The Effects of Maxillary Expansion on Late Alveolar Bone Grafting in Patients With Unilateral Cleft Lip and Palate

Objectives: To gather information about current practices and assess the opinions, preferences, and clinical knowledge of surgeons who perform alveolar bone grafts. In addition, surgical training differences in correlation to techniques and outcomes are evaluated. Methods: A survey with both multiple choice and narrative answers regarding surgeons’ practices for alveolar bone grafting was designed and sent via email to members of the American Cleft Palate/Craniofacial Association (ACPA) identified as general craniofacial or oral maxillofacial surgeons. Responses were collected via an anonymous online survey tool. Participants: Members (336) of ACPA identified as craniofacial or oral-maxillofacial surgeons were contacted, and 62 responses were recorded. Results: The majority of survey respondents were oral-maxillofacial surgeons in practice for more than 15 years. 98.4% of respondents had used iliac crest and at least one additional source for grafting, while only 52.7% had performed grafting using recombinant bone morphogenetic protein (RhBMP). 82% used cone beam CT as their evaluation of choice for graft assessment and the majority (62.9%) waited more than 8 weeks postoperatively to image. Chi-square analysis demonstrated significantly longer time in practice for practitioners without craniofacial fellowship training. Conclusions: The results of this study demonstrate that there remains significant variation in alveolar bone grafting practices among surgeons. While some consensus exists, new innovations and technologies will require continued evaluation of surgical practices and outcomes. Long-term follow-up studies are needed especially with regard to the use of RhBMP in alveolar clefts.

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“…16,17 Expansion also provides postgraft stimulation that may encourage maturity and decrease resorption of the bone graft. 18…”

Section: Discussionmentioning

confidence: 99%

Trends in Alveolar Bone Grafting and the Use of Recombinant Bone Morphogenetic Protein (RhBMP) in the United States

Kanack

Krasnoff

Daly

et al. 2019

Journal of Advanced Oral Research

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“…In addition to the dento-alveolar effect obtained in patients without clefts, the main bony effect of the Quad-Helix in UCLP cases is the expansion of the lateral maxillary shelves when the de-rotation of the maxillary molars is achieved [19,23]. In such cases, dento-alveolar expansion before surgery results in similar treatment outcomes than in patients with maxillary expansion [24], with the benefit of working with minimum risk of creating secondary maxillary fistulas. Dento-alveolar expansion could also be obtained by other orthodontic appliances such as the reverse Quad-Helix (with poor correction of the molar rotation) [25], conventional or modified jointed fan (or butterfly) expander [26][27][28], NiTi palatal expander [29], or self-ligation appliances [30].…”

Section: Correct Alignment Of Maxillary Segments With Normal Transversal Maxillary Molar Widthmentioning

confidence: 99%

“…Dento-alveolar maxillary expansion is usually followed by maxillary dentition segmental leveling and alignment (using an anterior [3*2] utility arch) [21,[31][32][33][34]. In order to obtain similar results than those achieved using an inverse treatment protocol (alveolar grafting followed by orthodontics with maxillary expansion) [24], an orthodontic approximation of maxillary segments using a sectional arch approach -after obtaining proper maxillary width but before surgery-should be considered. In older patients, a mini-screws based molar distalization plus orthodontic dental retraction -by controlling the mesial inclination of the canine for greater bone approximation-is often required to create an alveolar defect with parallel walls to minimize the alveolar gap size when a segmental surgery is planned (Figure 3) [35,36].…”

Section: Correct Alignment Of Teeth Inside the Segmentsmentioning

confidence: 99%

“…The ideal age range for surgical procedure should be when the canine on the cleft side is from less than 5 mm of its eruption place to a partially erupted canine (1/3 to ½ of crown visible). Late SABG cases with narrow alveolar clefts at the right age allows to work with bone graft stimulation (either with compression osteogenesis or RPE) to obtain excellent results in both cases (Figure 4) [24,37]. Using SABG as an alveolar bone matrix, we achieve high degree of success in correcting the canine eruption and migration pathway [38].…”

Section: Timing Of the Graftmentioning

confidence: 99%

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Alternative Craniofacial Orthodontics Treatment Approaches for Differential Severity in Patients with Unilateral Cleft Lip with/without Palate

Gómez-Gil¹

2021

Recent Advances in the Treatment of Orofacial Clefts [Working Title]

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The treatment of patients with cleft lip with/without cleft palate is still a challenge for its correct team management. The fact that not all clefts are alike, based on anatomical findings and ortho/surgical alternatives used in their correction, requires that clinicians -working in interdisciplinary or multidisciplinary teams- direct efforts not only to repair the facial and oral characteristics of the cleft, but also to work in the context of the patient’s craniofacial growth and development, tri-dimensionally affected by this type of craniofacial difference. The first part of this chapter is focused on the diagnostic approach for patients with unilateral cleft lip and palate (UCLP), using a modified version of the GOSLON yardstick (GOSLON+) that considers not only dental components but also 3D facial aspects of a complex malocclusion originated from this congenital malformation. Second, current treatment alternatives based on patient’s stages of dental development and cleft width, using either straight-wire or passive self-ligation appliances are presented, directed to avoid dental prosthetic replacements if possible. Finally, our treatment algorithms summarized in a step-by-step fashion the treatment of such differences with approaches that will focus on these two key aspects, essential for a successful, patient-based, interdisciplinary treatment protocol.

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“…The acquired CT images were imported into Fuji ImageJ software, and the three-dimensional (3D) script plugin was used to 3D reconstruct and evaluate the samples. Materialize Mimics version 21.0 software was also used to calculate the volume of new bone formed in the defect area, 40 and the bone volume in the surgically made defect area was calculated as the newly regenerated bone volume. For subsequent histological evaluation, the samples were embedded in resin, sliced into 30−40 μm sections in the coronal plane, stained with toluidine blue, and observed under an optical microscope.…”

Section: ■ Experimental Sectionmentioning

confidence: 99%

Single-Walled Carbon Nanotube Membranes Accelerate Active Osteogenesis in Bone Defects: Potential of Guided Bone Regeneration Membranes

Hirata

Iizumi

et al. 2022

ACS Biomater. Sci. Eng.

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Carbon nanotubes (CNTs) are potentially important biomaterials because of their chemical, physical, and biological properties. Our research indicates that CNTs exhibit high compatibility with bone tissue. The guided bone regeneration (GBR) technique is commonly applied to reconstruct alveolar bone and treat peri-implant bone defects. In GBR, bone defects are covered with a barrier membrane to prevent the entry of nonosteogenic cells such as epithelial cells and fibroblasts. The barrier membrane also maintains a space for new bone formation. However, the mechanical and biological properties of materials previously used in clinical practice sometimes delayed bone regeneration. In this study, we developed a CNT-based membrane for GBR exhibiting high strength to provide a space for bone formation and provide cellular shielding to induce osteogenesis. The CNT membrane was made via the dispersion of single-walled CNTs (SWCNTs) in hyaluronic acid solution followed by filtration. The CNT membrane assumed a nanostructure surface due to the bundled SWCNTs and exhibited high strength and hydrophilicity after oxidation. In addition, the membrane promoted the proliferation of osteoblasts but not nonosteogenic cells. CNT membranes were used to cover experimental bone defects made in rat calvaria. At 8 weeks after surgery, more extensive bone formation was observed in membrane-covered defects compared with bone defects not covered with membrane. Almost no diffusion of CNTs was observed around the membrane. These results indicate that the CNT membrane has adequate strength, stability, and surface characteristics for osteoblasts, and its shielding properties promote bone formation. Demonstration of the safety and osteogenic potential of the CNT membranes through further animal studies should facilitate their clinical application in GBR.

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The Effects of Maxillary Expansion on Late Alveolar Bone Grafting in Patients With Unilateral Cleft Lip and Palate

Cited by 16 publications

References 34 publications

Trends in Alveolar Bone Grafting and the Use of Recombinant Bone Morphogenetic Protein (RhBMP) in the United States

Trends in Alveolar Bone Grafting and the Use of Recombinant Bone Morphogenetic Protein (RhBMP) in the United States

Alternative Craniofacial Orthodontics Treatment Approaches for Differential Severity in Patients with Unilateral Cleft Lip with/without Palate

Single-Walled Carbon Nanotube Membranes Accelerate Active Osteogenesis in Bone Defects: Potential of Guided Bone Regeneration Membranes

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