Iliac Versus Cranial Bone for Secondary Grafting of Residual Alveolar Clefts

Cohen, Mimis; Figueroa, Álvaro A.; Haviv, Yoram; Schäfer, Michael; Aduss, Howard

doi:10.1097/00006534-199103000-00004

Cited by 68 publications

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“…7,15 Bone harvest from this site, however, has the disadvantage of the need for a separate donor site with its inherent morbidity. The complications of the anterior iliac approach include prolonged post-operative pain, [16][17][18] altered gait, 10,19 sensory nerve damage, 17,18 poor scar placement and altered bone contour, 18 delayed healing, 18 herniation of abdominal contents, 11 clicking during walking, 18 ilium fracture, 20 peritonitis, 6 excessive blood loss 18 and rarely retroperitoneal haematoma. 21 The precise cause of donor site pain remains obscure.…”

Section: Discussionmentioning

confidence: 99%

An investigation of post-operative morbidity following iliac crest graft harvesting

2004

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Objective A study which examined the morbidity experienced by patients who underwent iliac crest bone graft procedures. Design A post-operative questionnaire was forwarded to patients who underwent iliac crest bone graft procedures at a single centre. Subjects One hundred and fourteen patients underwent iliac crest bone grafts for intra-oral augmentation. Results Ninety-eight patients (80%) returned post-operative questionnaires. Eighty of the 98 (81.6%) patients suffered postoperative pain with 70% of patients being pain-free after four weeks. However, 10% of patients experienced pain for more than 16 weeks. Eighty-five (86.7%) patients were able to walk without any difficulties six weeks post-operatively. Gait disturbance was not related with age, however there was a significant association between pain and disturbance of gait (P< 0.001). Twenty two patients required the use of a walking stick and the use of such aids varied from 0.5 to 26 weeks. Women used walking aids for longer periods than men (P< 0.05). Twenty five patients had altered sensation with about half of them experiencing altered sensation in the distribution of the lateral femoral cutaneous nerve. Other morbidities included deformity at the hip site (2.4%), haematoma (2.4%), infection (3.2%), stress fracture (4.1%) and meralgia paraesthetica in one patient. Despite the above morbidities, 82 patients were willing to undergo the same procedure again and 89 patients would recommend the procedure to their relatives and friends. Conclusion This study demonstrates considerable morbidity following anterior iliac crest bone harvest for intra-oral augmentation. Clinicians referring patients for such bone graft procedures must be aware of the above morbidities so that any patients referred for such procedures are fully informed.Teeth are usually lost as a result of disease or trauma but some patients may have congenitally missing teeth. One of the key elements involved in successful prosthetic rehabilitation is the

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Section: Discussionmentioning

confidence: 99%

An investigation of post-operative morbidity following iliac crest graft harvesting

2004

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“…Damage to these teeth is an unaccept able complication. So, if there is a chance o f damaging the toothbuds, autografts taken from rib, ilium or calvarium are indicated (Borstlap et al, 1990;Witsenburg and Freihofer, 1990;Cohen et al, 1991;Koole et al, 1991;Kortebein et al, 1991).…”

Section: Introductionmentioning

confidence: 99%

Tooth eruption through autogenous and xenogenous bone transplants: a histological and radiographic evaluation in beagle dogs

Merkx

Maltha

Hoff

et al. 1997

Journal of Cranio-Maxillofacial Surgery

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S U M M A R Y . The effect of implanting autogenous and xenogenous (Bio-Oss) bone transplants into metabolically active sites within beagle dog mandibles during permanent premolar tooth eruption was examined. Ten 14-weekold beagles were used. Before commencing the radiographic experiments, metal bone markers were placed in the caudal margin of the mandible at the age of 10 weeks. The deciduous first and third molar teeth were extracted and their sockets over the permanent second and fourth premolars were implanted with autogenous particulate enchondral iliac crest bone, autogenous particulate membraneous mandibular body bone, xenogenous bovine anorganic bone mineral spongiosa granules (1 -2 mm3) (Bio-Oss, Geistlich Pharma, Switzerland) or left empty. The third premolar served as a control site. Standardized oblique lateral radiographs were taken once a week. A number of coordinates of defined points and structures were determined by means of a coordinate digitizing system. Animals were killed 4, 10 and 16 weeks after bone transplantation for histological examination of the transplan tation sites. All premolars showed no delay in eruption or disruption of crown and root development. On histology, the Bio-Oss particles were not resorbed or integrated in the alveolar bone but were pushed forward into the gingiva. We have demonstrated that there is no difference in the eruption curve of the permanent premolars in the four groups (ANOVA ^> 0 .5 ) and that bone transplantation has no inhibitory effect on eruption (ÀNO VÀ P > 0 .3 ) and crown development of the underlying permanent premolar but that Bio-Oss does not have the same resorbable or integrating capability as autogenous bone grafts.

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“…Wolfe and Berkowitz (5) reported good ossification of bone grafts using cranial bone donor sites with ease of harvest and decreased donor site morbidity. Some authors reported unsatisfactory results comparing cranial bone and iliac crest, while some others reported similar results (15)(16)(17)(18). As long as cancellous bone was used, there was no significant difference seen in the final outcome (19,20).…”

Section: Discussionmentioning

confidence: 97%

Secondary alveolar bone grafting: An outcome analysis

Murthy¹,

Lehman²

2006

CAN J PLAST SURG

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OBJECTIVE: To review the outcome of secondary alveolar bone grafting in unilateral and bilateral cleft lip and palate. DESIGN: A surgeon's experience, by retrospective chart review, of 70 consecutive patients at a tertiary care centre. OUTCOME MEASURE: Periapical radiographs were taken at least six months after secondary alveolar bone grafting. The Enemark grading system was used to stratify graft-take. RESULTS: In unilateral clefts, 33% were level 1, 36% were level 2, 20% were level 3 and 11% were level 4. In bilateral clefts, 29% were level 1, 50% were level 2, 14% were level 3 and 7% were level 4. There was no statistically significant difference between the level of take and the type of cleft. Complications encountered were infection (n=3), fistula (n=3), pain (n=4) and bone graft exposure that led to failure (n=2). Two patients required reoperation for bone grafting. CONCLUSIONS: The iliac crest is a good donor site with excellent results and minimal morbidity.Key Words: Alveolar bone grafting; Cleft lip and palate; Enemark grading system; Iliac crest donor site; Secondary bone grafting Greffe osseuse alvéolaire secondaire : analyse de résultats BUT : L'étude avait pour but d'évaluer les résultats de la greffe osseuse alvéolaire secondaire chez des patients présentant une fente labiale et palatine unilatérale ou bilatérale. PLAN D'ÉTUDE : L'étude consistait à évaluer l'expérience d'un chirurgien chevronné, auprès de 70 patients consécutifs, par un examen rétrospectif des dossiers, dans un établissement de soins tertiaires. MESURES : Des radiographies périapicales ont été prises au moins six mois après la greffe osseuse alvéolaire secondaire. La prise de greffe a été classée selon l'échelle de cotation Enemark. RÉSULTATS : Dans les cas de fente unilatérale, 33 % des greffes étaient de niveau 1; 36 %, de niveau 2; 20 %, de niveau 3 et 11 %, de niveau 4. Dans les cas de fente bilatérale, 29 % des greffes étaient de niveau 1; 50 %, de niveau 2; 14 %, de niveau 3 et 7 %, de niveau 4. Il n'y avait pas d'écart statistiquement significatif entre le niveau de prise de greffe et le type de fente. Les complications observées ont été l'infection (n=3), la fistule (n=3), la douleur (n=4) et l'exposition de la greffe osseuse qui a abouti à l'échec de la prise (n=2). Deux patients ont dû être réopérés pour une greffe osseuse. CONCLUSION : La crête iliaque constitue une bonne zone donneuse; elle produit d'excellents résultats et est accompagnée d'une très faible morbidité. B one grafting of the cleft maxilla before eruption of the permanent cuspid has become an accepted part of the management of patients with clefts involving the maxillary alveolus. The reasons for performing a bone graft are to stabilize the maxillary segments, provide bony support for the teeth adjacent to the cleft, give additional support for the alar base and allow for the movement of the cuspid into the lateral incisor position. Typically, this procedure is performed at a stage of transitional dentition, when the canine root has not fully formed; thi...

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Iliac Versus Cranial Bone for Secondary Grafting of Residual Alveolar Clefts

Cited by 68 publications

References 0 publications

An investigation of post-operative morbidity following iliac crest graft harvesting

An investigation of post-operative morbidity following iliac crest graft harvesting

Tooth eruption through autogenous and xenogenous bone transplants: a histological and radiographic evaluation in beagle dogs

Secondary alveolar bone grafting: An outcome analysis

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