Secondary alveolar bone grafting: An outcome analysis

Abstract

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...

Bone fill following secondary alveolar bone grafting for children with cleft of the alveolus in New Zealand

“…Secondary alveolar bone grafting is a common procedure for the treatment of children with cleft involving the alveolus . This procedure is undertaken to restore sufficient bone volume in the tooth‐bearing region of the alveolar cleft to provide favourable periodontal support to adjacent teeth and enables orthodontic tooth movement into the cleft site . Additional benefits include closure of fistulae, bulking of mucosal defects and the alar bases .…”

Naso Alveolar Cleft Reconstruction: Does Patients’ Age Play a Factor in Postoperative Complication Rate?

“…These authors concluded that the infection rate did not show any correlation to patient age or cleft type [12], however, the study did not spot the light on the possible factors contributing to the postoperative complications. J. Lilja et al [13] reported that grafting at the age of 7 -9 years old led to complete orthodontic cleft closure in 100% of those patients compared to 91% of those patients in the 9 -11 years old group.…”

Mid Versus Late Secondary Alveolar Cleft Grafting Using Iliac Crest Corticocancellous Bone Graft

“…Studies have also shown that inlay endochondral cancellous bone grafts have a higher percentage increase in bone volume within the defect than cortical membranous or cortical endochondral bone grafts [3]. Use of cancellous bone results in rapid revascularization of the graft over 3 weeks unlike that of cortical bone, which maintains volume by creeping substitution which is a slow process [8].…”

“…In the mid-secondary group, two 10-year old and two 11-year old males, operated cases of cleft lip and palate, were taken up for closure of the residual alveolar clefts (Figs. [1][2][3][4][5][6][7][8][9][10][11]. In all the four cases, the cleft was lateral to the central incisor.…”