Grafting in Alveolar Clefts With Implant Placement

Journal of Oral and Maxillofacial Surgery, 1997

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2008

Objective. The purpose of this study was to evaluate the long-term follow-up of dental implants placed in the grafted alveoli of patients with cleft lip or palate clinically. Patients and methods. Sixteen patients (8 males and 8 females) who had dental implants placed in alveoli grafted using particulate cancellous bone and marrow (PCBM) from the iliac crest were evaluated. The marginal bone level around the implant was evaluated radiologically at 1 (stage I), 3 (stage II), and 6 years (stage III) after connecting the abutment. The interdental alveolar bone height (IABH) was also evaluated radiologically for up to 6 years. Results. During the follow-up period of an average of 8.6 Ϯ 0.6 years (range: 7.2 to 9.4 years), only 2 implants were lost in 1 patient, the cumulative survival rate was 90.9%, and the clinical outcome was uneventful in all implants. The marginal bone levels around the implants were 0.29 Ϯ 0.18, 0.29 Ϯ 0.19, and 0.28 Ϯ 0.15 mm at stages I to III, respectively. Moreover, IABH was reduced only in 2 of 16 (12.5%) of the implant-placed grafted alveoli, and was maintained after implant placement for up to 6 years.

The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association, 2018

To evaluate 2 iliac corticocancellous-block grafting techniques for dental implant placement in residual alveolar clefts. Nonrandomized prospective clinical trial between March 2010 and December 2014. National Hospital of Odonto-Stomatology, Hanoi, Vietnam. Thirty-two patients (23 female, 9 male; mean age, 21.28 years; range, 16-31 years) with unilateral complete alveolar cleft after reconstructive surgery for cleft lip and palate (CLP). Harvested iliac crest bone was cut into 2 corticocancellous blocks. The smaller block was adapted against the sutured nasal mucoperiosteum and overlaid with cancellous bone; the larger one overlapped the labial cleft margin and was fixed with screws. Endosteal dental implants were placed after 4 to 6 months, and final restorations were delivered 6 months later. Flap statuses were assessed clinically. Bone formation was assessed using the Enemark scale. Cone-beam computed tomography was used for graft height and width measurements. Implant health was...

The International Journal of Periodontics & Restorative Dentistry

Journal of Oral and Maxillofacial Surgery, 2009

Alveolar bone grafting is an integral part of the surgical management of oral clefts. The rationale behind alveolar cleft repair includes maxillary arch stabilization, closure of the oronasal fistula, nasal base support, nasolabial soft tissue reconstruction, and creation of bony support for tooth eruption or dental implant placement. Currently, the graft material of choice is autogenous bone graft from the anterior iliac crest. Nonetheless, autogenous bone grafting carries the significant risk of donor-site morbidity, leads to postoperative pain, and entails an additional operative cost. With the success of allograft bone material in implant site development, we explore the option of using human mineralized cancellous bone allograft in alveolar cleft patients. This article reports on the success of using mineralized human allograft to treat 2 adult patients with severe alveolar cleft defects. The repairs were accomplished with a guided bone regeneration technique without the use of any autogenous bone, with subsequent successful placement of endosseous implants. This opens up the possibility of avoiding harvesting iliac crest bone graft and its associated morbidities and expense by use of only mineralized allograft and a guided bone regeneration technique in an outpatient office setting.

Dental Press Journal of Orthodontics, 2013

INTRODUCTION: Secondary bone grafting consists in a routine procedure on the treatment of patients with alveolar cleft. Usually, it is performed by the end of the mixed dentition, when the permanent canine is erupting, with autogenous cancellous bone from the iliac crest. OBJECTIVE: The present article discusses the alternative of autogenous bone grafting with allogeneic bone, obtained from human bone bank, illustrating the result with the presentation of a clinical case of left unilateral alveolar cleft.

Türkiye klinikleri diş hekimliği bilimleri olgu dergisi, 2016

econdary alveolar bone grafting provides a reliable method in the management of patients with alveolar clefts. Successful grafting is important in terms of maxillary arch stabilization by uniting the segments, supporting for soft tissue nasal base and lip, closure of oronasal fistulae, reconstruction of the hypoplastic piriform aperture. The main advantage of alveolar bone grafting is the ability of moving the teeth by means of orthodontics into previous cleft sites. There are numerous sources of bone graft including calvarium, ribs, outer site of the parietal bone, mandibular symphysis, tibia and iliac crest. Among these bones the gold standard for secondary grafting is the iliac crest. However, alternative donor sites are required to avoid post-op pain, scar tissue causing esthetical problems and long hospitalization period. Therefore, if the cleft area is not too wide and mandibular 3 rd molars are impacted with no chance to erupt, the bone over the impacted teeth can be used as bone graft material in such cases.

The Cleft Palate-Craniofacial Journal, 2003

Objective To longitudinally evaluate the outcome of secondary bone grafting (SBG) using computed tomograms (CTs) and conventional dental radiographs. Subjects Nineteen alveolar clefts from 17 patients were used in this study. Method A two-dimensional evaluation of SBG was performed using dental radiographs at 1 year after SBG by assigning scores of 1 to 4 (from very good to poor) based on postoperative marginal bone level on the alveolar side. On the basis of postoperative marginal bone levels on the nasal side, clefts were also assigned to groups with the bony bridge on or above (group I) or below (group II) a horizontal reference line. Three-dimensional evaluation of the SBG was performed on horizontal CT slices with the residual cortical bone (RCB) ratio before SBG (T0) as well as 1.5 (T1), 3 (T2), 6 (T3), and 12 months (T4) after SBG. Results The RCB ratio at T4 in the group with scores 1 and 2 was significantly smaller than that of score 3. Furthermore, the mean RCB ratio at T4...

International Journal of Medical Arts, 2021

Background: Orofacial clefts are common congenital malformations, with alveolar cleft as the most common [75%] of all anomalies. Many treatment modalities are available. However, our clinical experience with bone graft modality is not well addressed. The aim of the work: To evaluate the effectiveness of early [2 to 12 years; before complete eruption of the cleft canine] versus late [> 12 years; after complete eruption of the cleft canine] cancellous anterior iliac bone grafting for alveolar cleft reconstruction. Patients and Methods: Twenty-three patients with alveolar clefts who were admitted for alveolar cleft reconstruction surgery were included. They were categorized into early and late secondary grafting groups. All patients inquired about their history. Submitted to full clinical examination, laboratory and radiological examinations. The imaging studies include two-dimensional orthopantomogram for all patients, while 3-D fascial computed tomography and cone-beam computed tomography were done for selected patients. Both intraoperative and postoperative data were collected, any complications were registered and patients followed up regularly up to 6 months. Results: Both groups were comparable as regarding patient characteristics except younger age in early group, and there was a statistically significant difference between early and late groups regarding cleft side and cleft permanent canine full eruption. Males represented 69.9%. The cleft was on the left side in 56.4%. Seven patients [30.4%] had maternal risk factor [five in early and two in late group]. Blood loss was less than 80 ml in all patients in both groups. All oronasal fistulas were sealed off successfully in all patients [100%] and all had normal healthy gingival contour with vital teeth adjacent to the cleft. All showed evidence of good bone filling in the alveolar defect after 6 months postoperatively. Only one patient developed hypertrophic scars at each group. Conclusion: Alveolar cleft reconstruction is preferred to perform autologous cancellous bone grafting harvested from the iliac crest bone to repair the cleft with excellent outcome on short-term follow-up.