Optimization of Dental Status Improves Long-Term Outcome after Alveolar Bone Grafting in Unilateral Cleft Lip and Palate

Abstract

Objective

To evaluate the importance of dental status for long-term outcome after alveolar bone grafting in patients with unilateral cleft lip and palate.

Design

Retrospective longitudinal study.

Setting

Cleft lip and palate-craniofacial center, Uppsala University Hospital, Sweden.

Patients

A total of 67 consecutive patients with unilateral complete cleft lip and palate.

Interventions

Secondary alveolar bone grafting, prior to the eruption of the permanent canine, was performed at the average age of 10.0 years (range, 8.5 to 12.0 years).

Main Outcome Measures

Alveolar bone height was evaluated with the modified Bergland index at 1 and 10 years after surgery.

Results

Of the patients, 97% had modified Bergland index grade I and the remaining 3% had modified Bergland index grade II at 1 year after surgery. At 10 years' follow-up, 43% showed modified Bergland index grade I; 55%, modified Bergland index grade II; and 2% (one patient), modified Bergland index grade III. The degree of dental anomalies in the cleft area, such as enamel hypoplasia, incisor rotation, incisor inclination, canine inclination, and oral hygiene registered preoperatively, all correlated negatively to the modified Bergland index at 10 years after surgery. Enamel hypoplasia (ρ = 0.70195, P < .0001), followed by canine inclination (ρ = 0.55429, P < .0001), showed the strongest correlation to reduced bone height in the cleft area.

Conclusions

In patients with unilateral cleft lip and palate, excellent results from secondary alveolar bone grafting in terms of bone height in the alveolar cleft tend to decrease with time. This seems to be correlated with factors that might to some extent be treated preoperatively through adequate planning and execution of the orthodontic treatment.

Keywords

alveolar bone grafting cleft lip and palate orthodontics

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References

Åbyholm

F.E.

Bergland

Semb

Secondary bone grafting of alveolar clefts. A surgical/orthodontic treatment enabling a non-prosthodontic rehabilitation in cleft lip and palate patients. Scand J Plast Reconstr Surg. 1981; 15: 127–140.

Baccetti

Tooth rotation associated with aplasia of nonadjacent teeth. Angle Orthod. 1998; 68: 471–474.

Bäckdahl

Noedin

K.E.

Replacement of the maxillary bone defect in cleft palate: a new procedure. Acta Chir Scand. 1960; 122–131.

Beirne

J.C.

Barry

H.J.

Brady

F.A.

Morris

V.B.

Donor site morbidity of the anterior iliac crest following cancellous harvest. Int J Oral Maxillofac Surg. 1996; 25: 268–271.

Bergland

Semb

Abyholm

F.E.

Elimination of the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment. Cleft Palate J. 1986; 23: 175–205.

Bergland

Semb

Abyholm

Borchgrevink

Eskeland

Secondary bone grafting and orthodontic treatment in patients with bilateral complete clefts of the lip and palate. Ann Plast Surg. 1986; 17: 460–474.

Boyne

P.J.

Sands

N.R.

Secondary bone grafting of residual alveolar and palatal clefts. J Oral Surg. 1972; 30: 87–92.

Brattström

McWilliam

The influence of bone grafting age on dental abnormalities and alveolar bone height in patients with unilateral cleft lip and palate. Eur J Orthod. 1989; 11: 351–358.

Ellwood

R.P.

O'Mullane

D.M.

Association between dental enamel opacities and dental caries in a north Wales population. Caries Res. 1994; 28: 383–387.

10.

Freihofer

H.P.

Borstlap

W.A.

Kuijpers-Jagtman

A.M.

Borstlap-Engels

V.M.

Bone repair in unilateral cleft: when? With what? [in Language]. Fortschr Kiefer Gesichtschir. 1993; 38: 30–32.

11.

Kalaaji

Lilja

Friede

Elander

Bone grafting in the mixed and permanent dentition in cleft lip and palate patients: long-term results and the role of the surgeon's experience. J Craniomaxillofac Surg. 1996; 24: 29–35.

12.

Kindelan

J.D.

Nashed

R.R.

Bromige

M.R.

Radiographic assessment of secondary autogenous alveolar bone grafting in cleft lip and palate patients. Cleft Palate Craniofac J. 1997; 34: 195–198.

13.

Kortebein

M.J.

Nelson

C.L.

Sadove

A.M.

Retrospective analysis of 135 secondary alveolar cleft grafts using iliac or calvarial bone. J Oral Maxillofac Surg. 1991; 49: 493–498.

14.

Long

Jr Semb

Shaw

W.C.

Orthodontic treatment of the patient with complete clefts of lip, alveolus, and palate: lessons of the past 60 years. Cleft Palate Craniofac J. 2000; 37: 533–546.

15.

Long

Jr Spangler

B.E.

Yow

Cleft width and secondary alveolar bone graft success. Cleft Palate Craniofac J. 1995; 32: 420–427.

16.

Lopes

L.D.

Mattos

B.S.

Andre

Anomalies in number of teeth in patients with lip and/or palate clefts. Brazil Dent J. 1991; 2: 9–17.

17.

Maciel

S.P.

Costa

Gomide

M.R.

Difference in the prevalence of enamel alterations affecting central incisors of children with complete unilateral cleft lip and palate. Cleft Palate Craniofac J. 2005; 42: 392–395.

18.

Malanczuk

Opitz

Retzlaff

Structural changes of dental enamel in both dentitions of cleft lip and palate patients. J Orofac Orthop. 1999; 60: 259–268.

19.

Peck

Kataja

The palatally displaced canine as a dental anomaly of genetic origin. Angle Orthod. 1994; 64: 249–256.

20.

Ranta

A review of tooth formation in children with cleft lip/palate. Am J Orthod Dentofacial Orthop. 1986; 90: 11–18.

21.

Ranta

Numeric anomalies of teeth in concomitant hypodontia and hyperdontia. J Craniofac Genet Dev Biol. 1988; 8: 245–251.

22.

Ranta

Rintala

Tooth anomalies associated with congenital sinuses of the lower lip and cleft lip/palate. Angle Orthod. 1982; 52: 212–221.

23.

Samman

Cheung

L.K.

Tideman

A comparison of alveolar bone grafting with and without simultaneous maxillary osteotomies in cleft palate patients. Int J Oral Maxillofac Surg. 1994; 23: 65–70.

24.

Seow

W.K.

Clinical diagnosis of enamel defects: pitfalls and practical guidelines. Int Dent J. 1997; 47: 173–182.

25.

Shapira

Lubit

Kuftinec

M.M.

Congenitally missing second premolars in cleft lip and cleft palate children. Am J Orthod Dentofac Orthop. 1999; 115: 396–400.

26.

Shapira

Lubit

Kuftinec

M.M.

Hypodontia in children with various types of clefts. Angle Orthod. 2000; 70: 16–21.

27.

Steinberg

Padwa

B.L.

Boyne

Kaban

State of the art in oral and maxillofacial surgery: treatment of maxillary hypoplasia and anterior palatal and alveolar clefts. Cleft Palate Craniofac J. 1999; 36: 283–291.

28.

Suckling

G.W.

Pearce

E.I.

Developmental defects of enamel in a group of New Zealand children: their prevalence and some associated etiological factors. Community Dent Oral Epidemiol. 1984; 12: 177–184.

29.

Suckling

G.W.

Developmental defects of enamel—historical and present-day perspectives of their pathogenesis. Adv Dent Res. Sep 1989; 3: 87–94.

30.

Suzuki

Takahama

Maxillary lateral incisor of subjects with cleft lip and/or palate: part 1. Cleft Palate Craniofac J. 1992; 29: 376–379.

31.

Tortora

Meazzini

M.C.

Garattini

Brusti

Prevalence of abnormalities in dental structure, position, and eruption pattern in a population of unilateral and bilateral cleft lip and palate patients. Cleft Palate Craniofac J. 2008; 45: 154–162.

32.

Troxell

J.B.

Fonseca

R.J.

Osbon

D.B.

A retrospective study of alveolar cleft grafting. J Oral Maxillofac Surg. 1982; 40: 721–725.

33.

Tsai

T.P.

Huang

C.S.

Huang

C.C.

See

L.C.

Distribution patterns of primary and permanent dentition in children with unilateral complete cleft lip and palate. Cleft Palate Craniofac J. 1998; 35: 154–160.

34.

Warford

J.H.

Jr ., Grandhi RK, Tira DE. Prediction of maxillary canine impaction using sectors and angular measurement. Am J Orthod Dentofacial Orthop. 2003; 124: 651–655.