Evolution of Postoperative Edema in Alveolar Graft Performed with Bone Morphogenetic Protein (rhBMP-2)

Bone Grafting of Alveolar Clefts

The goals of alveolar cleft repair include (1) stabilization of the maxilla, (2) permitting tooth eruption, (3) eliminating the oronasal fistula, (4) improving aesthetics, and (5) improving speech. Alveolar cleft repair should be considered one of the steps of a larger comprehensive orthodontic management plan. In conjunction with closure of the oronasal fistula, a variety of grafting materials can be used in the alveolar cleft. Autogenous grafts have been found to have greater efficacy compared with allogenic or xenogeneic bone, substitute bone, and alloplasts but with more donor site morbidity.

Outcomes of Alveolar Graft With Rhbmp-2 in CLP: Influence of Cleft Type and Width, Canine Eruption, and Surgeon

OBJECTIVE

To evaluate the influence of cleft type and width, canine eruption stage, and surgeon on the outcomes of alveolar graft with rhBMP-2.

DESIGN

Cross-sectional.

SETTING

Tertiary craniofacial center.

PARTICIPANTS

Ninety individuals submitted to alveolar graft in late mixed or early permanent dentition.

INTERVENTIONS

The 90 individuals (mean age: 16.8 years) were submitted to alveolar graft with rhBMP-2. Periapical radiographs were obtained before and 6 months after surgery. Surgeries were performed by 4 experienced maxillofacial surgeons. The alveolar grafts were assigned as success or failure by 3 blinded raters based on the modified Bergland and Chelsea scales. Permanent canines adjacent to the defect were assigned as erupted and not erupted. The greatest cleft width was measured on preoperative periapical radiographs.

MAIN OUTCOME MEASURES

The influence of 4 independent variables (cleft type, cleft width, canine eruption phase, and surgeon) on the outcome of alveolar graft was analyzed by multivariate logistic regression ( P < .05).

RESULTS

All independent variables presented significant influence on alveolar graft outcome. The subgroup of unerupted maxillary canines demonstrated better outcomes than erupted canines ( P = .001). The group with cleft lip and alveolus (CL/A) demonstrated better outcomes than complete cleft lip and palate (CLP; P < .001). The greater the alveolar cleft width, the less favorable were the graft outcomes ( P = .027). The surgeon also had a significant influence on the surgery success ( P = .003 and .001).

CONCLUSION

The type and width of CLP, the eruption of permanent canines, and the surgeon influenced the outcome of alveolar graft surgeries performed with rhBMP-2.

Three-Dimensional Upper Lip and Nostril Sill Changes After Cleft Alveolus Reconstruction Using Autologous Bone Grafting Versus Recombinant Human Bone Morphogenetic Protein-2

Cleft alveolus in patients with unilateral complete cleft lip and palate has been alternatively reconstructed with recombinant human bone morphogenetic protein (rhBMP)-2. However, its effects on upper lip and nostril sill anatomy are not known. Thus, the objective of this investigation was to assess and compare upper lip and nostril sill changes after cleft alveolus reconstruction with autologous bone from the iliac crest region and rhBMP-2. Patients were randomly allocated into 2 groups. In group 1, autologous bone from the iliac crest region was used to fill the cleft alveolus (n = 4), and in group 2, rhBMP-2 was used to fill the cleft alveolus (n = 8). Preoperatively and at one after the surgery, computerized tomography (CT) was performed. Reformatted CT imaging was used to perform cephalometric linear measurements of the upper lip and nostril sill regions. Inter- and intragroup data of the pre and postoperative reformatted CT measurements of the upper lip and nostril sill regions did not show differences (P >0.05) in cutaneous upper lip height and projection, nostril sill elevation, and subnasale projection. There were no significant upper lip and nostril sill anatomical changes after cleft alveolus reconstruction using autologous bone grafting and rhBMP-2.

Alveolar Bone Graft: Clinical Profile and Risk Factors for Complications in Oral Cleft Patients

OBJECTIVE

The aim of this study was to investigate clinical aspects and predisposing factors for alveolar bone graft complications in persons born with oral clefts.

DESIGN

A total of 105 patients, aged 7 to 57 years old, who received alveolar bone graft at the Cranio-maxillofacial Surgery Center in the National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro (RJ) from 2009 to 2014 were selected. Data were collected concerning the type of oral cleft, family history of cleft, medical and dental exam, donor area, type of graft material, repaired surgical treatment done, and postoperative follow-up examinations.

RESULTS

Postoperative complications developed in 31 patients (32.9%). The mean age at grafting was 16.79 years for the group without complications (n = 63) and 20.13 years for the group with postoperative complications (n = 31). There was a positive association between age and type of graft and cases with alveolar bone graft complications. Patients aged 12 years or more had a four times more chance of developing alveolar bone graft complications. Particulate bone graft from iliac crest demonstrated better results compared with block graft or mixed graft.

CONCLUSION

Patients with cleft lip and palate who were 12 years or older had a greater chance of developing complications after grafting the alveolar bone. Furthermore, particulate alveolar graft from iliac crest had significantly better outcomes.

Fissuras labiopalatinas: pós-operatório com vastos nichos microbiológicos?

As fissuras labiopalatinas correspondem às malformações craniofaciais mais prevalentes na espécie humana, as quais podem acarretar perda de continuidade dos tecidos labiais, alveolares e palatinos da maxila, necessitando na grande maioria dos casos de numerosos procedimentos cirúrgicos para a reabilitação estética e funcional.Com o propósito de reparar o defeito ósseo alveolar ocasionado pelas fissuras, tem sido empregada no HRAC/USP a técnica de enxerto alveolar secundário com rhBMP-2. Diante de uma possível exacerbação edematosa, sugerida por alguns autores através de observação subjetiva, no período pós-operatório desta cirurgia quando comparada à técnica convencional com utilização de osso ilíaco, pressupõe-se a ocorrência de agravos consideráveis do ponto de vista microbiológico.