Cleft Alveolar Bone Graft Materials: Literature Review

Abstract

Introduction: Since the early stages of alveolar bone grafting development, multiple types of materials have been used. Iliac cancellous bone graft (ICBG) remains the gold standard. Design/Methods: A review of literature is conducted in order to describe the different bone filling possibilities, autologous or not, and to assess their effectiveness compared to ICBG. This review focused on studies reporting volumetric assessment of the alveolar cleft graft result (by computed tomography scan or cone beam computed tomography). Results: Grafting materials fall into 3 types: autologous bone grafts, ICBG supplementary material, and bone substitutes. Among autologous materials, no study showed the superiority of any other bone origin over iliac cancellous bone. Yet ICBG gives inconsistent results and presents donor site morbidity. Concerning supplementary material, only 3 studies could show a benefit of adding platelet-rich fibrin (1 study) or platelet-rich plasma (2 studies) to ICBG, which remains controversial in most studies. There is a lack of 3-dimensional (3D) assessment in most articles concerning the use of scaffolds. Only one study showed graft improvement when adding acellular dermal matrix to ICBG. Looking at bone substitutes highlights failures among bioceramics alone, side-effects with bone morphogenetic protein-2 composite materials, and difficulties in cell therapy setup. Studies assessing cell therapy–based substitutes show comparable efficacy with ICBG but remain too few. Conclusion: This review highlights the lack of 3D assessments in the alveolar bone graft materials field. Nothing dethroned ICBG from its position as the gold standard treatment at this time.

The strategy of composite grafting with BMP2-Loaded calcium phosphate cements and autogenous bone for alveolar cleft reconstruction

“…Secondary ABG, conducted in mixed dentition before canine eruption, is now regarded as a standard treatment for patients with alveolar cleft (Fahradyan et al, 2019;Mundra et al, 2022). Although autogenous bone grafting has remained the mainstream, its main drawbacks, donor site morbidity and limited bone supply, prompt clinicians to develop alternative materials that could meet the complicated clinical requirements of ABG (Kang, 2017;Francisco et al, 2021;Dissaux et al, 2022). Therefore, the appeal of BMP2 as a potential alternative is to avoid autogenous bone harvesting while preserving the osteogenic potential of the graft (da Rosa et al, 2019;Motamedian et al, 2022;Chou et al, 2022).…”

“…Among the multidisciplinary sequential treatments for lip-alveolus-palate cleft patients, secondary alveolar bone grafting is a fundamental step for the stabilization of the maxillary dental arch, facilitation of prosthodontic and orthodontic treatment, induction of canine eruption, closure of vestibular fistulae and improvement of nasal symmetry and facial morphology (Guo et al, 2011;Chhajlani et al, 2021;Francisco et al, 2021). Although autogenous bone graft has still been suggested as the "gold standard" for ABG, its drawbacks, such as donor site morbidity, limited bone supply and post-surgical resorption, are also prominent (McCrary and Skirko, 2021;Dissaux et al, 2022).…”

“…Facing this dilemma, clinicians and researchers have developed various grafting strategies to remedy the drawbacks of autogenous bone graft. Previous reviews of clinical trials identified several potential alternatives for ABG: BMP2, deproteinized bovine bone (DBB) and synthetic grafting materials [hydroxyapatite (HA), β-tricalcium phosphate (β-TCP), calcium phosphate cements (CPC)] (Liang et al, 2018;Dissaux et al, 2022). Among these materials, BMP2 was intensively studied and showed good bone-repairing efficacy comparable to that of autogenous bone graft in terms of reconstructed bone volume and density (Osorio et al, 2020;Francisco et al, 2021;Alkaabi et al, 2022).…”

Secondary bone grafting for alveolar clefts: surgical timing, graft materials, and evaluation methods

“…Disadvantages of iliac bone that may limit its use include postoperative pain and residual scarring [ 38 ]. However, postoperative pain was found to be frequently overestimated and easily controlled by analgesics [ 39 ]. In particular, harvesting bone via a minimally invasive technique with a trephine instead of via an open technique could reduce postoperative pain.…”

The potential role of cfDNA-related innate immune responses in postoperative bone loss after alveolar bone grafting

“…Postoperative bone loss after bone grafting possibly happens as the following: (1) surgery leads to sterile Inflammation, which increases the levels of damage-associated molecular patterns (DAMPs) (24,25); (2) It is impossible to be a totally sterile environment in oral and maxillofacial surgery (26), which can lead to the increasing levels of pathogen-associated molecular patterns (PAMPs); (3) cfDNA levels will be increased because of the accumulation of DAMPs and PAMPs, and will consequently activate the TLR9/NF-kB pathway (19,20) and may lead to the bone loss after alveolar bone grafting. In this perspective, we try to preliminarily demonstrate that cfDNA-and TLR9-related innate immune responses could happen after alveolar bone grafting in patients with alveolar bone cleft, which possibly is associated with postoperative bone loss, by showing pilot analyses of the pre-and post-operative levels of cfDNA in the gingival crevicular fluid (GCF) and serum of patients and use in vitro study to confirm that the cfDNA-and TLR9-related innate immune response can be activated after bone grafting surgery.…”