Changes in Grafted Autogenous Bone during Edgewise Treatment in Patients with Unilateral Cleft Lip/Palate or Alveolus

Abstract

Objective : To examine the changes in autogenous bone from 6 to 12 months after alveolar bone grafting (ABG) (T1) through completion of edgewise treatment (T2). Design : Retrospective longitudinal study. Setting : Multidisciplinary long-term follow-up at Kagoshima University Hospital. Patients : Forty-three patients with unilateral cleft lip and palate or alveolus. Main Outcome Measures : At T1 and T2, the bone bridge and quantity of grafted bone were evaluated using the Chelsea scale and the ABG scale. The cleft-adjacent tooth angles before ABG and at T2, as well as the number of orthodontic space closures, were examined. Patients were classified as having either adequate (type A or C; adequate group) or poor bone bridges (type B, D, E, or F; poor group) by the assessment at T1. Results : At T1, the ABG scores for the cleft-adjacent central incisor side of patients in the adequate group were higher than those of patients in the poor group (P < .001). At T2, the adequate group had higher ABG scores for the cleft-adjacent central incisor side (P = .022) and the canine sides (P = .034). No significant differences in tooth angles or the number of orthodontic space closures were noted between the groups. Conclusions : These results suggest that the quantity of grafted bone in the cleft-adjacent central incisor at 6 to 12 months post-ABG may be an indicator of the quantity of grafted bone that will be present after edgewise treatment.

Difference in the Surgical Outcome of Unilateral Cleft Lip and Palate Patients with and without Pre-Alveolar Bone Graft Orthodontic Treatment

“…Two-dimensional dental radiographs have been used to assess the success of ABGs for more than three decades 2 3 4 5 6 . Success was concluded based upon the measurement of bone bridges formed after bone grafting, but it has been shown that success rates can be overestimated using this methodology 7 .…”

Cryogel scaffolds from patient-specific 3D-printed molds for personalized tissue-engineered bone regeneration in pediatric cleft-craniofacial defects

“…Additionally, the cylinder and rectangle have a much larger range of pore sizes; however, there was no significant difference between any of the average pore heterogeneities (Figure 4(b)). Despite this, all cryogels had a fairly similar pore interconnectivity between 22 and 27,000 1/mm 3 (Figure 4(c)). Both the stacked cube and horseshoe cryogels had significantly greater pore interconnectivity than the cylinder cryogels (p < 0.05).…”

“…Most children with cleft lip-palate have bone missing in their alveolus (gum) and maxilla (jaw), which requires bone grafting during childhood to reunite the cleft and form a normal face. 3 As the alveolar cleft is a complex three-dimensional (3D) defect, a significant disadvantage with current treatment methods is the lack of specificity to the child. In addition, the use of bone grafts remains the gold standard for treatment which can often prove difficult as children have less donor bone availability.…”

Orthodontics in Relation with Alveolar Bone Grafting in CLP Patients

“…Orthodontic movement of the cleft-adjacent teeth in the direction of the grafted bone can be instituted at an average of 3 months after the bone grafting, if needed. Combined interceptive bone grafting and orthodontic treatment at an early age avoid more extensive prolonged treatment later in the patient's life [5,13,19,34].…”

“…Before treatment, orthodontists should be able to explain the predicted outcome of bone grafting to patients and their parents [34].…”