Mandibular Ramus Cortical Tenting Graft and Particulate Allograft in the Management of Unilateral Alveolar Cleft

A Comparative Evaluation of Iliac Crest Cortical-Cancellous Bone Blocks Graft With and Without Concentrated Growth Factors (CGFs) in Secondary Alveolar Bone Grafting: A Retrospective Study

BACKGROUND

The purpose of this study was to investigate the clinical effect and bone resorption of iliac crest cortical-cancellous bone block grafts combined with concentrated growth factor (CGF) compared with iliac crest cortical-cancellous bone block grafts only in secondary alveolar bone grafting.

MATERIALS AND METHODS

Eighty-six patients (43 in the CGF group and 43 in the non-CGF group) with unilateral alveolar clefts were examined. Patients (17 in the CGF group and 17 in the non-CGF group) were randomly chosen for radiologic evaluation. Quantitative evaluation of the bone resorption rate was made with cone-beam computed tomography and Mimics 19.0 software at 1 week and 12 months after surgery.

RESULTS

The success rate of bone grafting was 95.3% and 79.1% in the CGF and non-CGF groups, respectively ( P =0.025). The mean bone resorption rate at 12 months postoperatively was 35.66±15.80% and 41.39±19.57% in the CGF and non-CGF groups, respectively ( P =0.355). The bone resorption patterns of the 2 groups were similar on the labial, alveolar process, and palatal sides, and there was no obvious bone resorption on the labial side in either group. Nasal side bone resorption in the CGF group was significantly less than that in the non-CGF group ( P =0.047).

CONCLUSIONS

Cortical-cancellous bone block grafts reduce labial bone resorption, while CGF reduces nasal bone resorption and improves the success rate. The combination of bone block and CGF in secondary alveolar bone grafting is worthy of further clinical application.

Effectiveness of corticocancellous bone graft in cleft lip and palate patients: A systematic review

OBJECTIVE

Both cancellous bone graft and corticocancellous bone graft are the most common grafts for repairing alveolar cleft, but there is no clear conclusion as to which method is beneficial to repair the alveolar cleft. The aim was to determine the effectiveness of corticocancellous bone graft in cleft lip and palate patients.

MATERIALS AND METHODS

Electronic databases including PubMed, Ovid, Embase, Cochrane Library, Web of Knowledge, and China Biology Medicine disc (SinoMed) were searched. Only studies published in English or Chinese were included. The last search was updated on 1 January 2020. 2638 articles remaining after the exclusion of duplicates. Finally, there were 16 publications (15 in English and 3 in Chinese) eligible for systematic review according to the previously established inclusion and exclusion criteria. A descriptive statistical method was used to present data. The methodological index for non-randomized studies (MINORS) was used to determine the risk of bias.

RESULT

Sixteen articles were included in this review, of which 15 publications were retrospective study and one was a comparative study. The average success rate of reconstruction with block bone was approximately 90.8%, while the success rate of the cancellous bone graft was about 85.3%. The incidence of wound dehiscence was approximately 10% to 16%, and infection is about 9% to 20%. The incidence of oronasal fistula resulting from severe bone resorption and infection was approximately 7.5% to 10.5%.

CONCLUSION

There is a higher bone formation rate of corticocancellous bone graft in patients with the alveolar cleft. However, more studies with high methodological quality and with a longer follow-up are needed to offer more safety for practitioners and patients regarding the surgical method selected to repair the cleft alveolar.