Alveolar Bone Grafting and Cleft Lip and Palate: A Review

Abstract

Alveolar bone grafting in the mixed dentition stage is an accepted step in the management of cleft alveoli, providing maxillary arch support for dentition and mastication. Points of contention regarding best practices remain, including specific timing, perioperative orthodontic management, bone harvest and substitutes, pain management, and outcomes evaluations. SCOPUS and MEDLINE were searched for articles about alveolar bone grafting, which were read independently by two authors and selected for inclusion on the basis of relevance and merit. Articles on which recommendations were based were rated using the methodological index for non-randomized studies criteria. Three hundred thirty-three distinct articles were found, of which 64 were found to be suitable and relevant for inclusion. The average methodological index for non-randomized studies score was 10.39, with an interrater weighted kappa of 0.7301. Prospective comparative studies about alveolar bone grafting are rare, but available evidence suggests grafting before canine eruption with targeted preoperative orthopedic interventions, the continued use of iliac crest corticocancellous autologous graft, and adjunctive pain control methods. Greater consensus must be reached about valuable outcome measures for research, including use of imaging and indications for regrafting following graft failure.

Mucosal Perfusion Preservation by a Novel Shapeable Tissue Expander for Oral Reconstruction

“…Similarly, challenges have been reported in expanding oral mucosa for cleft palate reconstruction, where alveolar bone grafting is a key part of the procedure. 1 Current practice to cover a bone graft relies on a tension-free mucosa coverage that involves superficial split-thickness flap and a pedicle flap. Many variations of these techniques have been developed 2 , 3 though reduction of perfusion in the flaps has been shown.…”

Persistent symptomatic anterior oronasal fistulae in patients with Veau type III and IV clefts: A therapeutic protocol and outcomes

“…1,2 Reconstruction of the alveolar cleft using cancellous bone graft closes the communication in the anterior part surrounding the premaxilla area (the primary palate). 3,4 Failure of the procedures results in the formation of oronasal fistulae. [1][2][3][4][5][6][7] Oronasal fistulae represent an important problem in cleft care, 5 as symptomatic fistulae substantially impact patient's quality of life owing to presence of nasal regurgitation of air, food, and/or liquid 6 and therefore may require surgical repair.…”

“…3,4 Failure of the procedures results in the formation of oronasal fistulae. [1][2][3][4][5][6][7] Oronasal fistulae represent an important problem in cleft care, 5 as symptomatic fistulae substantially impact patient's quality of life owing to presence of nasal regurgitation of air, food, and/or liquid 6 and therefore may require surgical repair. [7][8][9] Oronasal fistula reconstructions by adopting myriad surgical techniques (e.g., local flaps, regional intraoral or extraoral flaps, and free flaps) have been widely addressed in cleft literature, [7][8][9] but the surgical management of persistent anterior oronasal fistulae (Electronic supplementary material 1) neighboring the alveolar cleft (i.e., the Pittsburgh classification type V to VII fistulae 10 ) has only been sparsely reported in sporadic cases.…”

Comparative Volume Analysis of Alveolar Defects by 3D Simulation

“…Secondary alveolar bone grafting (ABG) using autologous iliac crest bone tissue is a standard procedure for the management of patients with cleft lip and palate (CLP); a successful alveolar cleft defect repair produces maxillary arch continuity, provides adequate bony support, facilitates the eruption of permanent teeth, preserves periodontal health of teeth adjacent to the cleft, permits orthodontic tooth alignment, allows the placement of implants, and improves alar base symmetry [1,2].…”

“…Defining an accurate volume of an alveolar defect is essential for ABG surgery because it helps the multidisciplinary cleft team to prepare for the procedure, such as in selecting the donor site and assessing the treatment outcome [7,8]. A sufficient quantity of cancellous bone grafting can be harvested from the anterior iliac crest [1,2,11]. However, this harvesting process involves the elevation of musculoperioteal flaps with significant dissection of bone and soft tissues, which leads to iatrogenic complications at the donor site (e.g., acute and chronic postoperative pain, paresthesia, seroma, hematoma, ambulation impairment, contour deformity, and scar-related cosmetic concern) and subsequent morbidity [1,2,11].…”