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Parmar S, Datarkar A, Valvi B, Deshpande A. Evaluation of maxillary alveolar ridge formation and ridge continuity after secondary alveolar bone grafting using cancellous and cortico-cancellous bone graft in unilateral cleft alveolus using cone beam computed tomographic scan - a randomized controlled trial. Oral Maxillofac Surg 2024; 28:315-321. [PMID: 36826684 DOI: 10.1007/s10006-023-01145-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/19/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE The aim of present study was to compare and evaluate the maxillary alveolar ridge formation and ridge continuity using cancellous and corticocanellous bone graft harvested from anterior iliac crest for complete secondary unilateral cleft alveolus defects. MATERIAL AND METHOD All patients were randomized into two groups for secondary alveolar bone grafting. Group I (n = 10) patients treated with cancellous particulate bone graft and group II (n = 10) patients treated with cortico-cancellous block graft. Maxillary alveolar ridge bone formation was assessed with the help of cone beam computed tomography (CBCT) scan using Planmeca Romexis Viewer 5.0 software. Maxillary alveolar ridge continuity was assessed with axial section of CBCT scan and clinical occlusal photograph. Preoperative CBCT scan and occlusal photographs were compared with post-op 6-month CBCT scan and occlusal photographs. RESULT The mean preoperative volume of cleft defect in group I was 4.2576 cm3 whereas in group II it was 4.2268 cm3. The mean postoperative bone bridge formation after 6 months in group I was 4.055 cm3 whereas in group II it was 3.8103 cm3. Preoperative and 6-month postoperative axial sections of CBCT scans were compared and 100% maxillary alveolar ridge continuity was achieved in both groups. The preoperative and postoperative occlusal photographs of both the groups were compared and showed accurate bone and well aligned maxillary alveolar ridge formation in all patients. CONCLUSION The present study concluded that maxillary alveolar ridge formation rate is less in cortico-cancellous iliac crest block graft compared to cancellous iliac crest particulate graft, but is equally good as cancellous bone graft. CLINICAL TRIAL REGISTRATION NO (REF/2020/09/031605)/ CTRI/ 2020/09/028001.
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Affiliation(s)
- Suraj Parmar
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Nagpur, Maharashtra, 440003, India
| | - Abhay Datarkar
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Nagpur, Maharashtra, 440003, India
| | - Bhavana Valvi
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Nagpur, Maharashtra, 440003, India.
| | - Archana Deshpande
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Nagpur, Maharashtra, 440003, India
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Marquez JL, Sudduth J, DeMay H, Kuo K, Battistini A, Yamashiro DK, Siddiqi FA, Gociman B. Early Results on the Efficacy of Demineralized Bone Matrix, Bone Morphogenic Protein, and Freeze-dried Bone Chips in Alveolar Cleft Repair. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5600. [PMID: 38322815 PMCID: PMC10846763 DOI: 10.1097/gox.0000000000005600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/15/2023] [Indexed: 02/08/2024]
Abstract
Background Conventional treatment for alveolar cleft repair is done using autologous iliac crest alveolar bone graft (ABG). However, this method may not be ideal in all patients. Analysis of the efficacy of a mixture of demineralized bone matrix (DBX), bone morphogenic protein (rhBMP-2), and freeze-dried bone chips (FDBC) as an alternative for alveolar cleft repair was performed. Methods Consecutive patients from August 2019 to June 2022 undergoing early alveolar cleft repair, concomitant hard palate and alveolar cleft repair, secondary alveolar cleft repair, and regrafting from a previously failed ABG were analyzed. Computed tomography scans were performed to evaluate graft take at least 6 months postoperatively. Images were reviewed and scored. Alveolar graft height and graft thickness were recorded. A standardized scoring system was developed, with a score of 0 representing no graft take and 3 representing best possible graft take. Results Fifty-five consecutive alveolar clefts (43 patients) were identified as having undergone ABG and satisfied all the other inclusion criteria. Of these, 29 underwent first time ABG and 26 underwent redo ABG. The mean graft height and graft thickness recorded for all clefts was 2.2 and 2.0, respectively. Conclusions Early results evaluating the efficacy of ABG using DBX, rhBMP-2, and FDBC show feasibility in regard to both graft height and thickness when using a maxillary computed tomography scan to measure the bone graft take. These results suggest that DBX, rhBMP-2, and FDBC may act as a versatile bone graft material in cleft care, although further studies are needed to determine long-term outcomes.
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Affiliation(s)
- Jessica L. Marquez
- From Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jack Sudduth
- From Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Henning DeMay
- From Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Keith Kuo
- From Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Andrea Battistini
- From Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Duane K. Yamashiro
- From Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Faizi A. Siddiqi
- From Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Barbu Gociman
- From Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
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Current Concepts and Challenges in the Treatment of Cleft Lip and Palate Patients-A Comprehensive Review. J Pers Med 2022; 12:jpm12122089. [PMID: 36556309 PMCID: PMC9783897 DOI: 10.3390/jpm12122089] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/05/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Cleft lip and cleft palate has one of the highest incidences in the malformations of the oral cavity, that varies between populations. The background underlying the issue of cleft lip and palate is multifactorial and greatly depends on the genetic factors and environmental factors. The aim of this nonsystematic narrative review is to present the cleft palate and or lip pediatric population as target for interdisciplinary treatment. The purpose of this narrative review is to sum up the modern knowledge on the treatment of patients with clefts, as well as to highlight the importance of the great need for cooperation between different dental specialists along with medical professionals such as oral surgeons, prosthodontists, orthodontists along with medical professions such as pediatricians, speech therapists and phoniatrics, and laryngologist.
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Anterior Dental Implant in Grafted Cleft Alveolus: A Clinical Comparison Between Intramembranous and Endochondral Bone Graft. J Craniofac Surg 2022; 34:916-921. [PMID: 36730469 DOI: 10.1097/scs.0000000000009127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/12/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Alveolar bone graft is usually performed during the early mixed dentition phase, at the chronological age of 6 to 8 years old, to reconstruct the cleft alveolus. As the appropriate time for implant placement is after completion of full growth, it can result in a likelihood of resorption. The aim of this study is to compare the clinical outcomes of anterior dental implants with delayed bone grafting using iliac crest (endochondral) and mandibular ramus or symphysis (intramembranous) bone in adolescents to adulthood patients with cleft alveolus. MATERIALS AND METHODS This study included 10 patients with cleft alveolus who underwent delayed bone grafting with autogenous block bone and particulate cancellous bone and marrow (PCBM) from the mandibular ramus and symphysis with dental implant placement, and iliac crest. The success of the treatment was evaluated through clinical and radiographic examination including marginal bone loss measurement of the implants. RESULTS All patients underwent delayed bone grafting between the ages of 11 and 21.1 years (mean age: 15.1±4.3 y). The implant diameters ranged from 3.8 to 4.5 mm and the lengths ranged from 8.0 to 11.5 mm. All of the implants were integrated successfully and survived during the 3-year follow-up period. CONCLUSIONS Delayed bone grafting followed by implant placement showed long-term stability with satisfactory esthetic and functional rehabilitation. One of the main advantages of delayed bone grafting is to achieve adequate bone support for future dental implant placements with less bone resorption compared with those of primary, early secondary, and secondary bone grafting.
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Doucet JC, Russell KA, Daskalogiannakis J, Mercado AM, Hathaway RR, Semb G, Shaw WC, Long RE. Early Secondary Alveolar Bone Grafting and Facial Growth of Patients with Complete Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2022; 60:734-741. [PMID: 35171057 DOI: 10.1177/10556656221080990] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the craniofacial growth outcomes of early secondary alveolar bone grafting(ABG) around 6 years of age. DESIGN Retrospective cohort study. SETTING 1 North-American and 5 Northern-European cleft centers. SUBJECTS 33 subjects with CUCLP consecutively treated with secondary ABG around 6 years of age were compared to 105 subjects from 4 centers treated with late secondary ABG and 19 subjects from 1 center with primary ABG. METHODS Preorthodontic standardized lateral cephalometric radiographs taken after 12 years of age were traced and analyzed according to the Eurocleft Study protocol. Fourteen angular and two proportional measurements were performed. Measurement means from the Study Center(SC) were compared to 5 Northern-European centers using analysis of variance and Welch's modified t-tests, and P < .05 was considered statistically significant. RESULTS For the SC, the mean age ± SD at the time of bone graft was 5.85 ± 0.71 years and the mean age at the time of the lateral cephalogram was 13.4 ± 1.8 years. The sagittal maxillary prominence of the SC was favorably comparable to the 5 Northern-European centers. The mean SNA (78.1 ± 4.3) for the SC was significantly higher compared to 4 of the 5 Northern-European centers(all P < .05), and the mean ANB angle was comparable to 4 of the 5 centers. Similarly, the mean soft tissue ANB angle was not significantly different to the 5 centers. The soft tissue vertical proportions compared favorably to all 5 Northern-European centers(all P < .01). CONCLUSIONS Craniofacial growth outcomes of early secondary ABG around 6 years compare favorably to the outcomes of late secondary ABG.
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Affiliation(s)
- Jean-Charles Doucet
- Department of Oral and Maxillofacial Sciences, 3688Dalhousie University, Halifax, Canada.,Cleft Palate Team, 3682IWK Health Care Center, Halifax, Canada
| | - Kathleen A Russell
- Cleft Palate Team, 3682IWK Health Care Center, Halifax, Canada.,Division of Orthodontics, 3688Dalhousie University, Halifax, Canada
| | - John Daskalogiannakis
- Department of Orthodontics, University of Toronto, Toronto, Ontario, Canada.,Department of Dentistry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ana M Mercado
- Division of Orthodontics, Ohio State University, Columbus, OH, USA
| | - Ronald R Hathaway
- Department of Orthodontics and Pediatric Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Gunvor Semb
- University of Manchester, Manchester, UK.,OsloCleft-CraniofacialCenter, Norway
| | | | - Ross E Long
- Lancaster Cleft Palate Clinic, Lancaster, PA, USA
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Simultaneous Closure of the Cleft Alveolus and Hard Palate with Concomitant Bone Grafting. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4099. [PMID: 35169529 PMCID: PMC8830839 DOI: 10.1097/gox.0000000000004099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/03/2021] [Indexed: 11/27/2022]
Abstract
Cleft repair has been in constant evolution since its inception. Conventional repair of the cleft hard palate involves closure of nasal and oral mucosa without bony reconstitution. In many instances, this approach is adequate, but, particularly in complete clefts, the lack of bony support can lead to collapse of the maxillary arch, dental crowding, and posterior cross-bite. To address these shortcomings, our institution performs a two-staged palatoplasty with concomitant bone grafting of the alveolus and hard palate in the second stage. A retrospective review of children who underwent a two-staged palatoplasty at our institution was performed. These patients’ records and images were reviewed for complications and changes in maxillary morphology. Fourteen patients with complete clefts had a two-staged palatoplasty with bone grafting in the second stage. The mean age at surgery was 37.5 months, and the mean follow-up was 16 months. One patient had resorption of the alveolar bone graft requiring additional bone grafting. The remaining patients were without complications and had good consolidation of the bone graft on follow-up imaging. Our early results support that there is a low complication rate (7% regrafting) in those patients who underwent bone grafting at the time of cleft palate repair with early evidence of bony consolidation on imaging and clinical examination. Wide exposure during the repair allows complete grafting of the maxillary bony deficit, which is not possible with traditional alveolar cleft repair and may alleviate the shortcoming of soft-tissue closure only. Future study is necessary to determine long-term outcomes.
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Brudnicki A, Regulski PA, Sawicka E, Fudalej PS. Alveolar Volume Following Different Timings of Secondary Bone Grafting in Patients with Unilateral Cleft Lip and Palate. A Pilot Study. J Clin Med 2021; 10:jcm10163524. [PMID: 34441820 PMCID: PMC8396845 DOI: 10.3390/jcm10163524] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022] Open
Abstract
This study was intended to evaluate the relationship between secondary alveolar bone grafting (SABG) timing and the alveolar volume in patients with unilateral cleft lip and palate (UCLP). The material consisted of CTs of 35 patients (17 males, 18 females) with UCLP who underwent a one-stage primary cleft repair at a mean age of 8.4 months and SABG at different timings ranges of 1.8–18.8 years. The mean age at CT was 17.2 years. The relative coefficient (Ꞷ) which was independent from factors such as individual maxillary size, gender or age at the CT was introduced in order to compare volumes of the cleft-side in relation to the non-cleft-side alveolus. Pearson correlation coefficient r between Ꞷ coefficient and SABG timing was weak negative (r = −0.34, p = 0.045). The multiple regression analysis implied that the dependent variable-Ꞷ coefficient was associated with independent variables (cleft repair and SABG timings and age at CT) with r2 = 0.228. Only patient’s age at SABG explained the dependent variable (p = 0.003). The study cautiously indicates a tendency to larger alveolar volume following earlier timing of SABG. Nevertheless, the further research on a larger group of patients should be performed before formulating any clinical indications.
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Affiliation(s)
- Andrzej Brudnicki
- Department of Maxillofacial Surgery, Clinic of Pediatric Surgery, Institute of Mother and Child, 01-211 Warsaw, Poland;
- Correspondence:
| | - Piotr A. Regulski
- Dentomaxillofacial Radiology Department, Medical University of Warsaw, 02-091 Warsaw, Poland;
- Center of Digital Science and Technology, Cardinal Stefan Wyszynski University, 01-815 Warsaw, Poland
| | - Ewa Sawicka
- Department of Maxillofacial Surgery, Clinic of Pediatric Surgery, Institute of Mother and Child, 01-211 Warsaw, Poland;
| | - Piotr S. Fudalej
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, 3012 Bern, Switzerland;
- Department of Orthodontics, Institute of Dentistry and Oral Sciences, Palacký University Olomouc, 779 00 Olomouc, Czech Republic
- Department of Orthodontics, Jagiellonian University, 31-155 Krakow, Poland
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Regenerative Strategies in Cleft Palate: An Umbrella Review. Bioengineering (Basel) 2021; 8:bioengineering8060076. [PMID: 34205126 PMCID: PMC8230219 DOI: 10.3390/bioengineering8060076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 01/08/2023] Open
Abstract
(1) Background: Alveolar bone defects or decreased alveolar bone height and width may have different causes, such as cleft palate. Regenerative procedures in oro-dental defects are challenging due to anatomical factors and the distinct cell populations involved. The iliac crest bone graft remains the gold-standard for cleft palate closure. However, tissue regeneration approaches have been employed and their outcome reviewed, but no conclusions have been made about which one is the gold-standard. (2) Methods: this umbrella review aims to critically appraise the effectiveness of the current approaches in bone defects regeneration in non-syndromic patients with cleft palate. A search was performed in PubMed, Cochrane Library, Scopus, Web of Science and EMBASE databases. (3) Results: Systematic reviews of randomized and non-randomized controlled trials with or without meta-analysis were included. Nine articles were included in the qualitative analysis and five in the quantitative one. The included studies quality was evaluated with AMSTAR2. (4) Conclusions: The use of new regenerative strategies, such as bone morphogenic protein 2, appears to provide similar results regarding bone volume, filling, and height to the standard technique with the iliac crest bone graft.
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Téllez-Conti C, Mora-Diaz II, Díaz-Báez D, Ocampo-Arias IJ, Jiménez-Luna NE, Niño-Paz JC, González-Carrera MC. Craniofacial Growth Analysis of Individuals With and Without Cleft Lip and Palate in Colombia. Cleft Palate Craniofac J 2021; 59:577-588. [PMID: 34000838 DOI: 10.1177/10556656211013690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Craniofacial growth is a dynamic and unpredictable process influenced by genetic and environmental factors, presenting phenotypic and gender differences. OBJECTIVE Evaluate the differences in craniofacial growth and development in a group of Colombian individuals with complete unilateral and bilateral cleft lip and palate (CLP) and without CLP, classified by gender and age. SETTING AND SAMPLE POPULATION Five hundred forty-one profile radiographs of 126 patients with unilateral CLP, 126 with bilateral CLP, and 289 without CLP. All patients of affected groups had a history of CLP correction surgery without nasoalveolar molding with orthopedic and orthodontic treatments. MATERIALS AND METHODS This cross-sectional study was performed comparing 8 cephalometric measurements on radiographs, 5 linear/3 angular. Analysis was performed by median and interquartile range for all cephalometric measurements. Comparison between the groups was performed using Kruskal-Wallis and Mann-Whitney U, with a 95% confidence. RESULTS Significant differences between the groups of patients with and without CLP, between types of clefts and genders. The skeletal structures of patients with CLP were smaller than those of control but improved with growth. Patients with unilateral CLP presented flat profiles and predominant class III malocclusions, while patients with bilateral CLP, at early ages, were class II and in the prepubertal stage, the values were progressively negative until the end of the growth period, suggesting class III. Patients with CLP presented posteroinferior rotation of the mandible, vertical measurements increased, and deflection of the cranial base. CONCLUSION Given their growth alterations, patients with CLP benefit from orthopedic and orthodontic treatment.
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Affiliation(s)
- Carolina Téllez-Conti
- Integral Management Unit of Craniofacial Abnormalities-UMIMC, School of Dentistry, 28009Universidad El Bosque, Bogotá, Colombia
| | | | - David Díaz-Báez
- Unit of Basic Oral Investigation-UIBO, School of Dentistry, 28009Universidad El Bosque, Bogotá, Colombia
| | | | | | | | - María Clara González-Carrera
- Integral Management Unit of Craniofacial Abnormalities-UMIMC, School of Dentistry, 28009Universidad El Bosque, Bogotá, Colombia
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Brudnicki A, Sawicka E, Fudalej PS. Maxillofacial morphology in post-pubertal patients with unilateral cleft lip and palate following early vs. late secondary alveolar bone grafting. J Craniomaxillofac Surg 2021; 49:809-814. [PMID: 33965325 DOI: 10.1016/j.jcms.2021.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 03/14/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022] Open
Abstract
The study aimed at comparing maxillofacial morphology and burden of surgical treatment in post-pubertal patients with unilateral cleft lip and palate (UCLP) following early vs. late secondary alveolar bone grafting (SABG). In this retrospective study maxillofacial morphology was assessed on lateral cephalograms of skeletally matured patients with UCLP operated on consecutively in one center by the same method of one-stage primary cleft repair followed by SABG. Cephalometric analysis comprised 8 angular and 7 linear measurements. Maxillary growth restriction was evaluated by measuring SNA angle and Co-A and PNS-A distances. Five linear regression models with SNA, SNB, ANB, Co-A, and MP/SN as dependent variables and age at primary cleft repair, age at SABG, age at taking cephalogram, surgeon, and total number of surgical interventions as independent variables were also created. 135 patients were included in the study - 70 patients (47 males and 23 females) had early SABG (E-SABG group) and 65 patients (40 males and 25 females) had late SABG (L-SABG group). Mean age at bone grafting procedure was 2.7 years (range 1.5-5.9, SD 1.1) and 10.3 years (range 6.1-18.8, SD 3.2) in E-SABG and LSABG group respectively. The variables describing the degree of maxillary growth restriction - SNA, Co-A, and PNS-A - were comparable in both groups (p = 0.707, 0.116, and 0.932, respectively). Regression models demonstrated that independent variables were not associated with the values of SNA angle, SNB angle, ANB angle, MP/SN angle, and Co-A distance (p = 0.761, 0.088, 0.249, 0.380, and 0.363, respectively). The percentages of oronasal fistula repair, VPI repair, repeated SABG, upper lip correction, rhinoplasty, orthognathic surgery were 22.9, 7.1, 15.7, 24.3, 42.9, 2.9 in E-SABG group and 27.7, 7.7, 9.2, 36.9, 47.7, 3.1 in L-SABG group respectively. Mean number of all surgical interventions was 3.2 in E-SABG and 3.4 in L-SABG group, respectively (p = 0.271). Considering the comparable maxillofacial morphology and burden of surgical care in matured patients after early and late SABG, the choice of timing of bone grafting surgery could be left to the discretion of the surgeon.
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Affiliation(s)
- Andrzej Brudnicki
- Department of Maxillofacial Surgery, Clinic of Pediatric Surgery, Institute of Mother and Child Warsaw, Poland.
| | - Ewa Sawicka
- Department of Maxillofacial Surgery, Clinic of Pediatric Surgery, Institute of Mother and Child Warsaw, Poland
| | - Piotr Stanisław Fudalej
- Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic; Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Switzerland; Department of Orthodontics, Institute of Dentistry, Jagiellonian University College of Medicine, Krakow, Poland
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Udalova NV, Korolenkova MV, Gridasova UA. [Presurgical orthopedic treatment of children with unilateral cleft lip and palate with a sequential splints method: indications and long-term results]. STOMATOLOGII︠A︡ 2021; 99:5-9. [PMID: 33416226 DOI: 10.17116/stomat2020990625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To justify the use of the Sequential Splints Method of presurgical orthopedic treatment for children with unilateral cleft lip and palate depending on extent of initial deformation and to estimate long-term results. MATERIALS AND METHODS The method was applied in 17 unilateral cleft lip and palate infants who received treatment at the age from 4 days to 3 months. There was a control group of 28 cleft lip and palate patients operated with no early orthodontics. Average age in both groups at the time of research was 3.8±0.9 years. Comparative assessment was conducted before the beginning of the post-operative orthodontic treatment for the following parameters: residual width of the alveolar process cleft, presence of lateral incisor's bud, the extent of the nose deformation on the cleft side. RESULTS It was found that residual width of the alveolar process cleft was, on average, 5.95 mm in the main group and 12.6 mm in the control group. The percentage of the lateral incisor adentia was 28% in the main group and 66% in the control group. The mean score of alar nose deformation was 3.9 and 3.1 points, correspondingly. CONCLUSION According to obtained results patients who did not receive the presurgical orthopedic treatment were more likely to have residual deformations and larger residual width of the alveolar process cleft. There was higher risk of teeth germs loss in the control group. The Sequential Splints Method of presurgical orthopedic treatment is recommended as a necessary part of the treatment for the unilateral cleft lip and palate.
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Affiliation(s)
- N V Udalova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - M V Korolenkova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - U A Gridasova
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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Bittermann GKP, van Es RJJ, de Ruiter AP, Bittermann AJN, Koole R, Rosenberg AJWP. Retrospective analysis of clinical outcomes in bilateral cleft lip and palate patients after secondary alveolar bone grafting and premaxilla osteotomy, using a new dento-maxillary scoring system. J Craniomaxillofac Surg 2020; 49:110-117. [PMID: 33357967 DOI: 10.1016/j.jcms.2020.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/20/2020] [Accepted: 12/11/2020] [Indexed: 12/25/2022] Open
Abstract
Evaluation of relevant clinical outcomes in patients with bilateral cleft lip and palate (BCLP) after secondary aveolar bone grafting (SABG) and premaxilla osteotomy (PMO), through the use of a new scoring system. Data were collected retrospectively from all patients with BCLP who were operated on between 2004 and 2014, at the end of follow-up. The treatment protocol consisted of SABG + PMO in patients aged between 9 and 13 years. At the end of follow-up, the following parameters were scored: (un)interrupted dental arch, skeletal sagittal relationship, bone height using the Bergland/Abyholm criteria, and the presence of postoperative fistula. These parameters were combined to produce a dento-maxillary scoring system, giving a final score between 1 and 10. For statistical analysis, the independent t-test was used. Of 55 children, 45 were suitable for analysis. The mean age at time of surgery was 12.0 years (8.9-16.4 yrs), and the mean follow-up time was 11.7 years (5.8-15.8 yrs). The average number of surgeries executed under general anesthesia was 6 (range: 3-11). The average dento-maxillary score in this patient cohort was 7.6 (1-10; median: 8). Among these patients, 31 had an uninterrupted dental arch; the average Bergland/Abyholm score was 2.07; 30 patients exhibited an Angle class I incisor relationship; and, in 38 cases, the oronasal communication was closed after SABG + PMO treatment. A significant effect of fistulas was seen on dento-maxillary score (p = 0.001). Specifically, a significant effect of fistulas was seen on interrupted dental arch (p = 0.002) and on Bergland/Abyholm score (p = 0.037). The proposed dento-maxillary scoring system is a straightforward tool that can be used to describe and analyze the amount of dento-maxillary rehabilitation at the end of the treatment. Persistence of oronasal fistulas in patients with BCLP has a significant impact on interruption of the dental arch, and can influence dental results at the end of the second decade.
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Affiliation(s)
| | - Robert J J van Es
- Department of Oral and Maxillofacial Surgery, Utrecht University, Heidelberglaan 100, PO Box 85500, 3508 AB, Utrecht, the Netherlands
| | - Adrianus P de Ruiter
- Department of Oral and Maxillofacial Surgery, Utrecht University, Heidelberglaan 100, PO Box 85500, 3508 AB, Utrecht, the Netherlands
| | - Arnold J N Bittermann
- Department of Pediatric Otorhinolaryngology, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 AB, Utrecht, the Netherlands
| | - Ron Koole
- Department of Oral and Maxillofacial Surgery, Utrecht University, Heidelberglaan 100, PO Box 85500, 3508 AB, Utrecht, the Netherlands
| | - Antoine J W P Rosenberg
- Department of Oral and Maxillofacial Surgery, Utrecht University, Heidelberglaan 100, PO Box 85500, 3508 AB, Utrecht, the Netherlands
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Brudnicki A, Sawicka E, Brudnicka R, Fudalej PS. Effects of Different Timing of Alveolar Bone Graft on Craniofacial Morphology in Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2019; 57:105-113. [PMID: 31370693 DOI: 10.1177/1055665619866363] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the effect of the timing of secondary alveolar bone graft (SABG) on craniofacial morphology in patients with complete unilateral cleft lip and palate (UCLP). DESIGN Single-center retrospective assessment of consecutively treated nonsyndromic patients with complete UCLP. PARTICIPANTS One hundred sixty-seven patients (108 males, 59 females) with complete UCLP in whom the cleft was repaired with 1-stage method at approximately 8 months of age. The age of 128 patients at SABG varied from 1.4 to 11.5 years (SABG group), while 39 patients still awaited SABG at the moment of cephalometric evaluation (no-SABG group). METHODS Craniofacial morphology was assessed on lateral cephalograms taken at 10 years of age (standard deviation = 0.8; range: 7.5-12.3) using linear and angular measurements. T tests and regression models were made to analyze data. RESULTS Regression models demonstrated that the effect of SABG on the craniofacial morphology was limited-cephalometric variables which were statistically significantly different between SABG and no-SABG groups showed no association with the timing of SABG when (1) age of primary repair of the cleft, (2) age of cephalometric evaluation, (3) cleft side, (4) gender, and (5) operator were controlled for. Only the length of the maxilla (Condylion-point A) was affected-1-year delay of SABG corresponded with an increase in Co-point A distance by 0.52 mm. However, adjusted R 2 of the model was 0.11. CONCLUSIONS Our findings cautiously indicate that SABG performed before 8 years of age can have limited negative effect on craniofacial morphology. Nevertheless, our results should be confirmed by cleft centers practicing alternative surgical repairs of the cleft.
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Affiliation(s)
- Andrzej Brudnicki
- Maxillofacial Surgery Unit, Department of Pediatric Surgery, Institute of Mother and Child (IMC), Warsaw, Poland
| | - Ewa Sawicka
- Maxillofacial Surgery Unit, Department of Pediatric Surgery, Institute of Mother and Child (IMC), Warsaw, Poland
| | - Renata Brudnicka
- Department of Orthodontics, Central Military Medical Outpatient Clinic CePeLek, Warsaw, Poland
| | - Piotr Stanisław Fudalej
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Orthodontics, Institute of Dentistry and Oral Sciences, Palacký University Olomouc, Olomouc, Czech Republic
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