Optimization of Dental Status Improves Long-Term Outcome after Alveolar Bone Grafting in Unilateral Cleft Lip and Palate

Objective: To determine the rate of revision alveolar bone grafting (ABG) in patients with cleft lip and palate (CLP) before and after the introduction of postoperative computed tomography (CT). Design: Retrospective case–control study analyzing the incidence of revision ABG in patients with and without postoperative CT scans for graft success evaluation. Setting: Academic tertiary care pediatric hospital. Patients: Eighty-seven patients with CLP or cleft lip and alveolus treated with autologous iliac crest bone grafting for alveolar clefts over a 10-year period (January 2009 to March 2019) with minimum 6-month follow-up. Fifty patients had postoperative CT evaluation; 37 did not. Interventions: Postoperative CT to determine ABG success, versus standard clinical examination and 2-dimensional radiographs. Main Outcome Measures: Requirement for revision ABG, defined as failure of the original graft by clinical or radiographic examination. Results: Fifty-eight percent of patients underwent a postoperative CT scan at median interval of 10 months after surgery. Patients with postoperative CT evaluation had a 44% rate of revision ABG (22/50) for inadequate graft take, compared to 5% (2/37) in patients without postoperative CT ( P < .001; 95% CT, 31%-58% in the CT group, 1%-16% in the non-CT group). Conclusions: Computed tomography evaluation after ABG is associated with a significantly increased revision rate for inadequate graft take. The presence of a secondary palatal fistula at the time of original ABG is not associated with revision requirement. Lack of standardized dental and orthodontic records complicates the study of ABG outcomes and presents an area for systems-based improvement.

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Long Term Effects of the Latham Presurgical Maxillary Orthopedic Appliance, Including Effects on Tooth Growth

Canadian Journal of Plastic Surgery ◽

10.1177/229255030000800105 ◽

2000 ◽

Vol 8 (1) ◽

pp. 15-20 ◽

Cited By ~ 1

Author(s):

Michel C Samson ◽

Donald H Lalonde ◽

Donald Fitzpatrick ◽

Gerald L Sparkes

Keyword(s):

Bone Grafting ◽

Cleft Lip ◽

Alveolar Bone ◽

Consistent Difference ◽

Long Term Effects ◽

Beneficial Effects ◽

Alar Base ◽

Alveolar Bone Grafting ◽

Base Elevation

Reported beneficial effects of presurgical maxillary orthopedics in cleft lip include reduction of the cleft width, alignment of the maxillary segments, elevation of the alar base on the cleft side, diminished need for alveolar bone grafting and lip closure without tension. Possible adverse effects of presurgical maxillary orthopedics include tooth root damage and inability of periosteoplasty to make bone over the cleft. A series of wide cleft lip patients (n=15) treated with the Latham appliance at the time of lip closure were retrospectively compared with a similar group treated without the Latham appliance. The Latham appliance group (seven unilateral clefts, eight bilateral clefts; mean follow-up 9.5 years; range four to 18 years) was treated between the years 1980 and 1994. None of the 15 patients treated with the appliance had any tooth loss or damage attributable to the pins, and bone formation in the alveolar cleft was observed radiographically in all 13 of the patients who had a periosteoplasty at the time of lip repair, possibly obviating the need for secondary bone grafting. Five of these Latham group patients demonstrated clinical and radiographic evidence of tooth eruption into the periosteoplasty-formed bone. There was no consistent difference in the level of nasal alar base elevation in the two groups.

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Morbidity of Patients with Cleft Lip and Palate Treated with Alveolar Bone Grafting at About 6 Years of Age

Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.joms.2014.06.026 ◽

2014 ◽

Vol 72 (9) ◽

pp. e14

Author(s):

J.C. Doucet ◽

A.B. Cardoso ◽

C.G. Robertson ◽

D.S. Precious

Keyword(s):

Bone Grafting ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Alveolar Bone ◽

Alveolar Bone Grafting

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Permanent maxillary central incisor and first molar rotations in the mixed dentition in repaired complete unilateral cleft lip and palate and their relationship with absence of teeth in their vicinity

The Angle Orthodontist ◽

10.2319/121117-856.1 ◽

2018 ◽

Vol 88 (5) ◽

pp. 567-574

Author(s):

Sunjay Suri ◽

Suteeta Disthaporn ◽

Bruce Ross ◽

Bryan Tompson ◽

Diogenes Baena ◽

...

Keyword(s):

Bone Grafting ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Alveolar Bone ◽

Permanent Tooth ◽

Mixed Dentition ◽

Central Incisor ◽

Maxillary Central Incisor ◽

Anterior Teeth ◽

Alveolar Bone Grafting

ABSTRACT Objectives: To describe qualitatively and quantitatively the directions and magnitudes of rotations of permanent maxillary central incisors and first molars in the mixed dentition in repaired complete unilateral cleft lip and palate (UCLP) and study their associations with absence of teeth in their vicinity. Materials and Methods: Dental casts and orthodontic records taken prior to orthodontic preparation for alveolar bone grafting of 74 children with repaired UCLP (53 male, 21 female; aged 8.9 ± 1.0 years) were studied. Directions and magnitudes of permanent maxillary central incisor and first molar rotations were recorded. Tooth absence was confirmed from longitudinal radiographic records. Incisor and molar rotations were analyzed in relation to the absence of teeth in their vicinity. Results: Distolabial rotation of the permanent maxillary central incisor was noted in 77.14% on the cleft side, while distopalatal rotation was noted in 82.19% on the noncleft side. Incisor rotation was greater when a permanent tooth was present distal to the cleft side central incisor, in the greater segment. The permanent maxillary first molar showed mesiopalatal rotation, which was greater on the cleft side and when there was absence of one or more teeth in the buccal segment. Conclusions: Presence and absence of teeth were associated with the severity of incisor and molar rotations in UCLP. Crowding of anterior teeth in the greater segment was associated with a greater magnitude of rotation of the cleft side permanent central incisor. Absence of one or more buccal segment teeth was associated with greater magnitude of rotation of the molar.

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Surgical Repositioning of the Premaxilla in Combination with Two-Stage Alveolar Bone Grafting in Bilateral Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1998_035_0304_srotpi_2.3.co_2 ◽

1998 ◽

Vol 35 (4) ◽

pp. 304-309 ◽

Cited By ~ 12

Author(s):

Mitsuyoshi Iino ◽

Tomokazu Sasaki ◽

Shoko Kochi ◽

Masayuki Fukuda ◽

Tetsu Takahashi ◽

...

Keyword(s):

Bone Grafting ◽

Surgical Procedure ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Alveolar Bone ◽

Tooth Movement ◽

Orthodontic Tooth Movement ◽

Two Stage ◽

Alveolar Bone Grafting ◽

Bilateral Cleft Lip

Objective This paper introduces a surgical technique for premaxillary repositioning in combination with two-stage alveolar bone grafting for the correction of the premaxillary deformity of patients with bilateral cleft lip and palate (BCLP). The paper also reports on two patients with BCLP who underwent this surgical management. Surgical Procedure The operation is usually performed when the patient is 8 to 14 years of age. In the first stage of surgery, the side more accessible to the septopremaxillary junction is selected, and an osteotomy of the premaxilla and unilateral alveolar bone grafting are performed. Approximately 4 to 12 months after the first stage of surgery, contralateral alveolar bone grafting is carried out. Conclusion We have found that this surgical procedure is highly effective, because it ensures the blood supply to the premaxilla and minimizes the potential for surgical failure. Moreover, it affords wide exposure of the premaxillary bone surface, facilitating sufficient boney bridging and allowing for orthodontic tooth movement.

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Does Early Secondary Alveolar Bone Grafting Influence Need for Additional Maxillary Advancement Procedures in Cleft Lip and Palate?

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211042789 ◽

2021 ◽

pp. 105566562110427

Author(s):

Kathlyn K. Powell ◽

Paul Lewis ◽

Rae Sesanto ◽

Peter D. Waite

Keyword(s):

Bone Grafting ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Alveolar Bone ◽

Treated Patient ◽

Tertiary Care ◽

Mixed Dentition ◽

Maxillary Advancement ◽

Alveolar Bone Grafting ◽

Secondary Alveolar Bone Grafting

Objective To determine if secondary alveolar bone grafting (SABG) timing in patients with cleft lip and palate (CLP) influences the future need for additional maxillary advancement procedures, particularly Le Fort I osteotomy with rigid external distraction (RED). Design Retrospective cohort study. Groups were separated by SABG timing: early mixed dentition (ages 68 years) or late mixed dentition (ages 9-11 years). The criterion for RED was negative overjet ≥8 mm, and sufficient dental development for RED. Setting Single tertiary care institution. Patients Patients with CLP that underwent SABG from 2010 to 2015. Exclusion criteria included syndromic conditions, SABG surgery at age >12 years, current age <12 years, and <2 years follow-up. 104 patients were included. Main outcome measures The number of RED candidates and treated patients. Results There was no statistical difference in the number of RED candidates ( P = .0718) nor treated patients ( P = .2716) based on SABG timing; stratification by laterality was also insignificant. Early SABG is associated with higher odds of being a RED candidate (pooled, unilateral, bilateral) and treated patient (pooled and unilateral); however, there were no statistically significant associations between SABG timing and the number of RED candidates and treated patients as determined by logistic regression models. Conclusion There is no statistically significant association between SABG timing and the odds of being a RED candidate or treated patient. Future prospective studies are recommended to assess the relationship between SABG timing and maxillary growth in patients with CLP.

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