Observing the Eruption of Canine After Secondary Alveolar Bone Grafting

Root development differences between cleft-adjacent teeth on the cleft side in comparison to their analogs on the noncleft side in patients with nonsyndromic cleft lip and palate who received secondary alveolar bone grafting

OBJECTIVE

To assess differences in root development between the cleft side (CS) and noncleft side (NCS) for permanent maxillary central incisor and canine longitudinally in patients with nonsyndromic complete unilateral cleft lip and palate (cUCLP) who received secondary alveolar bone grafting (SABG) and to evaluate the effects of SABG on the acceleration of root development of these teeth.

MATERIALS AND METHODS

Permanent maxillary central incisors and canines of 44 subjects with nonsyndromic cUCLP who had all their cleft-related surgeries performed by the same surgeon were analyzed retrospectively from chart notes and radiographs. Panoramic and periapical radiographs at time point 1 (T1) (age, 7.55 years), at SABG (time point 2 [T2], 10.13 years), and a minimum of 2 years after SABG were studied. Root development rating scores on the NCS and CS were compared using paired t-tests and analyses of proportions.

RESULTS

Mean root development score differences (NCS - CS) for canines and central incisors were greatest at T2 but diminished at time point 3 (T3). A larger proportion of teeth on the CS trailed the teeth on the NCS by at least 1 point at T2 than at T1 or T3, with the smallest proportion being observed at T3. The change in root development scores from T1 to T2 and from T2 to T3 showed relative CS acceleration from T2 to T3, indicating a catch-up of root development of cleft-adjacent teeth after SABG.

CONCLUSIONS

Root development of cleft-adjacent central incisors and canines is slow in comparison with their noncleft analogs. Root development of these teeth accelerates following SABG.

Radiographic Assessment of Different Autogenous Bone Grafts in the Alveolar Cleft: A Retrospective Longitudinal Study

Objectives

To assess feasibility and maintenance of bone after alveolar cleft reconstructions using graft from iliac crest and mandibular symphysis.

Methods

51 alveolar clefts grafted with iliac crest and 51 ones grafted with mandibular symphysis bones were selected from patients aged between 7 and 12 years. At three (T1) and 12 months (T2) after surgeries, periapical radiographs were performed to measure the height of the grafted bone based on the modified Bergland scale. Chi-square and Mann-Whitney-Wilcoxon tests compared differences between T1 and T2 according to each bone graft.

Results

From the clefts grafted with mandibular symphysis bone, 47 were classified as type I (92.5%) and 04 as type II (7.84%) at T1. At T2, 36 were classified as type II (25.49%) and 02 as type III (3.92%). In the analysis of the clefts grafted with iliac crest at T1, 48 were classified as type I (94.11%) and three as type II (5.88%). At T2, 37 classifieds as type I (72.54%), 12 as type II (23.52%) and two as type III (3.92%). There was no statistically significant difference between treatments.

Conclusions

It was concluded that iliac crest and mandibular symphysis are adequate areas from which bone grafts can be obtained for reconstruction of alveolar cleft.

Evaluation of Dental Root Development Regarding Maxillary Canine Eruption Status after Secondary Alveolar Bone Grafting in Patients with Cleft Lip and Palate

In children born with cleft lip and palate, the timing of the secondary alveolar bone graft (SABG) is crucial to its success; this involves estimating the eruption of the permanent maxillary canine. Altered dental eruption in this patient group gives impetus to the identification of dental developmental factors concerning maxillary canine eruption, which may steer the clinical decision of SABG timing. Records of over nine hundred patients who received SABG with pre- and post-operative cone beam computed tomography (CBCT) scans were analyzed for inclusion and divided into two groups (erupting or non-erupting canine after SABG). Roots of the maxillary canines and premolars were segmented from the cementoenamel junction then linear and volumetric measurements were performed. The pre- and post-operative root length and volume differences were calculated and compared statistically using independent sample tests and paired t-tests. No statistically significant differences were found in the volume change (%), or reciprocal of mean root length in the erupted and unerupted groups in the canine, first premolar, or second premolar roots except for an association between the post-operative dental root length of the canine and the maxillary canine eruption status. Therefore, assessment of root development from pre-treatment CBCT scans was not deemed worthy from a diagnostic perspective.

Does absence of maxillary lateral incisor affect the status of maxillary canine before and after secondary alveolar bone grafting in patients with unilateral alveolar cleft?

Objectives

To investigate whether absence of maxillary lateral incisor (MXLI) would affect the status of maxillary canine (MXC) before and after secondary alveolar bone grafting (SABG) in patients with unilateral cleft lip and alveolus (UCLA) and unilateral cleft lip and palate (UCLP).

Materials and Methods

47 male patients with UCLA and UCLP, whose Bergland indices were type I or II after SABG, were divided into the MXLI-absence (n = 26) and MXLI-presence groups (n = 21). Using panoramic radiographs, the position, angulation, and development status of MXC on the cleft side, and the cleft width before SABG (T1) were evaluated. After full eruption of the permanent dentition (T2), the root length, root shape, and frequency of forced eruption of MXC on the cleft side were investigated. Then, statistical analysis was performed.

Results

Compared to the MXLI-presence group, the MXLI-absence group showed higher frequencies of mesial angulation of MXC at T1 (criteria: >25°; 46.2% vs 14.3%, P < .05) and dilaceration of MXC at T2 (26.9% vs 4.8%, P < .001). MXC on the cleft side showed positive correlations between horizontal position at T1 and forced eruption at T2, and between vertical position and mesial angulation at T1 and dilaceration at T2 (all P < .01).

Conclusions

In patients with UCLA and UCLP whose SABG outcome was successful, absence of MXLI on the cleft side increased only the frequencies of mesial angulation of MXC at T1 and dilaceration of MXC at T2, not frequency of forced eruption at T2.