Bone Reconstruction of the Maxillary Alveolus for Subsequent Insertion of a Dental Implant in Patients With Cleft Lip and Palate

Abstract

Bone grafting of maxillary alveolus cleft defect followed by insertion of dental implant may be a good alternative to conventional prosthetic treatment. The principle is the formation of stable alveolar crest with a sufficient three-dimensional volume. The problems are lack and quality of mucoperiosteum for the reconstruction of shell and bone gap characteristics for bone graft intake. The procedure was carried out by a single surgeon (MD) in 45 patients between 29 August 2001 and 30 June 2006, with an 86.7% success rate. The success was defined as completed process with dental implant insertion and its loading by a prosthetic suprastructure without a failure for at least 15 months from that last step. The success rate mainly depends on 1) good alveolar arch flow of maxilla segments in both horizontal and vertical planes; 2) the height of osseous poles of at least 12 mm and onlay augmentation of built-up section does not work; 3) adequate volume of cancellous bone graft, 3.7 cm on average. On the basis of histologic verification and clinical findings, the bone graft is matured enough to ensure a primary stability of a fixture in 12.5 weeks after reconstruction. Early load may prevent bone resorption. Prediction of complications are as follows: 1) graft resorption increases according to gap size and low possibility of revascularization; 2) a higher number of complications are linked to presence of oronasal fistula and to scarring of soft tissues; 3) because of more gracile skeleton and female metabolism, the risk is higher in women.

Guided Tissue Regeneration, Barrier Membranes and Reconstruction of the Cleft Maxillary Alveolus

“…Even though the double-layer membrane was used in those cases, the failure can be blamed on the poor local finding prior to the intervention rather than on the usage of a certain material. 34 …”

Cleft Lip and Palate

“…[10][11][12][13] The objectives of bone grafting include providing bony support to the adjacent teeth, facilitating prosthetic restoration, providing bony matrix for tooth eruption into the cleft site, stabilizing the segments, elevating the alar base, eliminating the oronasal fistula, and providing adequate bone volume for implant placement. [11][12][13] It has been reported that the best results are achieved if the graft was done between the ages of 9 to 11 before A B the eruption of the canines. [11][12][13] It has been reported that the best results are achieved if the graft was done between the ages of 9 to 11 before A B the eruption of the canines.…”

“…In addition, the premolar may have to be recontoured into the shape of the cuspid or will require placement of a porcelain veneer. 11,20 Conventional prosthodontics of either a removable partial denture or a fixed prosthesis may be used as a form of tooth replacement. 4,22,25 It has been reported in the literature that positioning the cuspid tooth into the lateral incisor position may predispose the patient to occlusal dysfunction, as well as transversal discrepancy problems and poor aesthetics.…”

Functional stability analyses of maxillofacial skeleton bearing cleft deformities

“…Such secondary collapse and displacement are often attributed to the “instability” of the disrupted maxillary buttresses 14–20 . Correspondingly, maxillae stabilization has always been listed among the major aims of bone graft management for the cleft defect in the literature 3,21 . The extent and pattern of the cleft-related maxillary instability, as well as the effectiveness of bone graft in stabilizing the maxillae, however, have rarely been illuminated 6,12,22,23 .…”