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

Abstract

Objective: To compare osseous outcomes of block and cancellous iliac bone grafting in older unilateral alveolar cleft patients. Design: Retrospective and observational follow-up study. Setting: Cleft Lip and Palate Centre, Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, China. Patients: Forty-five nonsyndromic patients with unilateral complete alveolar cleft were enrolled in this study (25 patients in block bone graft group and 20 patients in cancellous bone graft group). Interventions: In cancellous bone graft group, the alveolar cleft was filled with iliac cancellous bone particulate. In group of block bone graft, the harvested bone block was trimmed and fixed in alveolar defect. Main Outcome Measures: A novel method was proposed to investigate the volume and density of residual bone graft at 1-week, 3- and 6-month, 1- and 2-year postoperatively based on cone beam computed tomography scans. Results: No difference in bone graft volume was found between 2 groups at 1-week and 3-month postoperatively; however, the residual volume of block bone graft group was significantly larger than that of cancellous bone graft group at 6-month, 1- and 2-year postoperatively. The bone density of block bone graft group was lower at 1-week and 3-month postoperatively but was comparable at 6-month, 1- and 2-year postoperatively. Our method was reliable and accurate to identify the range of residual bone graft when the boundary of grafted bone could not be identified clearly. Conclusion: Block bone graft could achieve comparable bone density and retain a greater amount of residual bone comparing to cancellous bone graft.

Volumetric Analysis of Unilateral Alveolar Bone Defect Using Modified Subtraction in Older Chinese Patients

“…Our measurements are slightly smaller than those reported by a medical team affiliated with Nanjing Medical University. 17 In their study, the average preoperative defect volume measured using CAE technology was ∼1.7 cm 3 . We suspect that this result may be due to the difference in study sample size and compositions of cleft types 26 in the 2 studies.…”

“…Surgeons have used 3D-printed entity model skulls or CAE-assisted measurement methods for volume assessments. These are generally considered objective and accurate methods 15,17,19,24,25. Therefore, we used the 3D-printed model method as a comparison to test the accuracy and efficiency of our new CAE measurement method, for measuring the volume of preoperative defects in older patients with clefts.…”

“…Conversely, Reddy et al13 and Jabbari et al14 found presurgical cleft size is of no significance. Due to different measurement methods, the preoperative defects volume in CL/P patients varied widely in previous reports, with the highest being 5.3 cm 3 and the lowest 0.44 cm 3 13,15–17. Without the establishment of a standardized assessment protocol, the most critical influencing factors for the success of bone grafting cannot be elucidated.…”

Effectiveness of maxillary cortical bone graft chips harvested by bone scraper, covered with platelet-rich fibrin (PRF), in reconstruction of alveolar clefts: comparative study

“…It is frequently done using cancellous bone harvested from the iliac crest (Zhou et al, 2019), with an overall complication rate between 15% and 40% (Borba et al, 2014) and a failure rate between 1.5% and 6% (Lilja et al, 2000, Witherow et al, 2002, Newlands et al, 2000, Hynes et al, 2003.…”

A Follow-Up Study on the Clinical Outcomes of Alveolar Reconstruction Using Octacalcium Phosphate Granules and Atelocollagen Complex

“…Autologous bone grafting is the first option for filling a large alveolar bone defect that helps to acquire normal physiological bone function. [3][4][5][6] In general, alveolar bone reconstruction for alveolar cleft patients facilitates the eruption of permanent teeth and stabilizes the maxilla. 4,7 However, harvesting bone from the ilium or another part of the body is not only surgically invasive, but only a limited amount of bone can be harvested.…”