Block iliac bone grafting enhances osseous healing of alveolar reconstruction in older cleft patients: A radiological and histological evaluation

Abstract

BackgroundOlder alveolar cleft patients (&12 years old) often have wide bone defect as well as teeth loss, resulting in poor osseous healing with conventional alveolar bone grafting (ABG). In this study, we investigated a surgical technique of block iliac bone grafting for the alveolar cleft reconstruction and evaluated the clinical and radiological outcomes of these cleft patients.Material and MethodsFifteen patients were included in this study. All cases received preoperative cone bean computed tomography (CBCT) scans for the alveolar cleft evaluation. Osseous outcomes of block iliac bone grafting were assessed at 1 week, 3- and 6-month postoperatively. Volume changes and bone resorption rates were calculated using the measurement modules of Simplant software. Bone samples from one patient undergoing dental implantation were assessed by micro-CT and histological examination. The morbidities of donor-site were analyzed by clinical examination and questionnaire survey.ResultsThe average age of the case series was 18.53±2.50 years. The intraoral incision of thirteen cases healed well. However, two cases had oronasal fistula and graft exposure at 1-week postoperatively. The results of follow-up CBCT scans showed significant resistance to radiation on both sides of the bone graft, suggesting a good osseous healing and new bone formation. The mean residual bone volume was 1.68±0.26 cm3, 1.29±0.23 cm3 and 1.15±0.23 cm3 at 1-week, 3- and 6-month postoperatively. Correspondingly, the mean bone resorption rates in 3- and 6-month postoperative were 21.78±6.88% and 30.66±8.97%, respectively. From micro-CT and HE examinations, the block bone samples exhibited a cancellous structure in which mature bone trabecula and functional blood vessels appeared. The average scores of donor-site morbidities were drastically decreased at 3- and 6-month postoperatively compared with those at 1-week postoperatively.ConclusionsOur results demonstrated that block iliac bone grafting could achieve satisfying osseous outcomes in older alveolar cleft patients, and this technique provided favorable bony condition for further treatments, especially dental implantation. Key words:Alveolar bone grafting, Block bone grafting, Osseous healing, CBCT.

Comparative Outcomes of Block and Cancellous Iliac Bone Grafting in Older Unilateral Alveolar Cleft Patients

“…The reliability of block bone grafting for alveolar cleft patients was determined by recent studies, while shortcomings were lack of long-term follow-up and control group (Luque-Martin et al, 2014; Du et al, 2018; Van Nhan et al, 2018). In the present study, the cancellous iliac bone graft was set as a control, and all cases were followed up for 2 years.…”

“…Our results indicate that block iliac bone graft could preserve a greater bone amount with comparable bone density in contrast to sole cancellous iliac bone graft. It is probably due to its different bony architecture from particulate bone, which could enhance revisualization of grafted bone and resistance to bone resorption (Du et al, 2018). Furthermore, the rigid fixation of the block bone could minimize the mobility and provide a stable condition for bone healing.…”

“…From the year of 2013, block iliac bone graft technique was approved at our center and was performed in older cleft patients. In our previous study, we demonstrated that block iliac bone grafting enhanced the osseous healing in older cleft patients (Du et al, 2018). However, the long-term comparative evaluation between block and cancellous iliac bone grafts in alveolar cleft patients has not been investigated yet.…”

Aesthetic Concepts and Interdisciplinary Approach in a Patient With Bilateral Cleft Lip and Palate and Missing Premaxilla: A Case Report

“…During the orthodontic treatment, an iliac crest bone graft was attempted (Du et al, 2018), with the ultimate goal of potentially placing dental implants to support a fixed partial dental prosthesis. However, the procedure was unsuccessful and the graft resorbed, which is a possible complication in patients with large defects.…”

“…A more recent alternative for cases with a severe anterior maxillary deficiency, palatal fistula, and missing or malformed teeth is the alveolar distraction, which involves the advancement of 1 or 2 segments to the cleft deformity (Yilmaz et al, 2019). Bone grafting is also an alternative but is likewise challenging, due to the risk of resorption because of the absence of permanent teeth, graft exposure, and oronasal fistula development (Du et al, 2018). Soft tissue coverage of a graft is essential to improve the chance of success of the procedure, and tissue deficiency creates a high risk of infection (Witsenburg, 1985).…”