Long-Term Treatment Outcomes of Primary Alveolar Bone Grafts for Alveolar Clefts: A Qualitative Systematic Review

Abstract

Background: Alveolar bone grafting is utilized to manage alveolar clefts in patients with cleft lip and palate. However, the timing of bone grafting is variable with conflicting evidence supporting the use of primary alveolar bone grafting (PABG) in clinical practice. Primary Aim: To provide a qualitative systematic review analysis of long-term outcomes after PABG. Materials and Methods: A qualitative systematic review was performed following the Cochrane Handbook and reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Summative findings were evaluated using Confidence in the Evidence from Reviews of Qualitative research to assess the quality of evidence supporting the findings. Results: After removing duplication, 2182 publications were identified, and 2131 were excluded after screening through titles and abstracts. Inclusion criteria for this study included patients who underwent PABG at 24 months of age or younger and a minimum of 5 year follow-up. Thirty-two publications met the inclusion criteria and were included for qualitative analysis. Primary outcome measures included cephalometric analysis, bone graft survival, occlusal analysis, hypomineralization, tooth eruption, radiograph analysis, and arch relationships. Four assessment themes were characterized from the systematic review: (1) bone graft survival, (2) craniofacial skeletal relationships, (3) occlusion and arch forms, and (4) recommendations for utilizing PABG in practice. Conclusion: The reported systematic review provides evidence that performing PABG leads to poor long-term outcomes related to bone graft survival and maxillary growth restriction despite some reported positive outcomes.

Craniofacial Growth at Age 6–11 Years after One-Stage Cleft Lip and Palate Repair: A Retrospective Comparative Study with Historical Controls

“…Previous studies have reported maxillary retrusion due to primary alveolar bone grafting [ 8 , 9 , 10 , 11 , 27 , 28 , 29 , 30 ], but others have reported successful outcomes when following presurgical orthopedic therapy [ 27 , 29 , 30 ]. Presurgical therapy with passive plates is known to reduce the cleft of the palate [ 13 ].…”

“…Thus, the presented study of Groups A and B prompted changes in the surgical protocol at the study center. Primary alveolar bone grafting [ 10 ] and one-stage two-flap palatoplasty with secondary healing of lateral releasing incisions were abandoned. Following passive presurgical therapy, a one-stage protocol with bipedicled palatal flaps was implemented and modified for a continuous two-layer closure and primary healing [ 7 ].…”

“…Primary alveolar bone grafting, leading to an early connection of the cleft segments, showed negative effects on growth [ 8 , 9 , 10 ]. Combining primary alveolar bone grafting with primary cleft repair has been controversial [ 11 ], and it has been largely abandoned due to its negative effects on growth [ 8 , 9 ].…”

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

“…ABG has traditionally been classified as primary ABG (around 2 years), early secondary ABG (2–5 years), secondary ABG (6–12 years), and tertiary ABG (>12 years) according to chronological age [ 7 , 8 ]. By dental age, ABG can be divided into primary ABG (deciduous dentition), secondary ABG (mixed dentition), and tertiary ABG (permanent dentition).…”

Long-term follow-up of mandibular dental arch changes in patients with complete non-syndromic unilateral cleft lip, alveolus, and palate

“…Maxillary dental arch transverse dimensions and dental arch relationships following different treatment protocols for patients with orofacial clefts have been the topic of studies and systematic reviews that evaluated treatment outcome in relation to different treatment parameters such as timing of palatal surgery in relation to craniofacial outcome ( Kappen et al, 2018 ), timing of primary alveolar bone grafting ( Carbullido et al, 2021 ), outcome of maxillary distraction ( Kloukos et al, 2018 ), and rehabilitation of the maxillary arch with a dental implant or an anterior fixed partial denture replacing the missing lateral incisor at the cleft side ( Caballero et al, 2019 ; Rezende Pucciarelli et al, 2020 ; Pucciarelli et al., 2021 ; Soares et al, 2021a ; Soares et al, 2021b ). However, those studies did not pay much attention to concomitant changes in the mandibular arch of patients with cleft lip and palate that occur after treatment.…”