ABSTRACT
Cleft lip and palate is a common condition affecting thousands of children in India and overseas. With an incidence of 1 in 800 live births, these cleft lip and cleft palate patients face numerous aesthetic as well as functional challenges. The condition goes untreated in many scenarios, or patients do not receive adequate treatment due to various reasons like lack of awareness, lack of specialist dentists etc. leading to permanent facial deformity with significant deterioration of quality of life. There have been many changes in the management of alveolar cleft in the past 100 years. Documentation of the first cleft lip repairs dates back to 400 BC, and was performed by Hippocrates, while the first cleft velum repair was done for the first time by a French dentist, Monnier, in 1764. The treatment protocol for the same has been upgraded with time, with better understanding of the anatomy and pathophysiology of the condition, and for better results to the patients. Alveolar bone grafting (ABG) is now becoming an integral part of managing cleft patients. There still isn’t a fixed and widely accepted protocol for ABG in the management of cleft patients, but there are various opinions of researchers around the world regarding the indications of bone grafting, the type of grafting (primary or secondary) to be employed, timing of grafting, the source of bone graft and use of various bone graft substitutes in the procedure. An increasing value of multidisciplinary approach, including maxillofacial surgeons and orthodontists, towards managing such patients, is helping improve the outcome of such patients, and hence easing the overall treatment duration for the patient and relatives. Hence, through this article, we aim to shed some light over the evolvement and current place of alveolar bone grafting in treating cleft lip and palate patients. The anatomy of involved parts, types and indications of ABG, clinical evidences on the timing of the surgery, future evaluation, results and complications, and orthodontic treatment have been mentioned in this article.
ABSTRACT
INTRODUÇÃO: Enxerto ósseo autógeno é o padrão no tratamento da falha óssea alveolar. Como a morbidade na área doadora após a obtenção de enxerto ósseo continua sendo um problema relevante em pacientes fissurados, este estudo avaliou a dor na área doadora de pacientes fissurados submetidos ao tratamento de falhas ósseas alveolares com a transferência de enxerto ósseo obtido da crista ilíaca, por meio de um estudo prospectivo randomizado, comparando dois extratores ósseos. MÉTODO: Trinta e seis pacientes com fissura labiopalatina, submetidos ao reparo da falha óssea alveolar com enxerto obtido da crista ilíaca com auxílio do extrator ósseo SOBRAPAR (grupo A) ou extrator ósseo UCLA (grupo B), foram incluídos. A dor na área doadora foi avaliada no período pós-operatório com auxílio da escala numérica unidimensional de dor (0- "sem dor"; 10- "pior dor que se pode imaginar"). RESULTADOS: As médias das mensurações da dor na área doadora não revelaram diferenças significativas (p>0,05 para todas as comparações) nas comparações realizadas entre os grupos A e B, em nenhum dos momentos pós-operatórios avaliados. Houve um maior número (p<0,05) de pacientes do grupo B que não reportaram dor na área doadora, quando comparado ao grupo A. CONCLUSÕES: Este estudo apresentou um maior número de pacientes do grupo B "sem dor", quando comparado aos pacientes do grupo A, não existindo diferenças entre aqueles que reportaram quaisquer notas diferentes de zero.
INTRODUCTION: Autogenous bone grafting is the standard treatment for alveolar bone defects. However, morbidity in the donor area after the bone graft has been obtained continues to be a significant problem in cleft patients. This prospective randomized study compared donor area pain associated with the use of 2 bone extractors in patients with cleft lip and palate, who underwent treatment of alveolar bone defects using a bone graft obtained from the iliac crest. METHOD: Thirty-six patients with cleft lip and palate underwent alveolar bone defect repair using a graft from the iliac crest, harvested with either a SOBRAPAR bone extractor (group A) or UCLA bone extractor (group B). Donor area pain was evaluated in the postoperative period with the aid of a unidimensional numerical pain scale (0, "no pain"; 10, "worst pain imaginable"). RESULTS: Comparison of the mean donor area pain score did not reveal any significant differences (p >0.05 for all comparisons) between the groups A and B, at any of the postoperative times evaluated. A significantly higher number of patients in group B reported no pain in the donor area, compared with group A (p <0.05). CONCLUSIONS: This study showed that a significantly greater number of patients in group B reported "no pain", compared with patients in group A; with regard to patients who reported any level of pain greater than zero, there were no between-group differences.
Subject(s)
Humans , Male , Female , Child , History, 21st Century , Postoperative Complications , Pain Measurement , Case Reports , Comparative Study , Dipyrone , Prospective Studies , Cleft Lip , Cleft Palate , Bone Transplantation , Evaluation Study , Alveolar Bone Grafting , Ilium , Mouth Abnormalities , Postoperative Complications/drug therapy , Pain Measurement/adverse effects , Pain Measurement/methods , Dipyrone/therapeutic use , Cleft Lip/surgery , Cleft Palate/surgery , Bone Transplantation/adverse effects , Bone Transplantation/methods , Alveolar Bone Grafting/adverse effects , Alveolar Bone Grafting/methods , Ilium/surgery , Mouth Abnormalities/surgeryABSTRACT
The purpose of this retrospective study was to evaluate the level of alveolar bone support of the erupted permanent canine through the reconstructed cleft region compared to the contralateral canine on the non-cleft side. This study was limited to children with complete unilateral cleft lip and palate who underwent secondary alveolar iliac bone graft and the apices of the erupted canine roots were closed at the time of evaluation. With these criteria the study included 21 children whose average age at the time of bone graft reconstruction was 9.8 years, with a minimum of 12.4 years of age at the time of the evaluation. The study was limited to the use of iliac cancellous bone as the autograft material for reconstruction of the alveolar cleft. Cranial bone graft and other autogenous bone sources were excluded. The periapical radiographs were used to evaluate alveolar bone level of each canine. The percentages of root supported by the bone were established by dividing the amount of root covered with the bone by the anatomic root length. The canine of the non-cleft side was used as an internal control and the canine on the cleft side was used as an experimental. There was a statistically significant difference in the alveolar bone support ratio between the control (92.9%) and experimental canines (88.7%). An average of 95% level of alveolar bone support was achieved for the experimental canine in comparison to the control canine. Neither the presence of lateral incisor, nor the stage of root development of the canine at the time of the bone graft appeared to have affected the alveolar bone support ratio of the canine after the secondary bone graft.