Alveolar bone morphology of maxillary central incisors near grafted alveolar clefts after orthodontic treatment

Prognosis of Maxillary Central Incisors in Patients with Bilateral Cleft Lip/Palate

Evaluate periodontal bone support of maxillary central incisors (MCI) in patients with bilateral complete cleft lip and palate (BCCLP). Determine if syndromic diagnosis, age at time of alveolar bone graft (ABG), presence of maxillary lateral incisor (MLI), history of dentofacial orthopedics, maxillary expansion, and pre-maxillary osteotomy are associated with the periodontal bone support of MCI.

Retrospective radiographic study.

Tertiary care children's hospital.

One hundred seventy-nine patients with BCCLP (22 syndromic) who had post-operative ABG cone beam computed tomography (CBCT) scans taken between 2002-2018.

Crown to root (C/R) ratio of MCI measured on CBCT scans.

The C/R ratio in 65% of MCI indicated periodontally compromised teeth. Presence of a MLI improved bone support on adjacent MCI when compared to those missing a MLI (51.4% vs 28.4%, P = .010). There was no significant difference in C/R ratios for syndromic diagnosis, age at ABG, history of dentofacial orthopedics, maxillary expansion, and pre-maxillary osteotomy.

The majority of MCI in patients with BCCLP are periodontally compromised but bone support is improved when cleft adjacent lateral incisors are present.

Data on alveolar mandibular bone thickness in Class I skeletal patient with bimaxillary protrusion

The alveolar bone thickness influences both diagnosis and limitation of tooth movement, therefore significance retraction was commonly applied in treating patients with bimaxillary protrusion. This is a retrospective data collection of pre and post treatment lateral cephalographs from 18 to 40 years old patient treated with four premolars extraction. The alveolar mandibular bone thickness was identified in sagittal planes with Image-J software based on cephalometry lateral radiographs. Statistical analysis namely Wilcoxon test and Pearson correlation analysis coefficient were used to understand the correlation of alveolar mandibular bone thickness variables and mandibular incisors position to skeletal profile treated with first premolars extraction are presented. This data is essential for advancing in a further understanding of Class I skeletal patients with bimaxillary protrusion.

Does Timing of Secondary Alveolar Bone Grafting Affect the Need for Additional Bone Augmentation Prior to Implant Placement at Cleft Sites?

PURPOSE

The purpose of this study was to identify factors that influence the need for a supplemental bone graft prior to dental implant placement at previously grafted alveolar cleft sites.

PATIENTS AND METHODS

Retrospective case series of patients with cleft lip/palate who had both alveolar bone grafting (ABG) and placement of a dental implant(s) to replace a missing incisor(s) at the cleft site by the senior surgeon (BLP) at Boston Children's Hospital from 2005 through 2020. Primary outcome variable was need for a supplemental bone graft prior to dental implant placement. Predictor variables included gender, cleft type (unilateral vs. bilateral), implant site, number of implants placed, age at ABG and implant placement, time between ABG and implant, history of maxillary expansion and whether the patient had a Le Fort I osteotomy to correct maxillary hypoplasia before implant placement. Descriptive statistics were computed and comparative analyses were performed using Pearson X², Fisher exact, and Mann-Whitney U tests.

RESULTS

There were 84 implants placed in 59 patients (64.2% female) with cleft lip and palate who had alveolar bone grafting of which 57.1% (n = 48) required a supplemental graft prior to placement. Median time (IQR) from alveolar bone grafting to implant placement was significantly longer in patients who required additional grafting (8.1 versus 5.4 years, P < .001). Patients who required supplemental bone were significantly younger at the time of alveolar bone grafting (10.1 versus 12.3 years, P < .001). Cleft sites in patients who had a Le Fort I osteotomy prior to implant placement required bony augmentation more often than cleft sites in patients who did not have a Le Fort I osteotomy (58.7% versus 33.3%, P = .03).

CONCLUSIONS

Patients with cleft lip and/or palate who undergo alveolar bone grafting should be counseled that they are likely to require a supplemental bone graft prior to implant placement.

Alveolar bone heights of maxillary central incisors in unilateral cleft lip and palate patients using cone-beam computed tomography evaluation

PURPOSE

The aims of this retrospective cross-sectional study were to measure and compare labial and palatal alveolar bone heights of maxillary central incisors in unilateral cleft lip and palate patients, following STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines.

PATIENTS AND METHODS

The study group consisted of 21 patients with a mean age of 16 years. High-resolution cone-beam computed tomography was performed at least one year after secondary alveolar bone grafting. The experimental side was the cleft side and the contralateral side without congenital cleft was the control. Measurements were performed on incisors' midsagittal cross-sections. The Wilcoxon signed-rank test was used for intergroup comparisons.

RESULTS

The labial and palatal distances between alveolar bone crests and cementoenamel junctions were significantly greater on the cleft side than on the noncleft side. Mean differences were 0.75 and 1.41 mm, respectively. The prevalence of dehiscences at the cleft side maxillary central incisors was 52% on the labial surface and 43% on the palatal surface. In the controls, it was 19% and 14%, respectively.

CONCLUSION

The cleft-adjacent maxillary central incisors had more apically displaced alveolar bone crests on the labial and palatal sides of the roots than the controls. Higher prevalence of dehiscences was found on the cleft side. Bone margin differences predispose to gingival height differences of the central incisors. These differences could increase the demands of patients to obtain more esthetic treatment results with orthodontic extrusion and periodontal intervention on the cleft side.

A novel method for alveolar bone grafting assessment in cleft lip and palate patients: cone-beam computed tomography evaluation

Objectives

This retrospective cross-sectional study aimed to present a new method for secondary alveolar bone grafting (SABG) assessment and to qualitatively evaluate the SABG results in unilateral cleft lip and palate patients.

Materials and methods

Research was conducted according to the STROBE guidelines. The study group consisted of 21 patients with a mean age of 16 years. High-resolution cone-beam computed tomography (CBCT) was performed at least 1 year after grafting. The experimental side was the cleft side, and the contralateral side without a congenital cleft was the control. Measurements were performed at four levels of the maxillary central incisors’ roots according to the new scale with scores from 0 to 3. The sum of the scores provided a general assessment of bone architecture. The Wilcoxon signed-rank test was used for intergroup comparisons, and a Kappa coefficient was used for reproducibility measurements.

Results

High individual variability was found, and the bone architecture was significantly worse on the cleft side than on the noncleft side. The results showed 28.57% failure, 33.33% poor, 19.05% moderate, and 19.05% good results from the surgical procedure. Kappa coefficients produced results from 0.92 to 1.00 for intra-rater and from 0.81 to 1.00 for inter-rater reproducibility.

Conclusions

CBCT provides detailed information about alveolar bone morphology. The new assessment method is useful at every treatment stage and provides excellent repeatability. SABG did not provide good bone morphology, in most cases.

Clinical relevance

This research presents a new universal alternative for the assessment of SABG by utilizing CBCT.

Electronic supplementary material

The online version of this article (10.1007/s00784-020-03505-z) contains supplementary material, which is available to authorized users.

Eighteen-Year Follow-Up of 160 Consecutive Individuals Born With Unilateral Cleft Lip or Cleft Lip and Alveolus Treated by the Oslo Cleft Lip and Palate Team

OBJECTIVE

Describe patients born with unilateral cleft lip with or without cleft alveolus (CL±A) in relation to cleft severity and laterality, gender, associated anomalies and syndromes, number and type of lip- and nose operations, and time of alveolar bone graft (ABG) treatment in relation to dental status in cleft area.

MATERIALS AND METHODS

Patients included 220 children born with unilateral CL±A, born between 1988 and 1997 referred to the Oslo Cleft Lip and Palate Team. The data were collected retrospectively. All patients were followed up until 18 years of age.

RESULTS

Among all CL±A, 3.6% had recognized syndromes, 6.8% had associated anomalies, and in 89.6% CL±A was the only malformation. CL±A was more common, but not more severe, on the left side. Among the 160 individuals with CL±A without syndromes and associated anomalies, 66.9% had an isolated soft tissue CL, and 33.1% were diagnosed with a CL alveolus (CL+A). Male predominance was observed. Children with CL+A had more severe soft tissue clefts of the lip and underwent more lip and nose surgeries than children born with CL. The time of ABG was found to be at a younger age when the patient had a lateral incisor in the cleft area than when this tooth was missing.

CONCLUSION

Findings provide a reference for morphologic variations in CL±A, and insight into the surgical burden of care until the age of 18 years.