Need for Revision Surgery After Alveolar Cleft Repair

Abstract

The study assessed the need for revision surgery and the relating factors in alveolar cleft autogenous bone grafting in patients with complete cleft. It was a retrospective study carried out in 2009. The medical records of the 54 patients with alveolar cleft who underwent autogenous bone grafting in the maxillofacial department in Shariati Hospital from 2005 to 2008 were studied. The patients' age, sex, cleft type, age at palatal and alveolar clefts repair, tooth missing, surgery turn, and presence of orthodontic treatment were assessed. The patients' alveolar bone height was evaluated from their postoperative and follow-up panoramic radiographs. In general, 41% (n = 22) of patients needed revision surgery. Among all patients, 20 (37%) had secondary bone grafting and 34 (63%) had tertiary bone grafting. For 77% of the secondary unilateral clefts and 71% of bilateral ones, the remaining bone was at least three-fourths of the normal. Logistic regression model controlling for grafting time, surgery turn, orthodontic supervision, and age at palatal cleft closure showed that orthodontic treatment is associated with a lower need for revision surgery (odds ratio = 0.3; 95% confidence interval, 0.1-1.0). In conclusion, although alveolar cleft bone grafting is necessary for the reconstruction of the complete clefts, all these patients must be under the supervision of orthodontists to benefit from the surgical treatment.

Presurgical and postsurgical orthodontics are associated with superior secondary alveolar bone grafting outcomes

“…Our finding on postsurgical orthodontic treatment (Table 8) is consistent with a report suggesting that orthodontic space closure after grafting is linked to a lower level of graft resorption than orthodontic space openings (Schultze-Mosgau et al, 2003). Similarly, pre-or postsurgical orthodontic treatment was independently associated with lower need for revision after bone grafting (Shirani et al, 2012). Thus, post-SABG orthodontic movement of cleft-adjacent teeth can apply functional stress on the grafted bone and promote alveolar remodeling (Guidice et al, 2007;Shirani et al, 2012).…”

“…Similarly, pre-or postsurgical orthodontic treatment was independently associated with lower need for revision after bone grafting (Shirani et al, 2012). Thus, post-SABG orthodontic movement of cleft-adjacent teeth can apply functional stress on the grafted bone and promote alveolar remodeling (Guidice et al, 2007;Shirani et al, 2012).…”

“…Furthermore, higher grafting success was found in cases of orthodontic space closure than in cases of space openings (Schultze-Mosgau et al, 2003), suggesting the influence of postsurgical orthodontics. However, only a few studies have evaluated SABG outcomes from a multifactorial viewpoint (Williams et al, 2003;Oberoi et al, 2009;Shirani et al, 2012;Toscano et al, 2012). In addition, most previous studies failed to evaluate a three-dimensional (3D) defect from two-dimensional (2D) images.…”

The role of 3D printing in treating craniomaxillofacial congenital anomalies

“…However, despite reports of excellent long-term outcomes, the procedure is associated with donor site morbidity and the requirement for hospitalization due to pain in the graft donor site. In addition, graft resorption is well documented, and many studies have reported revision rates from 12 to 40% depending on cleft type (Goudy, Lott, Burton, Wheeler, & Canady, 2009;Montian Manosudprasit, Chaiyasang, & Chowchuen, 2011;Shirani, Abbasi, & Mohebbi, 2012) . Poor prognosis is more highly associated with patients that have wider or bilateral clefts.…”

Outcome of Bone Availability After Secondary Alveolar Bone Graft in Two Age Groups

“…11 Other studies have shown that the bone grafting at the mixed-dentition period is associated with a higher success rate. 12 In patients with a bilateral alveolar cleft in the mixed dentition, the teeth adjacent to the alveolar cleft are covered by a thin alveolar bone plate.…”