Orthodontically guided bone transport in the treatment of alveolar cleft: A case report

Abstract

IntroductionConventional treatments are sometimes not possible in certain alveolar cleft cases due to the severity of the gap which separates the fragments. Various management strategies have been proposed, including sequential surgical interventions or delaying treatment until adulthood to then carry out maxillary osteotomies. A further alternative approach has also been proposed, involving the application of bone transport techniques to mobilise the osseous fragments and thereby reduce the gap between lateral fragments and the premaxilla. Case ReportWe introduce the case of a 10-year-old patient who presented with a bilateral alveolar cleft and a severe gap. Stable occlusion between the premaxilla and the mandible was achieved following orthodontic treatment, making it inadvisable to perform a retrusive osteotomy of the premaxilla in order to close the alveolar clefts. Faced with this situation, it was decided we would employ a bone transport technique under orthodontic guidance using a dental splint. This would enable an osseous disc to be displaced towards the medial area and reduce the interfragmentary distance. During a second surgical intervention, closure of the soft tissues was performed and the gap was filled in using autogenous bone.Conclusions The use of bone transport techniques in selected cases allows closure of the osseous defect, whilst also preserving soft tissues and reducing the amount of bone autograft required. In our case, we were able to respect the position of the premaxilla and, at the same time, generate new tissues at both an alveolar bone and soft tissue level with results which have remained stable over the course of time. Key words:Alveolar cleft, bone transport, graft.

Manejo no quirúrgico de fisura alveolar severa en paciente adulta mediante tratamiento ortodóncico fijo. Reporte de caso

“…Esto permite el crecimiento en longitud del hueso, promoviendo la osteogénesis entre los segmentos fracturados, favoreciendo a su vez el desarrollo del tejido blando adyacente 5 . En pacientes fisurados, la distracción osteogénica se utiliza para reducir el ancho de los defectos óseos previo a la cirugía de injerto, facilitando además el cierre mucoso 6 .…”

Use of mandibular chin bone for alveolar bone grafting in cleft patients

“…DO can reconstruct both the alveolar bone and soft tissue [2, 5]. However, this method increases the treatment period, and DO devices can cause discomfort.…”