3D finite element analysis of the influence of upper lip pressure on the maxilla for patients with unilateral alveolar cleft / 口腔疾病防治

Objective @#To investigate the biomechanical effects of upper lip pressure on the maxilla in patients with a unilateral alveolar cleft and provide evidence for clinical diagnosis and treatment. @*Methods @#A 3D finite element maxillary model was generated based on cone beam CT (CBCT) data from an 11-year-old female patient with a unilateral alveolar cleft. Two different kinds of upper lip pressure, postsurgery pressure and normal pressure, were applied to the model. The displacement and stress of each reference node were compared and analyzed. @*Results @# By loading upper lip pressure, the maxillary alveolar crest rotated toward the defect and was displaced downward and backward. The displacement of the noncleft side was greater than that of the cleft side and it decreased gradually from the anterior to the posterior. The stress was concentrated on the anterior portion of the alveolar crest. The stress on the noncleft side was greater than that on the cleft side and it decreased gradually from the anterior to the posterior. The maximum stress was concentrated on the palate around the defect. The displacement and stress in the postsurgery group were greater than those of the normal group (P<0.05). @*Conclusion @#By loading upper lip pressure, the maxilla demonstrated asymmetry three-dimensionally. The adverse effects on the maxilla could be mitigated by reducing the upper lip pressure.

Clinical application of β-tricalcium phosphate artificial bone material for alveolar cleft repair / 口腔疾病防治

Objective@# To investigate the osteogenic effect of β-tricalcium phosphate (β-TCP) and bone morphogenetic protein-2 (BMP-2) in the repair of the alveolar cleft.@*Methods @# Fifty-nine patients with unilateral alveolar cleft who visited Capital Medical University School of Stomatology from January 2016 to May 2021 were included. They were divided into three groups according to the different bone repair materials: autologous bone, β-TCP and BMP-2 +β-TCP. The preoperative and postoperative CBCT data of the patients were imported into Mimics 21.0 software. The preoperative volume of the bone defect and the new volume of bone formation were calculated by the three-dimensional reconstruction method. The osteogenesis rate was calculated to evaluate the osteogenesis effect@*Results@#The wounds in the three groups healed well after the operation, without implant material discharge, infection, dehiscence, rejection or other symptoms. Twelve months after the operation, CBCT scanning and three⁃dimensional reconstruction images of the three groups of patients showed the formation of new bone bridges in the alveolar ridge fissure area. The image density of the new bone tissue was not significantly different from that of normal bone tissue, and the continuity of the maxilla was re⁃ stored to varying degrees. The bone rate of autogenous bone was 65.00% ± 16.66%, β⁃ TCP group and BMP⁃2+ β⁃ The bone composition rate of TCP was 69.82% ± 17.60%, 71.35% ± 17.51%, respectively, and there was no significant dif⁃ ference compared with the autogenous bone group (P = 0.382, P = 0.244). The β⁃TCP and BMP⁃2+ β⁃TCP groups had no significant differences in bone rate (P = 0.789). @*Conclusion@#β⁃TCP could be used to replace autologous bone for alveolar cleft repair. The addition of BMP⁃2 to β⁃TCP did not significantly improve the osteogenesis rate.

Effectiveness of iliac cancellous bone grafting in alveolar cleft repair and analysis of factors affecting it / 华西口腔医学杂志

OBJECTIVES@#To review the effectiveness of secondary alveolar bone grafting using iliac cancellous bone in patients with unilateral complete alveolar cleft and to investigate the factors influencing it.@*METHODS@#A retrospective study of 160 patients with unilateral complete alveolar clefts who underwent iliac cancellous bone graft repair at the Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, was conducted. Eighty patients in the young age group (6-12 years) and 80 in the old age group (≥13 years) were included. Bone bridge formation was determined using Mimics software, and the volume was measured to calculate the iliac implantation rate, residual bone filling rate, and resorption rate. The factors that affected bone grafting in both subgroups were investigated.@*RESULTS@#Using bone bridge formation as the clinical success criterion, the success rate for the entire population was 71.25%, with a significant difference of 78.75% and 63.75% for the young and old age groups, respectively (P=0.036). The gap volume in the latter was significantly larger than that in the former (P<0.001). The factors that influenced bone grafting in the young group were the palatal bone wall (P=0.006) and history of cleft palate surgery (P=0.012), but only the palatal bone wall affected the outcome in the old age group (P=0.036).@*CONCLUSIONS@#The results of alveolar bone grafting for the old age group were worse than those for the young age group. The palatal bone wall was an important factor that affected alveolar bone grafting, and alveolar bone grafting in the young patients was influenced by the history of cleft palate surgery.

Two-stage alveolar bone grafting for nasal floor reconstruction in adult cleft patients / 华西口腔医学杂志

Alveolar cleft is one of the key links of cleft lip and palate reconstruction due to its close relationship with tooth and jaw coordination and nasolabial deformity. The alveolar bone graft repairs the hole in the gum ridge and stabilizes the bone arch, providing better support for the base of the nose and new bone for the roots of the developing teeth to grow into. Unfortunately, bone graft failure in the traditional way, even among minor clefts, bony hypoplasia, or absence that affects the nasal base and piriform rim, is common. Two-stage alveolar bone grafting, which has advantages in addressing the underlying skeleton and deficiency, could be an optional surgical procedure for nasal floor reconstruction in adult patients with a broad alveolar cleft.

Condición Periodontal de los Dientes Temporales Adyacentes a la Hendidura Alveolar en Pacientes con Labio y Paladar Hendido Unilateral No Sindrómico, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Caja Costarricense de Seguro Social

RESUMEN: Los dientes adyacentes a la hendidura alveolar, en pacientes con labio y paladar hendido, presentan mayor incidencia de problemas periodontales, según la literatura. El objetivo de este trabajo fue evaluar si los dientes temporales adyacentes a la hendidura alveolar presentan mayor incidencia de problemas periodontales en niños con labio y paladar hendido unilateral completo no sindrómico, nacidos en 2010 y 2011, atendidos en el Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Caja Costarricense de Seguro Social. Este estudio prospectivo, transversal, descriptivo, e intervencional evaluó variables epidemiológicas, clínicas y radiográficas (placa bacteriana, profundidad de bolsa, nivel de inserción, recesión gingival, sangrado, encía queratinizada e insertada, cálculo y movilidad dental, tipo de hendidura alveolar). Se utilizó técnicas de análisis estadísticos descriptivas (distribución de frecuencias, cruce de variables y construcción de intervalos de confianza). El análisis de datos y procesamiento estadístico se realizó en SPSS versión 17.0 y en Excel. El grupo constó de 17 pacientes, con edad promedio de 5 años. Se encontró 47 % de placa dental y 0 % de cálculo dental. La profundidad de bolsa y el sangrado fueron estadísticamente mayores para los dientes dentro de la hendidura alveolar. Los dientes adyacentes a la hendidura presentaron menor cantidad de encía queratinizada e insertada. Referente a la movilidad dental no existe diferencia estadísticamente significativa. Solo un diente presentó recesión gingival. La hendidura alveolar completa predominó radiográficamente. Los dientes cercanos a la hendidura alveolar tienen mayor predisposición a problemas periodontales, por lo que es relevante el seguimiento regular de la salud periodontal.

ABSTRACT: The teeth adjacent to the alveolar cleft, in patients with cleft lip and palate, present a higher incidence of periodontal problems, according to the literature. The purpose of this study was to evaluate whether the temporary teeth adjacent to the alveolar cleft present a higher incidence of periodontal problems in children with non-syndromic complete unilateral cleft lip and palate, born in 2010 and 2011, treated at the Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Caja Costarricense de Seguro Social. This prospective, cross-sectional, descriptive, and interventional study evaluated epidemiological, clinical and radiographic variables (bacterial plaque, pocket depth, insertion level, gingival recession, bleeding, keratinized and inserted gingiva, dental calculus and mobility, type of alveolar cleft). It used descriptive statistical analysis techniques frequency distribution, crossing of variables and construction of confidence intervals. Data analysis and statistical processing was performed in SPSS version 17.0 and in Excel. The group consisted of 17 patients, with an average age of 5 years. 47 % dental plaque and 0 % dental calculus were found. Pocket depth and bleeding were statistically higher for teeth in the alveolar cleft. The teeth adjacent to the cleft had less keratinized and inserted gingiva. Regarding dental mobility, there is no statistically significant difference. Only one tooth had gingival recession. The complete alveolar cleft predominated radiographically. Teeth close to the alveolar cleft have a greater predisposition to periodontal problems, so regular monitoring of periodontal health is relevant.

Orthodontic treatment in cleft lip and palate team approach / 口腔疾病防治

@#Orthodontic treatment for dentofacial deformity is fundamental throughout the entire management process of cleft lip and palate. Orthodontist is one of those who are indispensable in the comprehensive multidisciplinary cleft team. Cleft lip and palate patients have unique dentofacial characteristics which makes the treatment goals and strategies different from those of other patients in different stages. For newborns with cleft lip and palate, the main treatment includes presurgical orthopedics. For patients in their primary dentition stage, the treatment mainly focuses on the prevention of bad oral habits and severe malocclusion. For those in their mixed dentition stage, the treatment mainly consists of dentition preparation for alveolar bone grafting and skeletal growth modification. For patients in their permanent dentition stage, treatment strategies include orthodontic camaflouge treatment, combined orthodontic-orthognathic approach and segmental alveolar distraction osteogenesis. In addition to routine orthodontic treatment, orthodontists should pay special attention to managing the compliance of cleft lip and palate patients with unique psychological characteristics. By summarizing the state-of-art cleft lip and palate orthodontic care in the multidisciplinary team, this review aims to involve more orthodontic clinicians to join in the modern biopsychosocial medical practice of cleft lip and palate team approach and to improve the standard of care for cleft lip and palate patients.

Application of autologous platelet-rich plasma in the repair of alveolar cleft / 中华整形外科杂志

Alveolar cleft is a congenital maxillofacial deformity, associated with cleft lip and palate. Autologous bone transplantation is the gold standard for alveolar cleft repair. However, this method has many shortcomings. Autogenous platelet-rich plasma (PRP) is concentrated platelet, obtained by the centrifugation of fresh autologous whole blood. After activation, a variety of highly concentrated growth factors could be quickly released. Then the PRP gel is formed. It is able to locally conglutinate transplanted bone particles, and prevent the displacement and loss of them. It also could repair tissue defect, prevent platelet loss, promote the platelet secreting growth factors for a long time. The combination of PRP and autologous bone transplantation, to a certain extent, could make up for the limitations of bone transplantation. Therefore, the concept, preparation, application, progress, mechanism and advantages of PRP in alveolar cleft repair were detailedly reviewed.

Proteína morfogenética ósea y su opción como tratamiento de la fisura alveolar / Bone morphogenetic protein and its option as an alveolar cleft treatment

La proteína morfogenética ósea (BMP), es una proteína endógena que ha mostrado efectos significativos en la promoción de la formación ósea. El uso de BMP ha sido descrito en la reconstrucción de defectos óseos de origen traumáticos y patológicos, incluyendo la fisura alveolar, el aumento de reborde alveolar, la elevación de seno maxilar, el injerto de alveolo post-extracción, y la cirugía perimplantaria entre otros. A pesar de las ventajas asociadas al uso de BMP y que en la actualidad se aplica en combinación con matrices de colágeno, ciertas propiedades tales como su baja resistencia mecánica y su elevada tasa de liberación inicial disminuyen su eficacia en la formación ósea. En este contexto, el desarrollo de nuevos sistemas de liberación prolongada de BMP que permitan la quimiotaxis de células mesenquimáticas y su posterior diferenciación a osteoblastos representa un desafío con alto potencial clínico para la estimulación de la formación ósea. En este trabajo, se describe el uso de BMP en la reconstrucción de fisuras alveolares y en particular se discuten las ventajas de su administración en micropartículas poliméricas comosistemas de liberación de BMP (rhBMP-2) con promisorias aplicaciones en la estimulación de la formación ósea.

Bone morphogenetic protein (BMP) is an endogenous protein that has shown significant effects in the promotion of bone formation. BMP also has been described in the reconstruction of traumatic and pathological bone defects, including alveolar cleft, alveolar ridge augmentation, maxillary sinus elevation, and applications in post-extraction alveolus graft, and peri-implant surgery among others. Despite the advantages associated with the use of BMP, currently is applied in combination with collagen matrices, which has certain properties such as low mechanical resistance and a high burst initial release that diminish its effectiveness in bone formation. In this context, the development of novel systems with greater mechanical resistance and prolonged release of BMP, that lead to chemotaxis of mesenchymal cells, following by its differentiation to osteoblasts represents a major challenge that holds outstanding clinical potential for the stimulation of bone formation. In this paper, we describe the use of BMP for the reconstruction of alveolar clefts, and its advantages being administrated in polymeric microparticles as sustain release system with promising applications in the stimulation of bone formation.

Use of mandibular chin bone for alveolar bone grafting in cleft patients / 대한악안면성형재건외과학회지

BACKGROUND: We evaluated and compared the outcomes of different ossification processes in patients with alveolar cleft in whom correction was performed using endochondral bone graft or intramembranous bone graft. METHODS: The patients were divided into two groups: the endochondral bone (iliac bone or rib bone) graft group and the intramembranous bone (mandibular bone) graft group. Medical records and radiologic images of patients who underwent alveolar bone grafting due to alveolar cleft were analyzed retrospectively. Through postoperative and follow-up radiologic images, the height of the interdental bone septum was classified into four types based on the highest point of alveolar ridge. Then, the height of the interdental bone septum and the area of the bone graft were evaluated according to the type of bone graft. In addition, the occurrence of complications and the need for an additional bone graft, the result of postoperative orthodontic treatment, and the eruption of impacted teeth were investigated. RESULTS: Thirty patients were included in this study. There was no significant difference in the change of the interdental bone height and the area of the bone graft according to the type of bone. There was no significant difference in the success rate of the surgery according to the type of bone. One patient underwent an additional bone graft surgery during the follow-up period. CONCLUSIONS: The outcomes of alveolar bone grafting were not significantly different according to the type of bone graft. If appropriate to the size of the recipient site, the chin bone is a useful graft material in alveolar cleft, as is the iliac bone.

Clinical application of heterogeneous acellular dermal matrix used in alveolar bone grafting / 中国医师进修杂志

Objective To observe the effect of bone repair and evaluate its esthetic outcome with heterogeneous acellular dermal matrix cover the alveolar cleft bone grafting area in the alveolar cleft operation.Methods In 67 cases,unilateral cleft palate,were treated by alveolar cleft conventional surgical method.Cancellous iliac bone grafting were control group,heterogeneous acellular dermal matrix cover the alveolar cleft bone grafting area were treatment group.Radiographs was taken at 1 st,3 rd,6 th,12 th,18 th,24 th month postoperatively to observe the bone regeneration alveolar cleft zone.Results The alveolar cleft graft area new bone formation with Ⅰ,Ⅱ,Ⅲ,Ⅳ grade after 6 months in control group was 15,11,9,6 cases and in treatment group was 13,9,3,1 case.The graft survival rate and success rate (97.8％,84.3％) of treatment group were higher than that of control group (84.5％,63.7％),the difference was statistically significant (P ＜ 0.05).Conclusion The successful rate of operation could be warranted,by the joint application of autogenous iliac bone grafts and heterogeneous acellular dermal matrix in the alveolar cleft operation.

Alveolar cleft graft

Comparison of autologous ilium spongy bone combined with human decalcified dentinal matrix in alveolar process cleft bone grafting / 实用口腔医学杂志

Objective: To study a new method of alveolar cleft bone grafting. Methods: Group A: 62 cases (74 sides) alveolar cleft patients were transplanted with self-ilium spongy bone. Group B: 26 cases (30 sides) alveolar process patients used autologous ilium combined with DDM. Anterior occlusal radiographs and panoramic oral radiogram were taken before and after the operation to observe if there was new bone formation in the bone grafting area. According to Bergland grade criterion, analyzed the X-ray results after 3 months of the operation. Results: Group A: 17cases(17 sides) in class 1 group(23%), 17 cases(20 sides) in class 2 group(27%), 13 cases(14 sides) in class 3 group (19%), 15 case(23 sides) in class 4 group(31%). The overall survival rate of ABGR was 68.9%, and the clinical success rate was 50 %;Group B:16 cases(16 sides) in class 1 group(53.3%), 7 cases(8 sides) in class 2 group(26.7%), 2 cases(4 sides) in class 3 group (13.3%), 1 case(2 sides) in class 4 group(6.7%). The overall survival rate of ABGR was 93.3%, and the clinical success rate was 80%. Conclusion: Ilium spongy bone combined with DDM is good for alveolar process cleft bone grafting. It is better to use decalcified dentinal matrix of human than autologous ilium spongy bone.

Correction of a Wide Alveolar Cleft with Reverse L Osteotomy and Liou Alveolar Distractor

PURPOSE: A successful surgical treatment for a wide alveolar cleft with bone graft is difficult to achieve due to several factors such as limitation of gingivoperiosteal flap, presence of large scar tissues, and poor blood circulation. To overcome these problems, alveolar distraction osteogenesis using Liou alveolar distraction device was applied. We analyzed the consequences of this surgical treatment. METHODS: From January 2006 to August 2007, we have conducted analysis on the methods and consequences of Liou alveolar distraction osteogenesis for 6 patients. The age of patients was 12 years and 6 months on average. The follow up period was 19months on average. The reverse L osteotomy followed by the placement of the Liou alveolar distraction device was performed. After serial distraction, the distractor was removed after 5 months of the process of osteogenesis. The results were analyzed using the computed tomography and the x-ray films of the alveolar bone and the teeth. RESULTS: The alveolar cleft with 12.5mm on average width was filled with 8.5mm of newly formed bone tissue on average width after 5 months of osteogenesis. Among the 6 cases, 5 required the additional bone graft and 1 case only required the gingivoperiosteoplasty. The newly formed bone tissues did not show any signs of bone resorption. However, a considerable degree of teeth displacement was noted. CONCLUSION: For the alveolar cleft too wide to be reconstructed by a general bone graft, it is strongly recommended to perform the reverse L osteotomy of the cleft side with Liou alveolar distraction device to initiate the alveolar osteogenesis. However, the migrated teeth showed some degree of relapse, thus, the orthodontic treatment is essential following the distraction osteogenesis treatment.

Effect of Bone Marrow Aspirate with Autogenous Bone Graft for Alveolar Cleft in a New Rabbit Model

PURPOSE: Alveolar bone grafting has become an essential process in the treatment of alveolar cleft patient for stabilization of the maxillary arch, elimination of oronasal fistula, the reconstruction of the soft tissue nasal base support, and creation of bony support for tooth eruption for implant. The use of Autologous iliac cancellous bone is preferable because it enables to use adequate quantity and its high osteoinductive potential. However, even with iliac bone, insufficient osteoregeneration or absorption occurs due to several factors such as the patient's age, cleft width, functional stress, and others. In order to increase osteoregeneration where the iliac bone is placed, the present study is associated with bone marrow aspirate(BMA).The experimental study evaluated the efficacy of osteoregeneration in normal cleft rabbits when alveolar bone grafting was performed with autologous iliac corticocancellous bone. METHODS: Twenty-four New Zealand White rabbits were divided randomly into 2 groups(BMA, control). All animals underwent harvesting of corticocancellous bone graft from the right posterior iliac crest via standard surgical technique. 1mL of BMA were obtained by scraping the needle and aspirate with 10mL syringe from the contralateral iliac bone wall. The muco-periosteal flap on the palate was elevated. A mixture of Equal bone's volumes with BMA and saline as its control was inserted into the cleft. Animals were sacrificed in 2, 4, and 8 weeks and maxilla was harvested for dental peri-apical X-ray, bone matrix density (BMD), and histologic analysis. RESULTS: BMD of regenerated bone to the cleft in the rabbits was higher than that of the control rabbits. X-ray, histologic analysis showed that increased osteoregeneration and low absorption rate were observed in the BMA group. CONCLUSION: Our experimental study shows BMA enhanced the osteoregeneration and survival rate of alveolar bone grafting. BMA is easy to extract and cost-time effective. So it can be an effective enhancers for bone grafting mixtures.

Analysis of Repeated Bone Graft after Secondary Bone Graft in Children with Alveolar Cleft

PURPOSE: The most widely accepted protocol for alveolar cleft reconstruction is to repair it during the mixed dentition stage. There were lower resorption rate (about 88%) at this stage. However we found some cases that need repeated bone grafting. Therefore we sought to analyze the cause of repeated alveolar bone grafting in connection with other factors. METHODS: From January 2000 to January 2006, thirty-nine secondary alveolar bone grafts with iliac crest spongiosa were carried out. In 39 patients, 5 patients who had significant bone graft resorption received repeated alveolar bone graft. In all the cases, the causes of repeated bone grafts were dental root exposure(angulation), and the deficiency of the bony support for lateral incisor or canine eruption. In 3 cases, there was deficiency of the alveolar bone at the cleft side. There was the need of repeated bone grafts for orthodontic treatment in 2 cases and for application of dental implants in 1 case. RESULTS: During the follow-up period, the clinical and radiologic examinations showed that repeated alveolar bone grafts were maintained successfully without any complications. The volume of the repeated bone graft was sufficient for orthodontic treatment and implantation. CONCLUSION: The essential conditions for successful alveolar bone grafting includes the status of cleft sided teeth, further treatment and planed schedule, as well as canine eruption. Alveolar bone grafting has to be performed with difference of each case in mind.

Prenatal Diagnosis of Accompanying Alveolar Cleft and Cleft Palate in Fetuses with Cleft Lip Using Prenatal 3D Sonographic Identification and Antenatal Counseling

PURPOSE: Cleft lip and/or palate is the most common congenital facial anomaly whose incidence is about 1 in 500~1000 live births. As this anomaly may be associated with the serious chromosomal anomalies or the multiple organ abnormalities resulting in the fetal loss or perinatal maternal morbidity and mortality, careful prenatal counseling with early and accurate detection is important. Although conventional prenatal ultrasound(US) examination in midterm pregnancy has been applied for screening of cleft lip, there are definite limitations in the diagnosis of accompanying cleft palate or alveolar cleft. We applied high-resolution 3D US along the serial axial, coronal and sagittal plane so that we could diagnose the cleft palate and/or alveolar cleft in fetuses with cleft lip. METHODS: From May 2005 to September 2005, 20 fetuses with cleft lip were examined with prenatal 3D US. Average maternal age was 28.8 years old(24-35 years old), and average gestational age was 24.8 weeks(17.6 to 34.2 weeks). Consecutive axial, coronal and sagittal multislice view were obtained via prenatal 3D US examination and diagnosis of cleft palate and/or alveolar cleft in cleft lip fetuses was followed. RESULTS: With noninvasive and safe prenatal 3D US examination, 17 of 20 cleft lip fetuses were demonstrated to have cleft palate and/or alveolar cleft. Prenatal counseling according to the result was made. CONCLUSION: Existing prenatal US examination is suitable for screening the cleft lip fetuses but has limitation in identifying the related existence of cleft palate and/ or alveolar cleft. Authors verify the presence of cleft palate and/or alveolar cleft acquiring the successive multislice axial, coronal, and sagittal view with prenatal 3D US examination. Therefore, prenatal 3D US examination could be regarded as a noninvasive and secure screening modality in fetuses with cleft lip for confirming whether cleft palate and/or alveolar cleft is accompanied.

The Long-term Results of Early Rib Bone Graft in the Alveolar Cleft

There are controversies in timing of the bone graft in the alveolar cleft. In many hospitals, secondary alveolar bone graft is performed and many surgeons or orthodontists maintain that primary or early bone graft have several disadvantages such as maxillary retrusion and poor maxillary development. But Nylen et al. and Rosenstein have reported favorable results. We treated 4 patients of unilateral complete alveolar cleft using early rib bone graft. Presurgical infantile orthodontics were done. At 12 weeks of age the cleft lip was corrected. The repaired lip has molding effect on the greater segment toward the lesser. When good arch alignment had been obtained after the molding period, bone graft was inserted between the segments. We analyzed these 4 patients by using cephalometric analysis, panoramic, occlusal, periapical radiograph and 3D-CT at the age of 12 years 10 months in average and evaluated the survival of the bone graft, facial growth and tooth eruption. In all patients, the grafted rib bones were absorbed partially. The 3 patients without cleft palate have normal maxillomandibular relation but the eruption of teeth was disturbed. The other patient with the cleft palate shows severe maxillary retrusion and disturbed tooth eruption including delayed eruption, underdevelopment and malposition. The additional iliac bone graft were performed in 2 of the patients and is scheduled in the other 2 patients In conclusion early rib bone graft in the alveolar cleft was not successful because of absorption which caused disturbance of teeth eruption.

Longitudinal Evaluation of Secondary Iliac Bone Grafting in the Alveolar Cleft

Secondary bone grafting in the alveolar cleft has proven effective in stabilizing the maxillary segments, providing continuity of the maxillary arch and facilitating the canine eruption into the proper position. The purpose of this study is to longitudinally evaluate the treatment results of secondary iliac bone grafting in 40 alveolar cleft patients with an observation period of more than 12 months. Interdental alveolar cleft height was measured in conventional dental radiographs taken no more than 1 month preoperatively, following the completion of all orthodontic expansion, using ratio of the adjacent tooth root and the narrowest point of cleft height. And then we measured the bone resorption rates in 1, 3, 6, and 12 postoperative months, respectively. There was significant positive correlation between presurgical alveolar cleft height and postoperative bone resorption rate. But there was not significant correlation between presurgical alveolar height and the age at operation. The overall success rate for achieving bony bridge across the cleft was 95%. The maximal bone resorption occured in 1 month after operation. In case that the secondary iliac bone graft was performed at the patient's pre-eruption stage of canine, 89% of the patient's canine erupted in 12 months after operation.

The Treatment of Wide Alveolar Cleft: Bilateral Interdental Distraction Osteogenesis

Alveolar bone graft has several benefits such as bony support to teeth adjacent to the cleft, bony matrix for eruption of teeth in the line of the cleft, stability of maxillary segments, and elimination of oronasal fistula. But wide gap alveolar cleft is difficult to treat using bone graft, because a large amount of bone harvesting is required and complete closure by using local attached gingiva is difficult to achieve. Therefore we introduced bilateral interdental distraction osteogenesis method to treat patients who had wide alveolar gap. From August, 1999 to April, 2000, we treated 4 patients of unilateral complete alveolar cleft(aged 10 - 4 years) by using this method. Distraction device was fitted to the supporting teeth. And then horizontal osteotomy was performed bilaterally at the level of 3 - 5 mm away from the dental roots, vertical osteotomy was performed between the second premolar and the first molar. Simultaneously, oronasal fistula was repaired. After the latency period of 3 to 5 days, we distracted bilateral distal segments as distraction protocol. After completing distraction, device was left for about 4 weeks before initiating the post-operative orthodontic treatment. The alveolar bone graft and buccal mucosa local flap were not required in these patients. By using interdental distraction osteogenesis, wide gap alveolar cleft was treated effectively.

Reconstruction of alveolar clefts with iliac cancellous particulate or block bone grafts: a comparative study

OBJECTIVE: The objective of this study was to determine which forms of iliac cancellous bone grafts better restore alveolar clefts. STUDY DESIGN: Forty consecutive patients who required a unilateral alveolar cleft graft were studied. Group I(20 patients) had reconstruction with iliac cancellous particulate bone grafts and group II(20 patients) had reconstruction with iliac cancellous block bone grafts. The two groups were evaluated radiographically and clinically. RESULTS: The group with the block bone grafts showed less postoperative problems and better incorporation of the bone graft than the group with the particulate grafts. CONCLUSION: Surgical reconstruction of alveolar process defects in patients with alveolar cleft using iliac cancellous block bone is a more reliable method than particulate bone grafts both for closing the oronasal fistula and for building interalveolar septal height.