Nonporous hydroxylapatite in the repair of alveolar clefts in a primate model: clinical and histologic findings

Retrospective analysis of secondary alveolar cleft grafts using iliac of chin bone

The osseous closure of alveolar clefts is an integral component of a comprehensive rehabilitation of patients with cleft lip and palate and has assumed an essential position in the reconstruction of cleft deformity. Our study consists of 35 patients aged between 7 and 11 years who received secondary bone grafting of their cleft alveolus over a 30 month period from July 1999 to December 2003. There were 22 (62.9%) males and 13 (37.1%) females. In 25 cases, bone graft was harvested from the iliac crest and in 10 others, from the mandibular symphysis. A total number of 41 osteoplasties was performed in the 35 patients. Twenty osteoplasties maintained an alveolar height up to 75% and approximately that number showed resorption varying between 50% and 75%. There was no case of complete resorption of graft. There were no serious periodontal pockets found. In all cases, the wound healed well, and there was no complication. Our experience demonstrates that secondary alveolar bone grafting is an efficacious method of rehabilitating patients with alveolar clefts.

Cancellous bone grafting in alveolar cleft repair: new experience

Bone grafting plays an important role in the dental rehabilitation of patients with alveolar cleft. During the period between 1993 and 2001, 12 patients with alveolar clefts have been treated in our clinic. Cancellous iliac bone grafts were used in all 12 patients. Seven patients had left and five patients had right complete unilateral cleft lip and complete cleft palate operations. All patients had palatal fistulas. The ages were between 4 and 18 years (mean age, 10.5 y). Seven of them were female (58.4%) and 5 were male (41.6%). All the cancellous grafts survived. Enough filling and the closure of the fistulas were achieved except one patient who had wound dehiscence and partial graft loss. The patients experienced a limp for 2 days (mean time) because of the donor site. This surgical procedure achieves successful results if it is used with the proper indication in suitable cases.

Prospective evaluation of morbidity associated with iliac crest harvest for alveolar cleft grafting

PURPOSE

This study prospectively evaluated the morbidity associated with iliac crest bone harvest when performed for alveolar cleft grafting.

PATIENTS AND METHODS

Twenty-two consecutive patients who underwent an alveolar cleft graft with iliac crest bone harvest were evaluated. The estimated blood loss, length of hip incision, and volume of bone that was harvested were recorded. The duration of time until postoperative ambulation and the length of hospitalization were measured.

RESULTS

All patients tolerated the iliac harvest without major complication, and the volume of bone was sufficient in all but one case. Postoperatively, ambulation occurred at an average of 3 hours 18 minutes. Twenty-one patients were discharged the day after surgery; one patient had the surgery performed as an outpatient.

CONCLUSIONS

Harvesting cancellous bone from the iliac crest does not result in delayed ambulation or prolonged hospitalization. The morbidity that has been reported to occur with iliac crest bone harvest was not consistent with the results of this study.

Osseous response to implanted natural bone mineral and synthetic hydroxylapatite ceramic in the repair of experimental skull bone defects

The purpose of this study was to assess and compare the osseous responses to implanted particles of resorbable anorganic xenograft bone mineral and non-resorbable dense synthetic hydroxylapatite of two different granule sizes. Four trephine calvarial defects were produced in each of 13 adult rabbits. The experimental materials were subsequently implanted in three defects, leaving the fourth defect for control purposes. Six animals were killed 4 weeks after surgery and seven at 14 weeks. The tissue responses were assessed by contact radiography, light microscopy, and histometry. The biocompatibility of the implants was confirmed. All defects healed uneventfully, although the resorbable hydroxylapatite seemed to promote initial bone regeneration. The importance to orthognathic surgery of early and effective healing of bone gaps, as well as of the advantage of implant resorbability to bone remodeling, are discussed.

A comparative investigation on autologous mandibular and iliac crest bone grafts. An experimental study in sheep

Nine Friesian sheep (age 1.5-2 years) were used to evaluate the quality of bone repair in artificial cleft-like maxillary defects repaired with autologous bone grafts of embryologically different origin. After bilateral extraction of the upper first deciduous molar the tooth socket was enlarged resulting in an open connection between the oral and nasal cavities. In the same session a graft, obtained from the iliac crest, was implanted in one of the two bilateral maxillary defects and on the opposite side a graft, obtained from the mandible, was inserted. During the experiment, serial radiographs were taken. After six months the sheep were sacrificed and the bone of the grafted areas was submitted to histological and histomorphometric investigation. Comparing both areas, it appeared that the quality of bone remodelling and alveolar reconstruction was independent of the origin of the grafts.