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Guo W, Lu B, Liu F, Jin D, Wu S, Zhou S, Li Z, Lv Y, Zhao Z, Zhang J, Li Y. Comprehensive repair of the alveolar cleft using cortical and cancellous bone layers: A retrospective study. J Craniomaxillofac Surg 2024; 52:310-315. [PMID: 38212164 DOI: 10.1016/j.jcms.2024.01.004] [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: 12/30/2022] [Revised: 10/11/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024] Open
Abstract
To retrospectively review the clinical effect of comprehensive treatment of alveolar cleft (CTAC) using the mandible as the bone source. Patients with alveolar clefts who met the inclusion criteria were subjected to a CTAC protocol that included the following: (1) preoperative orthodontic treatment for creating good soft-tissue conditions; (2) 'area-like grafting' with subperiosteal osteogenic chin bone instead of cartilaginous osteogenic iliac bone; (3) simulation of normal bone anatomy via a sandwich-like bone graft consisting of 'cortical bone + cancellous bone + cortical bone'; and (4) strong internal fixation to ensure initial bone block stability. At 6 months postoperatively, the titanium plate was removed and cone-beam computed tomography was performed to evaluate the surgical results. A total of 54 patients underwent treatment with the CTAC protocol. The average age at the initial operation was 10.3 ± 2.1 years, and the average hospital stay was 2.8 ± 0.6 days. At 6 months postoperatively, 49 patients (90.7%) showed good clinical results. The transplanted bone block formed a 'cortical bone + cancellous bone + cortical bone' structure similar to that of the normal jawbone. A mature bone bridge formed, and the impacted permanent teeth continued to erupt and enter the bone graft area. CTAC is a comprehensive restorative solution for alveolar cleft repair that integrates multiple concepts, including orthodontics, embryology, anatomy, and improvements to surgical methods. The method is easy to perform, causes little surgical trauma, and shows a stable success rate, and is thus worth promoting.
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Affiliation(s)
- Weiwei Guo
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Bin Lu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Fuwei Liu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Dan Jin
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Simo Wu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Shanluo Zhou
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Zhiye Li
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Yaoguang Lv
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Zhihe Zhao
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Junrui Zhang
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China.
| | - Yunpeng Li
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China.
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Normande Neto HDV, Oliveira-Neto OB, Ribeiro ILH, Andrade CSD, Sales PHDH, Lima FJCD. What is the Effectiveness of Premaxilla Surgical Repositioning and its Stabilization Methods in Mixed Dentition Patients With Bilateral Cleft Lip and Palate? Cleft Palate Craniofac J 2023; 60:1211-1219. [PMID: 35535395 DOI: 10.1177/10556656221096304] [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] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVE Verify the effectiveness of surgical repositioning of the premaxilla and its stabilization methods in patients with bilateral cleft lip and palate during mixed dentition. DESIGN Systematic review. MATERIAL AND METHODS The search was conducted in 7 databases (eg, Medline via PubMed; Scopus; Central Cochrane; LILACS; Embase, Web of Science; and Sigle via OpenGrey until August 2021), using the descriptors "premaxilla", "cleft Palate", and "bone transplantation". INCLUSION CRITERIA Clinical trials and observational studies that have patients with bilateral cleft who had a need for superior/posterior repositioning of the premaxilla on mixed dentition; Studies in any language was evaluted whitout time restriction of publication. RESULTS From 5572 records, 6 studies were included in the review with a total sample of 212 patients. Regarding the type of stabilization used in the premaxilla, the hybrid method (rigid and complementary semi-rigid stabilization) predominated, being observed in 184 patients (86.8%). A total of 17 failures were identified related to the surgical repositioning of the premaxilla, corresponding to 8% of the total number of surgeries. A meta-analysis of prevalence was performed, only with the retrospective studies. It was observed that the effectiveness rate of premaxilla repositioning was 92%, with a CI between 0.04 and 0.13, with all included studies showing a similar failure rate (0.08-0.09). The included studies also showed great homogeneity in this analysis (I2 = 0%; P = .75). CONCLUSION Although there are several alternatives and techniques for repositioning and stabilizing the premaxilla, the statistical result did not differ between the different techniques.
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Affiliation(s)
| | | | - Igor Lerner Hora Ribeiro
- Oral and Maxillofacial Surgeon at Santa Casa de Miséricrdia of São Miguel dos Campos, Alagoas, Brazil
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Sales PHDH, Cetira Filho EL, Goberlânio de Barros Silva P, Gurgel Costa FW, Leão JC. Effectiveness of Autogenous Chin Bone Graft in Reconstructive Surgery of Cleft Patients: A Systematic Review With Meta-Analysis and Algorithm of Treatment. J Oral Maxillofac Surg 2023:S0278-2391(23)00391-9. [PMID: 37182542 DOI: 10.1016/j.joms.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/30/2023] [Accepted: 04/17/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE Bone grafting is fundamental in the treatment of cleft patients, and several grafting materials have been used for this purpose. The objective of this study is to evaluate the effectiveness of autogenous bone graft from the chin in the reconstruction of cleft alveolus. METHODS Searches were performed in six databases (PubMed, Scopus, Cochrane, LILACS, Embase, and Google Scholar) by two researchers individually until July 2022. This study was registered in the International Prospective Register of Systematic Reviews (CRD42021267954) and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The predictor variable is reconstruction technique, grouped into three levels: autogenous genial grafts, other endochondral autogenous grafts, and bio- or tissue-engineered materials. The outcome variables were alveolar cleft healing rate and bone height. The secondary variables were complications that included infections, necrosis, paresthesia, and dehiscence. Data analysis included the risk of bias and assessment of the certainty of evidence by the risk of bias in nonrandomized studies of interventions and grading of recommendations, assessment, development, and evaluation tools, respectively. The meta-analysis was performed with heterogeneity based on random effects of I2 and 95% confidence. RESULTS In the initial search, 4,833 articles were found, and 10 of them were included in this systematic review. The included studies were from six countries on three different continents, with a sample of 692 patients. It was observed that the chin bone graft (214 patients) when compared to the endochondral bone graft (386 patients) reduced by 0.42 [confidence interval 95% = 0.18, 0.95] times the prevalence of bone resorption (P = .040 and I2 = 70%) analyzed in radiographic images. Two studies evaluated the bone filling through computed tomography, and there was no statistically significant difference between the groups (P = .340, I2 = 0%). Only two studies had a low risk of bias. CONCLUSION Based on a low certainty of evidence, the chin autogenous bone graft proved to be similar to the endochondral graft in the reconstruction of the cleft alveolar; however, the limited number of studies with high heterogeneity and an uncertain risk of bias decreased the strength of the results found in this systematic review. New controlled primary studies should be carried out with the purpose of safely determining the effectiveness of chin bone grafts for the reconstruction of cleft alveolar.
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Affiliation(s)
- Pedro Henrique da Hora Sales
- Student, Post-graduated program in dentistry, Department of Prothesis and Oral and Maxillofacial Surgery, Federal University of Pernambuco (UFPE), Recife, Pernambuco, Brazil.
| | - Edson Luiz Cetira Filho
- Student, Post-graduated program in dentistry, School of Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | | | - Jair Carneiro Leão
- Full Professor, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco, Recife, Brazil
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Matsuzawa Y, Okubo N, Tanaka S, Kashiwazaki H, Kitagawa Y, Ohiro Y, Mikoya T, Akazawa T, Murata M. Primary Teeth-Derived Demineralized Dentin Matrix Autograft for Unilateral Maxillary Alveolar Cleft during Mixed Dentition. J Funct Biomater 2022; 13:jfb13030153. [PMID: 36135589 PMCID: PMC9506084 DOI: 10.3390/jfb13030153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 12/21/2022] Open
Abstract
This clinical report describes the immediate autograft of primary (milk) teeth-derived demineralized dentin matrix (DDM) granules for a 6-year-old boy with unilateral alveolar cleft. First, four primary teeth were extracted, crushed in an electric mill for 1 min, and the crushed granules were demineralized in 2% HNO3 solution for 20 min. Simultaneously, the nasal mucoperiosteum was pushed upwards above the apices of the permanent central incisor adjacent to the cleft. The nasal and palatal openings were closed by suturing the mucoperiosteum on both sides of the cleft with absorbable threads. The wet DDM granules were grafted into the managed cleft triangle space, and a labial flap was repositioned. The radiographic images at 6 months showed the continuous hard tissues in the cleft area and DDM granules onto lateral incisor (22) and impacted canine (23). The 3D-CT views at 2 years showed impacted tooth (22) blocked by primary canine and the replacement of DDM granules by bone near teeth (22,23). At 4 years, tooth crown (22) was situated just under the mucous membrane, and teeth (22,23) erupted spontaneously until 6 years without a maxillary expansion and a tow guidance of canine. The DDM granules contributed to bone formation without the inhibition of spontaneous tooth eruption. We concluded that autogenous primary teeth DDM graft should become a minimally invasive procedure without bone harvesting and morbidities for unilateral alveolar cleft.
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Affiliation(s)
- Yusuke Matsuzawa
- Department of Oral and Maxillofacial Surgery, Graduate School of Dental Medicine, Hokkaido University, Sapporo 060-8586, Japan
- Division of Oral and Maxillofacial Surgery, Keiyukai Sapporo Hospital, Sapporo 003-0026, Japan
| | - Naoto Okubo
- Laboratory of Molecular and Cellular Medicine, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo 060-8586, Japan
| | - Soichi Tanaka
- Department of Oral and Maxillofacial Surgery, Graduate School of Dental Medicine, Hokkaido University, Sapporo 060-8586, Japan
| | - Haruhiko Kashiwazaki
- Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka 812-8582, Japan
| | - Yoshimasa Kitagawa
- Department of Oral Diagnosis and Medicine, Graduate School of Dental Medicine, Hokkaido University, Sapporo 060-8586, Japan
| | - Yoichi Ohiro
- Department of Oral and Maxillofacial Surgery, Graduate School of Dental Medicine, Hokkaido University, Sapporo 060-8586, Japan
| | - Tadashi Mikoya
- Department of Oral and Maxillofacial Surgery, Graduate School of Dental Medicine, Hokkaido University, Sapporo 060-8586, Japan
| | - Toshiyuki Akazawa
- Industrial Technology and Environment Research Development, Hokkaido Research Organization, Sapporo 060-0819, Japan
| | - Masaru Murata
- Division of Oral Regenerative Medicine, School of Dentistry, Health Sciences University of Hokkaido, Tobetsu 061-0293, Japan
- Correspondence:
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Attar BM, Soltani P, Davari D, Mehdizadeh M. Cone-beam computed tomographic comparison of chin symphysis bone particles and allograft versus iliac crest bone graft alone for reconstruction of alveolar bone defects in cleft patients. J Korean Assoc Oral Maxillofac Surg 2022; 48:85-93. [PMID: 35491139 PMCID: PMC9065643 DOI: 10.5125/jkaoms.2022.48.2.85] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/22/2022] [Accepted: 02/11/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Bijan Movahedian Attar
- Torabinejad Dental Research Center and Department of Oral and Maxillofacial Surgery, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parisa Soltani
- Department of Oral and Maxillofacial Radiology, Dental Implants Research Center, and Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davood Davari
- Department of Oral and Maxillofacial Surgery, Kashan University of Medical Sciences, Kashan, Iran
| | - Mojdeh Mehdizadeh
- Department of Oral and Maxillofacial Radiology, Dental Implants Research Center, and Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
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da Hora Sales PH, Teixeira Pinho Filho JE, Cetira Filho EL, Ferreira da Cunha Filho J. Mandibular symphysis bone graft for alveolar reconstruction in cleft patients: an alternative technique with a particular surgical drill. MINERVA STOMATOLOGICA 2019; 68:273-274. [PMID: 31822052 DOI: 10.23736/s0026-4970.19.04270-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Pedro H da Hora Sales
- Department of Oral and Maxillofacial Surgery, Santa Casa de Misericórdia Hospital of São Miguel dos Campos, Federal University of Pernambuco, Recife, Brazil -
| | - João E Teixeira Pinho Filho
- Department of Oral and Maxillofacial Surgery, Batista Memorial Hospital, Federal University of Ceará, Fortaleza, Brasil
| | | | - José Ferreira da Cunha Filho
- Department of Oral and Maxillofacial Surgery, Batista Memorial Hospital, Federal University of Ceará, Fortaleza, Brasil.,Department of Oral and Maxillofacial Surgery, Albert Sabin Children's Hospital, Fortaleza, Brazil
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Sales P, Oliveira-Neto O, Torres T, de Lima F. Effectiveness of dental implants placed in bone graft area of cleft Patients. Int J Oral Maxillofac Surg 2019; 48:1109-1114. [DOI: 10.1016/j.ijom.2019.01.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/24/2018] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
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Rahpeyma A, Khajehahmadi S. Mandibular Ramus Cortical Tenting Graft and Particulate Allograft in the Management of Unilateral Alveolar Cleft. Ann Maxillofac Surg 2019; 9:355-358. [PMID: 31909015 PMCID: PMC6933958 DOI: 10.4103/ams.ams_96_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background: Alveolar bone grafting in the mixed dentition stage is an important step in the management of cleft lip/palate patients. Intraoral donor sites are favored by patients and their parents. Objective: This study investigated a novel bilaminar cortical tenting grafting technique. The technique used a combination of autogenous mandibular ramus cortical bone and particulate allograft in unilateral cleft lip/palate patients during the mixed dentition stage. Materials and Methods: Five patients with nonsyndromic unilateral cleft lip and/or palate, in mixed dentition stage, were included in the study. Results: The operation was performed on five patients, and patients were followed up at least for one-year postoperation. Permanent maxillary canine erupted in the grafted alveolar region spontaneously in 80% of the patients. One wisdom tooth bud that had been exposed during the ramus bone harvest was removed. There was no alteration in the sensation of the lower lip as checked by light static and two discrimination tests. Conclusion: Unilateral alveolar clefts can be repaired using mandibular cortical block ramus bone in the form of bilaminar tenting grafts combined with particulate allografts.
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Affiliation(s)
- Amin Rahpeyma
- Oral and Maxillofacial Diseases Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Oral and Maxillofacial Surgery, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeedeh Khajehahmadi
- Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Oral and Maxillofacial Pathology, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
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Du Y, Zhou W, Pan Y, Tang Y, Wan L, Jiang H. Block iliac bone grafting enhances osseous healing of alveolar reconstruction in older cleft patients: A radiological and histological evaluation. Med Oral Patol Oral Cir Bucal 2018; 23:e216-e224. [PMID: 29476672 PMCID: PMC5911351 DOI: 10.4317/medoral.21991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 12/07/2017] [Indexed: 11/06/2022] Open
Abstract
Background Older alveolar cleft patients (&12 years old) often have wide bone defect as well as teeth loss, resulting in poor osseous healing with conventional alveolar bone grafting (ABG). In this study, we investigated a surgical technique of block iliac bone grafting for the alveolar cleft reconstruction and evaluated the clinical and radiological outcomes of these cleft patients. Material and Methods Fifteen patients were included in this study. All cases received preoperative cone bean computed tomography (CBCT) scans for the alveolar cleft evaluation. Osseous outcomes of block iliac bone grafting were assessed at 1 week, 3- and 6-month postoperatively. Volume changes and bone resorption rates were calculated using the measurement modules of Simplant software. Bone samples from one patient undergoing dental implantation were assessed by micro-CT and histological examination. The morbidities of donor-site were analyzed by clinical examination and questionnaire survey. Results The average age of the case series was 18.53±2.50 years. The intraoral incision of thirteen cases healed well. However, two cases had oronasal fistula and graft exposure at 1-week postoperatively. The results of follow-up CBCT scans showed significant resistance to radiation on both sides of the bone graft, suggesting a good osseous healing and new bone formation. The mean residual bone volume was 1.68±0.26 cm3, 1.29±0.23 cm3 and 1.15±0.23 cm3 at 1-week, 3- and 6-month postoperatively. Correspondingly, the mean bone resorption rates in 3- and 6-month postoperative were 21.78±6.88% and 30.66±8.97%, respectively. From micro-CT and HE examinations, the block bone samples exhibited a cancellous structure in which mature bone trabecula and functional blood vessels appeared. The average scores of donor-site morbidities were drastically decreased at 3- and 6-month postoperatively compared with those at 1-week postoperatively. Conclusions Our results demonstrated that block iliac bone grafting could achieve satisfying osseous outcomes in older alveolar cleft patients, and this technique provided favorable bony condition for further treatments, especially dental implantation. Key words:Alveolar bone grafting, Block bone grafting, Osseous healing, CBCT.
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Affiliation(s)
- Y Du
- Number 136, Hanzhong Road, Nanjing, China,
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Shahmohammadi R, Moeintaghavi A, Radvar M, Ghanbari H, Saghravanian N, Aghayan S, Sarvari S. Clinical and histological evaluation of increase in the residual ridge width using mineralized corticocancellous block allografts: A pilot study. J Dent Res Dent Clin Dent Prospects 2018; 11:229-235. [PMID: 29354249 PMCID: PMC5768955 DOI: 10.15171/joddd.2017.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 08/20/2017] [Indexed: 11/09/2022] Open
Abstract
Background. Lateral ridge augmentation is conventionally accomplished by means of autogenous bone grafts. However, due to its complications, the application of autogenous bone graft substitutes, e.g. mineralized corticocancellous allograft, is ecommended. Methods. In the present study, twelve patients were included, with insufficient alveolar ridge widths in the designated sites for dental implant placement. During the primary surgery, mineralized corticocancellous block allografts were fixed in deficient sites with titanium screws and resorbable collagen membranes were used to cover the blocks. After a period of six months, a flap was raised and variations in ridge width values was measured. Finally, a micro-biopsy was obtained from the sites for histologic investigation prior to preparing them for subsequent implant placement. Results. All the applied blocks were incorporated into the underlying bone except for one. A statistically significant difference was seen between the average ridge widths before placing the allografts compared with that of implant placement stage (2.62±1.02 mm vs. 7.75±1.63 mm, respectively). Vital bone tissue was detected in all the histological specimens obtained from the interface of blocks and the underlying bone. Conclusion. The results suggest that mineralized corticocancellous block allografts might be used as scaffolds for bone growth and ridge width augmentation.
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Affiliation(s)
- Reza Shahmohammadi
- Department of Endodontics, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Moeintaghavi
- Dental Material Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehrdad Radvar
- Dental Material Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Habibollah Ghanbari
- Department of Periodontics, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nasrollah Saghravanian
- Oral and Maxillofacial Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shabnam Aghayan
- Department of Periodontics, Dental Branch, Islamic Azad University (Tehran), Tehran, Iran
| | - Sara Sarvari
- Mashhad University of Medical Sciences, Mashhad, Iran
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Shirzadeh A, Rahpeyma A, Khajehahmadi S. A Prospective Study of Chin Bone Graft Harvesting for Unilateral Maxillary Alveolar Cleft During Mixed Dentition. J Oral Maxillofac Surg 2017; 76:180-188. [PMID: 28774851 DOI: 10.1016/j.joms.2017.07.143] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 06/29/2017] [Accepted: 07/05/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE The chin is a common donor site for alveolar cleft bone grafting. The amount of bone available at this site can be limited, because conservative harvesting with mixed dentition must consider the incisive nerve, the unerupted mandibular canine, and the integrity of the inferior mandibular border. MATERIALS AND METHODS Patients with nonsyndromic unilateral alveolar cleft in the mixed dentition stage were selected for this study. The volume of bone obtained from the mandibular symphysis (symphysis menti), degree of alteration in lower lip sensation, anterior tooth vitality, remaining bone in the alveolar cleft, and bone defects at the donor site 1 year after surgery were evaluated. RESULTS Eighteen patients were enrolled in this study. The mean volume of bone harvested from the symphysis was 2.1 mL (range, 1.6 to 2.3 mL). For all cases, the bone volume harvested from the symphysis was insufficient to fill the alveolar cleft defect, and allograft had to be added to completely fill the cleft. Allograft was admixed in the range of 0.5 to 1 mL with autogenous bone harvested from the mandible. Lower lip sensation and vitality of the anterior teeth of the mandible were within the normal range 1 year after surgery in all cases. Fourteen of 18 patients (77.8%) had normal bone height or bone height at least three fourths of the expected height in the grafted alveolar cleft after 1 year; only 10% of the defect remained in the mandible. CONCLUSION The amount of bone yielded by conservative monocortical bone harvest from the mandibular symphysis during the mixed dentition stage for unilateral alveolar cleft bone grafting is not sufficient in volume and should be mixed with allograft. However, donor site morbidity is low with this approach.
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Affiliation(s)
- AliReza Shirzadeh
- Undergraduate of Oral and Maxillofacial Surgery, Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Rahpeyma
- Associate Professor of Oral and Maxillofacial Surgery, Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeedeh Khajehahmadi
- Associate Professor of Oral and Maxillofacial Pathology, Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Current Methods for the Treatment of Alveolar Cleft. Arch Plast Surg 2017; 44:188-193. [PMID: 28573092 PMCID: PMC5447527 DOI: 10.5999/aps.2017.44.3.188] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/15/2017] [Accepted: 04/21/2017] [Indexed: 11/17/2022] Open
Abstract
Alveolar cleft is a tornado-shaped bone defect in the maxillary arch. The treatment goals for alveolar cleft are stabilization and provision of bone continuity to the maxillary arch, permitting support for tooth eruption, eliminating oronasal fistulas, providing an improved esthetic result, and improving speech. Treatment protocols vary in terms of the operative time, surgical techniques, and graft materials. Early approaches including boneless bone grafting (gingivoperiosteoplasty) and primary bone graft fell into disfavor because they impaired facial growth, and they remain controversial. Secondary bone graft (SBG) is not the most perfect method, but long-term follow-up has shown that the graft is absorbed to a lesser extent, does not impede facial growth, and supports other teeth. Accordingly, SBG in the mixed dentition phase (6–11 years) has become the preferred method of treatment. The most commonly used graft material is cancellous bone from the iliac crest. Recently, many researchers have investigated the use of allogeneic bone, artificial bone, and recombinant human bone morphogenetic protein, along with growth factors because of their ability to decrease donor-site morbidity. Further investigations of bone substitutes and additives will continue to be needed to increase their effectiveness and to reduce complications.
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