Implant Reconstruction of Maxillary Cleft Critical Size Defects in Adolescents and Young Adults

The maxillary lateral incisor in the rehabilitation of cleft lip and palate

Regenerative Strategies in Cleft Palate: An Umbrella Review

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