Secondary Alveolar Bone Grafting (CLEFTSiS) 2007–2010

Abstract

Objective To determine whether alveolar bone graft outcomes for unilateral and bilateral cleft lip and palate patients have continued to improve since the reorganization of cleft services in Scotland in 2000. Design Retrospective analysis of postoperative anterior occlusal radiographs. Patients and Participants Eighty-one of 106 patients who were eligible for alveolar bone grafting between 2007 and 2010 had suitable postoperative radiographs available. Interventions Twenty-seven percent of the patients (n = 22) had presurgical orthodontic intervention. All patients underwent alveolar bone grafting with bone harvested from the iliac crest. Main Outcome Measures The Kindelan bone-fill index was used to evaluate success. Weighted kappa statistics were used to assess intra- and interobserver reproducibility. A comparison was made with results from 2000 to 2004 to assess any improvement. Chi-square tests (or Fisher exact test) were used to determine whether outcomes differed depending on the laterality of the cleft, use of presurgical expansion, or age at bone grafting. Results Interobserver scoring agreement was good (weighted kappa = .383). Intraobserver reproducibility was greater (weighted kappas of .835 and .620). Success was achieved in 99% of bone grafts, compared with 76% in the period from 2000 to 2004 (P < .001). There was no statistically significant relationship between the laterality of the cleft (P = 1.000), use of presurgical expansion (P = 1.000), or age at time of bone grafting and outcome (P = .259). Conclusion Scottish secondary alveolar bone graft outcomes improved during 2007 to 2010 in comparison to the 2000 to 2004 results.

Alveolar Bone Graft Timing in Patients With Cleft Lip & Palate

“…However, there is debate over the optimal timing of surgery and coordinated orthodontic treatment as well as to how to specifically define bone graft success. Authors attempted to understand from the literature the ideal timing, appropriate use of orthodontics, and methods of evaluating bone graft outcomes, but there is no well-defined consensus regarding the above questions 7 …”

“…Authors attempted to understand from the literature the ideal timing, appropriate use of orthodontics, and methods of evaluating bone graft outcomes, but there is no well-defined consensus regarding the above questions. 7 Similar systematic reviews have been performed to evaluate the optimal timing of alveolar bone grafting in patients with CLP. Kaura et al 5 performed a review of seventeen manuscripts and concluded that the success of secondary bone grafting was high, but there was considerable variation and no consensus on the use of chronological age or dental age as a marker for appropriate timing.…”

“…The objectives of pregraft orthodontic treatment in patients with CLP are to: correct the maxillary transverse collapse that is often present, improve the malposition of the alveolar segments resulting from the cleft(s), facilitate surgical access to the cleft via expansion and/or judicious tooth orthodontic movement, and provide sufficient soft tissue for fistula closure. 7,8,11,16,17 If there is not sufficient soft tissue, postsurgical scar contraction may result in relapse of transverse expansion and increased risk of dehiscence. 17 The articles in this review varied in their orthodontic protocols.…”

Skeletal and Dental Habilitation of Residual Alveolar and Maxillary Clefts

“…Such studies based only on radiographic outcomes, despite their limitations, are definitely important and very valuable in our further understanding of details of such procedures. In particular, the studies based on multicenter evaluation with longitudinal data, analyzed by experts in the field can further advance our knowledge and possibly assist us to modifying/improving some of our surgical techniques 21–25 . Such studies should be considered in isolation, as they do not encompass all of the widely accepted final goals of the procedure including dental eruption, orthodontic success, and if needed prosthodontic care leading to definitive skeletal and soft tissue functional and esthetic habilitation.…”