Validation of a 3D methodology for the evaluation and follow‐up of secondary alveolar bone grafting in unilateral cleft lip and palate patients

Shaheen, Eman; Danneels, Margaux; Doucet, Kaat; Dormaar, Titiaan; Verdonck, Anna; Llano-Pérula, María Cadenas de; Willems, Guy; Politis, Constantinus; Jacobs, Reinhilde

doi:10.1111/ocr.12546

Cited by 8 publications

(25 citation statements)

References 53 publications

(115 reference statements)

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“…Immediate CBCT scans were performed between 1 and 6 weeks post-operatively to computationally define the grafted region rather than for early outcomes evaluation. 12 Zhang et al 13 examined 60 patients with unilateral clefts of the alveolus who underwent iliac crest bone grafting to determine the ideal timing of dental implant placement. CBCT analysis at 3 months post-operatively revealed that bone mineral density remained stable while bone height declined with time—suggesting that satisfactory bone stock for implant placement is discernable by 3 months.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Shockwave Therapy Improves Outcomes Following Secondary Alveolar Bone Grafting

Coombs,

Patel,

Kochenour

et al. 2023

FACE

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Background: Recent studies have reported that extracorporeal shock wave therapy (ESWT) enhances bone formation during mandibular distraction osteogenesis. This study seeks to investigate the clinical outcomes in children undergoing ESWT alongside secondary alveolar bone grafting procedures at our institution. Methods: Retrospective review of all children that underwent secondary alveolar cleft bone grafting with adjunctive ESWT between 2019 and 2021. Variables including age, gender, cleft type, cleft width, pre-operative cleft dentition, volume of bone graft placed intraoperatively, ESWT settings, pain medication utilization, length of stay (LOS), follow-up, cone beam computed tomography (CBCT) data, and complications were recorded. Results: Twenty patients met inclusion criteria. Median age at surgery was 9 years (range 8-16). Four (20%) patients were female; 16 (80%) were male. Eight (40%) patients had bilateral alveolar clefts; 12 (60%) had unilateral clefts. All (100%) patients were discharged on the day of surgery. Twelve (60%) patients required a median of 1.3 oxycodone doses post-operatively (range 0-6.5). All patients received ESWT treatments intra and post-operatively. All patients demonstrated an increase in bone graft volume visualized on CBCT: median increase of 6.8% (range 1.3%-35.7%) between 106.5 days (17.5% of ideal visualized, range 5%-42%) and 245.5 days (27.9% of ideal, range 8%-55.7%). Three (15%) patients experienced minor complications. Conclusions: Initial outcomes suggest that ESWT may expedite visualization of bone consolidation and facilitate recovery without increasing complications. ESWT could further represent an opportunity to improve care in craniofacial surgery. Pertinent considerations, the role of standardized assessment protocols, and future directions will be reviewed.

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Section: Discussionmentioning

confidence: 99%

Extracorporeal Shockwave Therapy Improves Outcomes Following Secondary Alveolar Bone Grafting

Coombs,

Patel,

Kochenour

et al. 2023

FACE

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“…Alveolar bone grafting (ABG) was of great importance in the cleft lip and palate team approach. It could not only fill the cleft area but also support the alar base, close oroantral fistulae, and help the eruption of canines within the cleft area [ 5 ]. ABG included primary alveolar bone grafting (PABG) and secondary alveolar bone grafting (SABG).…”

Section: Introductionmentioning

confidence: 99%

“…When the requirement of bone is small, the mandibular angle can be the donor site, so there is no need for an extra-oral incision [ 15 ]. However, to obtain the accurate cleft volume, most researchers segmented the maxilla and filled the clefts through threshold division and manual modification, time-consumingly and laboriously [ 5 , 16 ]. Machine learning is a branch of artificial intelligence that uncovers patterns in data automatically and then applies the detected patterns for future data prediction [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Machine learning in 3D auto-filling alveolar cleft of CT images to assess the influence of alveolar bone grafting on the development of maxilla

et al. 2023

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Background Machine learning based auto-segmentation of 3D images has been developed rapidly in recent years. However, the application of this new method in the research of patients with unilateral cleft lip and palate (UCLP) is very limited. In this study, a machine learning algorithm utilizing 3D U-net was used to automatically segment the maxilla, fill the cleft and evaluate the alveolar bone graft in UCLP patients. Cleft related factors and the surgery impact on the development of maxilla were analyzed. Methods Preoperative and postoperative computed tomography images of 32 patients (64 images) were obtained. The deep-learning-based protocol was used to segment the maxilla and defect, followed by manual refinement. Paired t-tests and Mann-Whitney tests were performed to reveal the changes of the maxilla after surgery. Two-factor, two-level analysis for repeated measurement was used to examine the different trends of growth on the cleft and non-cleft sides of the maxilla. Pearson and Spearman correlations were used to explore the relationship between the defect and the changes of the maxillary cleft side. Results One-year after the alveolar bone grafting surgery, different growth amount was found on the cleft and non-cleft sides of maxilla. The maxillary length (from 34.64 ± 2.48 to 35.67 ± 2.45 mm) and the alveolar length (from 36.58 ± 3.21 to 37.63 ± 2.94 mm) increased significantly only on the cleft side while the maxillary anterior width (from 11.61 ± 1.61 to 12.01 ± 1.41 mm) and posterior width (from 29.63 ± 2.25 to 30.74 ± 2.63 mm) increased significantly only on the non-cleft side after surgery. Morphology of the cleft was found to be related to the pre-surgical maxillary dimension on the cleft side, while its correlation with the change of the maxilla after surgery was low or not statistically significant. Conclusion The auto-segmentation of the maxilla and the cleft could be performed very efficiently and accurately with the machine learning method. Asymmetric growth was found on the cleft and non-cleft sides of the maxilla after alveolar bone graft in UCLP patients. The morphology of the cleft mainly contributed to the pre-operation variance of the maxilla but had little impact on the maxilla growth after surgery.

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“…There is currently no consensus methods to analyse the alveolar bone reconstruction. 7 Very recently, Kamperos et al, in 2020, proposed a new score measuring the height and width of the alveolar bone as well as the level of the nasal floor. 8 They compared it with the usual 2D scores.…”

mentioning

confidence: 99%

“…While their methods are becoming more accurate, few analyse the alveolar bone as a whole and some are tedious to apply in daily practice. There is currently no consensus methods to analyse the alveolar bone reconstruction 7 …”

mentioning

confidence: 99%

Evaluation of Alveolar Bone Reconstruction In Clefts With Early Or Late Secondary Bone Grafting: Use Of The 3d Kamperos score

Mattei

Maggiulli

Baümler

et al. 2023

Journal of Craniofacial Surgery

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There is still no consensus on the optimal age for alveolar grafting. In order to decide on the success of this graft, the best known radiographic assessments lacks precision. Kamperos recently proposed a 3D CBCT score that simultaneously assesses alveolar bone height and thickness, as well as the nasal floor level. The aim of this study was to apply this new score and compare it between an early secondary alveolar grafting « ESAG » (4-7 y) and a late secondary alveolar grafting « LSAG » (8-11 y) surgery group. A total of 32 cases of ESAG and 17 of LSAG were analysed. On 3D imaging, the median age of ESAGs was 10 years and 15 years for LSAGs. In the ESAGs, 78% of the permanents canines were not on the arch compared to 18% in the LSAGs. In both groups, the reconstruction of the nasal floor was very adequate but the height and thickness appeared less good in the ESAGs. The final score was higher in LSAG (Chi2, P < 0.005). The analysis of the alveolar bone with the Kamperos score is accurate and relevant but it should preferably be performed in the permanent dentition phase. This is because the area of rhizalysis of the primary teeth and the follicular sac of the erupting permanent teeth influence the presence of effective bone.

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Validation of a 3D methodology for the evaluation and follow‐up of secondary alveolar bone grafting in unilateral cleft lip and palate patients

Cited by 8 publications

References 53 publications

Extracorporeal Shockwave Therapy Improves Outcomes Following Secondary Alveolar Bone Grafting

Extracorporeal Shockwave Therapy Improves Outcomes Following Secondary Alveolar Bone Grafting

Machine learning in 3D auto-filling alveolar cleft of CT images to assess the influence of alveolar bone grafting on the development of maxilla

Evaluation of Alveolar Bone Reconstruction In Clefts With Early Or Late Secondary Bone Grafting: Use Of The 3d Kamperos score

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