Secondary bone grafting for alveolar cleft in children with cleft lip or cleft lip and palate

Guo, Jing; Li, Chunjie; Zhang, Zuo‐Feng; Wu, Gang; Deacon, Scott; Chen, Jianwei; Hu, Haikun; Zou, Shujuan; Ye, Qingsong

doi:10.1002/14651858.cd008050.pub2

Cited by 65 publications

(59 citation statements)

References 38 publications

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“…A large number of systematic reviews with meta-analyses has been published in the last five years [7][8][9][10][11][12][13][14][15], but most were of suboptimal conduct or reporting and / or had methodological limitations [16], while none performed network meta-analysis to compare directly all existing bone graft alternatives.…”

Section: Introductionmentioning

confidence: 99%

Comparative effectiveness of natural and synthetic bone grafts in oral and maxillofacial surgery prior to insertion of dental implants: Systematic review and network meta-analysis of parallel and cluster randomized controlled trials

Papageorgiou

Papageorgiou²,

Deschner

et al. 2016

Journal of Dentistry

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OBJECTIVES Bone grafts are often used to enhance bone volume/quality prior to implantation insertion. This systematic review compares the histomorphometric effectiveness of bone grafts in an evidence-based manner. DATA Randomized clinical trials comparing histomorphometrically the % of newly-formed bone between two grafts were included. Risk of bias within and across studies was assessed with the Cochrane tool and the GRADE approach, respectively. Random-effects pairwise meta-analyses were conducted, followed by network meta-analysis, network meta-regression and sensitivity analyses. SOURCES Four electronic databases were searched from inception to June 2015 without limitations. STUDY SELECTION A total of 12 trials (5 parallel; 7 cluster) with a total of 231 patients (302 grafted sites) were included. No statistically significant differences were found in the % of new bone from pairwise comparisons between any two bone grafts. Treatment ranking based on the evidence network indicated that autografts presented the highest percentage of new bone, followed by synthetic grafts, xenografts, and allografts. No differences according to patient age, sex, healing time, membrane used or kind of surgical graft use were identified. Our confidence on pairwise comparisons was moderate to very low due to study limitations, inconsistency, and imprecision; our confidence on graft ranking was moderate due to study limitations. CONCLUSIONS No significant differences were found in the percentage of new bone between any two grafts. CLINICAL SIGNIFICANCE Synthetic bone substitutes or xenologous bone grafts can be used as an alternative to autologous graft in order to overcome problems of additional surgeries or limited graft availability. A B S T R A C TObjectives: Bone grafts are often used to enhance bone volume / quality prior to implantation insertion. This systematic review compares the histomorphometric effectiveness of bone grafts in an evidencebased manner.Data: Randomized clinical trials comparing histomorphometrically the % of newly-formed bone between two grafts were included. Risk of bias within and across studies was assessed with the Cochrane tool and the GRADE approach, respectively. Random-effects pairwise meta-analyses were conducted, followed by network meta-analysis, network meta-regression and sensitivity analyses.Sources: Four electronic databases were searched from inception to June 2015 without limitations.Study selection: A total of 12 trials (5 parallel; 7 cluster) with a total of 231 patients (302 grafted sites) were included. No statistically significant differences were found in the % of new bone from pairwise comparisons between any two bone grafts. Treatment ranking based on the evidence network indicated that autografts presented the highest % of new bone, followed by synthetic grafts, xenografts, and allografts. No differences according to patient age, sex, healing time, membrane used or kind of surgical graft use were identified. Our confidence on pairwise comparisons was moderate to very l...

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Section: Introductionmentioning

confidence: 99%

Comparative effectiveness of natural and synthetic bone grafts in oral and maxillofacial surgery prior to insertion of dental implants: Systematic review and network meta-analysis of parallel and cluster randomized controlled trials

Papageorgiou

Papageorgiou²,

Deschner

et al. 2016

Journal of Dentistry

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“…Compostos como as proteínas morfogené-ticas ósseas (BMP) têm mostrado resultados promissores em diversos estudos, sendo necessário contudo realizar mais estudos, com amostras populacionais maiores e tempos de follow-up mais prolongados. [2][3][4]13,14 Estão descritos na literatura alguns fatores que promovem o sucesso da intervenção, nomeadamente a fase de erupção, o tipo de material enxertado, desenho do retalho cirúrgico e manuseamento dos tecidos durante o enxerto, assim como a experiência do cirurgião responsável. 9,15 Também a adesão ao plano terapêutico e higiene dentária podem constituir um importante fator de sucesso ou falência da intervenção.…”

Section: Discussionunclassified

“…15 Um aumento da acuidade da mensuração do volume ósseo necessário a enxertar poderá contribuir para o seu sucesso, uma vez que uma quantidade inferior à necessária falhará na promoção da formação de novo osso mas, por outro lado, uma quantidade excessiva poderá comprometer o encerramento da ferida e a densidade do novo osso. 15 Desta forma, consideramos que a avaliação pré e pós cirúrgica com recurso a imagens a três dimensões (3D) de feixe cónico, por tomografia computadorizada, deverá ser implementada no futuro 14 pois, para além de permitirem uma maior acuidade na avaliação volumétrica, possibilitam uma avaliação mais completa da fenda e uma programação mais eficaz da intervenção. O presente estudo tem algumas limitações.…”

Section: Discussionunclassified

Enxerto Ósseo na Fenda Lábio-Palatina: Experiência de um Hospital de Referência Português

et al. 2016

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RESUMOIntrodução: A fenda lábio-palatina é a malformação congénita craniofacial mais frequente. Na presença de defeito ósseo, a técnica de enxerto ósseo alveolar secundário é o método de correção mais consensual entre os autores. Neste estudo avalia-se o resultado da aplicação desta técnica num hospital terciário. Material e Métodos: Análise dos enxertos ósseos alveolares secundários realizados entre 2007 e 2014, sendo incluídos os casos em que a crista ilíaca foi a região dadora e em que a informação clínica e imagiológica estava completa. A eficácia da intervenção foi avaliada radiologicamente com recurso à escala de Bergland (tipo I-IV), e correlacionada com variáveis associadas à patologia e/ou correção cirúrgica. Resultados: Dos 32 enxertos ósseos alveolares secundários realizados, 29 cumpriam os critérios de inclusão: 13 casos (44,8%) correspondiam a fendas pré-forâmen unilaterais completas; quatro (13,8%) a fendas pré-forâmen bilaterais completas; oito (27,6%) a fendas transforâmen unilaterais e quatro (13,8%) a fendas transforâmen bilaterais. Pela escala de Bergland (aplicada com um seguimento médio de 8 ± 5 meses), seis eram do tipo I, 15 do tipo II, cinco de tipo III e três do tipo IV. Não foi encontrada associação entre a eficácia da intervenção cirúrgica e o tipo de fenda lábio-palatina, presença do incisivo e fase de erupção do canino. Cinco doentes foram submetidos a novo enxerto ósseo alveolar (três tipo II e dois tipo III na avaliação inicial). Discussão: Na presente série, o enxerto ósseo alveolar foi eficaz na maioria dos doentes (72%, tipo I e II), independentemente do tipo de fenda lábio-palatina. A proporção de falências (10,3%) e a necessidade ulterior de reintervenção (17%) foram relativamente altas justificando o seguimento a longo-prazo e a continuação deste estudo. Conclusão: Importa realçar o envolvimento multidisciplinar para identificação atempada do momento ideal para intervenção e otimização dos resultados. Palavras-chave: Enxerto de Osso Alveolar; Fenda Labial; Fenda Palatina; Procedimentos Cirúrgicos Reconstrutivos. ABSTRACT Introduction:Orofacial clefts are the most frequent craniofacial birth defects. In the presence of bone defect, the secondary alveolar bone grafting is the correction method most commonly accepted by clinicians. This study evaluates the result of this technique in a tertiary hospital. Material and Methods: Analysis of the secondary alveolar bone grafting performed between 2007 and 2014, with inclusion of cases in which the iliac crest was the donor site for the graft and the clinical and imaging information was complete. The success of the intervention was assessed radiographically using the Bergland scale (type I-IV) and correlated to variables associated with pathology and/or surgical correction. Results: Of the 32 secondary alveolar bone grafting performed, 29 met the inclusion criteria: 13 cases (44.8%) corresponded to complete unilateral pre-foramen clefts; four (13.8%) to complete bilateral pre-foramen clefts; eight (27.6%) to transforamen unilateral cl...

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“…The final step in the protocol, and the focus of the present study, more particularly involves the orthodontist. Since Boyne and Sands' work in the 1970s, gingivoperiosteoplasty (GPP) has usually been associated to alveolar graft 7,11,29 . Several benefits are expected, and notably restoring alveolar bone continuity over and above mere tight closure, restoring an adequate bone support for dental …”

Section: Treatmentmentioning

confidence: 99%

Description of transverse maxillary expansion in patients with bilateral cleft lip and palate undergoing gingivoperiosteoplasty with alveolar bone graft. A preliminary study

Niez¹,

Nham²,

Vi‐Fane

2015

J Dentofacial Anom Orthod

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Secondary bone grafting for alveolar cleft in children with cleft lip or cleft lip and palate

Cited by 65 publications

References 38 publications

Comparative effectiveness of natural and synthetic bone grafts in oral and maxillofacial surgery prior to insertion of dental implants: Systematic review and network meta-analysis of parallel and cluster randomized controlled trials

Comparative effectiveness of natural and synthetic bone grafts in oral and maxillofacial surgery prior to insertion of dental implants: Systematic review and network meta-analysis of parallel and cluster randomized controlled trials

Enxerto Ósseo na Fenda Lábio-Palatina: Experiência de um Hospital de Referência Português

Description of transverse maxillary expansion in patients with bilateral cleft lip and palate undergoing gingivoperiosteoplasty with alveolar bone graft. A preliminary study

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