Mandibular Symphyseal Bone Graft for Reconstruction of Alveolar Cleft Defects: Volumetric Assessment with Cone Beam Computed Tomography 1-Year Postsurgery
Restricted accessOtherFirst published online January, 2016
Mandibular Symphyseal Bone Graft for Reconstruction of Alveolar Cleft Defects: Volumetric Assessment with Cone Beam Computed Tomography 1-Year Postsurgery
The aims of this retrospective study were to evaluate the volumetric outcome of mandibular symphyseal bone graft in patients with unilateral cleft lip and palate by estimating the bone fill 1-year postoperatively on cone beam computed tomography. The outcome was assessed in relation to the (1) root development stage of the cleft side canine, (2) presence/absence of a cleft side lateral incisor, and (3) volume size of the preoperative cleft defect.
Methods
The alveolar bone defect volume of 32 consecutive unilateral cleft lip and palate patients aged 8 years 1 month to 11 years 11 months was evaluated using a recently defined and standardized protocol. The outcome was calculated as the percentage of bone fill using the formula (VOLpre - VOLpost) / VOLpre) x 100.
Results
The preoperative mean alveolar cleft volume was 934 mm3, and the average percentage bone fill was 87%. There was no significant difference between bone fill and root developmental stage of the cleft-side canine (P = .882) nor presence/absence of the cleft side lateral incisor (P = .803). The size of the cleft defect did not correlate with the bone fill (r = .03, P = .84).
Conclusions
Secondary alveolar bone grafting with mandibular symphyseal bone graft in patients with unilateral cleft lip and palate is an attractive procedure assessed from the volumetric outcome using cone beam computed tomography. The 1-year average bone fill of 87% was not significantly influenced by root development stage of the cleft-side canine, presence or the absence of a cleft side lateral incisor, or size of the alveolar defect.
AlbuquerqueM.A., GaiaB.F., CavalcantiM.G.Comparison between multislice and cone-beam computerized tomography in the volumetric assessment of cleft palate. Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2011; 112: 249–257.
2.
AmanatN., LangdonJ.D.Secondary alveolar bone grafting in clefts of the lip and palate. J Craniomaxillofac Surg.1991; 19: 7–14.
3.
AmirlakB., TangC.J., BeckerD., PalomoJ.M., GosainA.K.Volumetric analysis of simulated alveolar cleft defects and bone grafts using cone beam computed tomography. Plast Reconstr Surg.2013; 131: 854–859.
4.
AndersenK., NørholtS.E., KnudsenJ., KüselerA., JensenJ.Donor site morbidity after reconstruction of alveolar bone defects with mandibular symphyseal bone grafts in cleft patients—111 consecutive patients. Int J Oral Maxillofac Surg.2014; 43: 428–432.
5.
ArctanderK., KolbenstvedtA., AaløkkenT.M., AbyholmF., FroslieK.F.Computed tomography of alveolar bone grafts 20 years after repair of unilateral cleft lip and palate. Scand J Plast Reconstr Surg Hand Surg.2005; 39: 11–14.
6.
BerglandO., SembG., AbyholmF.E.Elimination of the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment. Cleft Palate J.1986; 23: 175–205.
7.
BooijA., RaghoebarG.M., JansmaJ., KalkW.W., VissinkA.Morbidity of chin bone transplants used for reconstructing alveolar defects in cleft patients. Cleft Palate Craniofac J.2005; 42: 533–538.
8.
BoskerH.L., van DijkL.Het bottransplantaat uit de mandibula voor herstel van de gnathopalatoschisis. Ned Tijdschr Geneeskd.1980; 87: 383–388.
9.
BoyneP.J., SandsN.R.Secondary bone grafting of residual alveolar and palatal clefts. J Oral Surg.1972; 30: 87–92.
10.
BoyneP.J., SandsN.R.Combined orthodontic-surgical management of residual palato-alveolar cleft defects. Am J Orthod.1976; 70: 20–37.
11.
CattaneoP.M., MelsenB.The use of cone-beam computed tomography in an orthodontic department in between research and daily clinic. World J Orthod.2008; 9: 269–282.
12.
ChenN.T., GlowackiJ., BuckyL.P., HongH.Z., KimW.K., YaremchukM.J.The roles of revascularization and resorption on endurance of craniofacial onlay bone grafts in the rabbit. Plast Reconstr Surg.1994; 93: 714–722, discussion 723-724.
13.
ChoiH.S., ChoiH.G., KimS.H., ParkH.J., ShinD.H., JoD.I., KimC.K., UhmK.I.Influence of the alveolar cleft type on preoperative estimation using 3D CT assessment for alveolar cleft. Arch Plast Surg.2012; 39: 477–482.
DempfR., TeltzrowT., KramerF.J., HausamenJ.E.Alveolar bone grafting in patients with complete clefts: a comparative study between secondary and tertiary bone grafting. Cleft Palate Craniofac J.2002; 39: 18–25.
16.
DielemanF.J., TumpP., BaartJ.A., TuinzingD.B., BezemerP.D.A computed tomographic evaluation of change in bone volume after secondary bone grafting over the first postoperative year. Plast Reconstr Surg.2004; 114: 738–742.
17.
EnemarkH., JensenJ., BoschC.Mandibular bone graft material for reconstruction of alveolar cleft defects: long-term results. Cleft Palate Craniofac J.2001; 38: 155–163.
18.
EnemarkH., Sindet-PedersenS., BundgaardM.Long-term results after secondary bone grafting of alveolar clefts. J Oral Maxillofac Surg.1987; 45: 913–919.
19.
FeichtingerM., MossbockR., KarcherH.Evaluation of bone volume following bone grafting in patients with unilateral clefts of lip, alveolus and palate using a CT-guided three-dimensional navigation system. J Craniomaxillofac Surg.2006; 34: 144–149.
20.
FeichtingerM., MossbockR., KarcherH.Assessment of bone resorption after secondary alveolar bone grafting using three-dimensional computed tomography: a three-year study. Cleft Palate Craniofac J.2007; 44: 142–148.
21.
FreihoferH.P., BorstlapW.A., Kuijpers-JagtmanA.M., VoorsmitR.A., van DammeP.A., HeidbuchelK.L., Borstlap-EngelsV.M.Timing and transplant materials for closure of alveolar clefts. A clinical comparison of 296 cases. J Craniomaxillofac Surg.1993; 21: 143–148.
22.
GrauerD., CevidanesL.S., ProffitW.R.Working with DICOM craniofacial images. Am J Orthod Dentofacial Orthop.2009; 136: 460–470.
23.
HamadaY., KondohT., NoguchiK., IinoM., IsonoH., IshiiH., MishimaA., KobayashiK., SetoK.Application of limited cone beam computed tomography to clinical assessment of alveolar bone grafting: a preliminary report. Cleft Palate Craniofac J.2005; 42: 128–137.
24.
HonmaK., KobayashiT., NakajimaT., HayasiT.Computed tomographic evaluation of bone formation after secondary bone grafting of alveolar clefts. J Oral Maxillofac Surg.1999; 57: 1209–1213.
25.
HoppenreijsT.J., NijdamE.S., FreihoferH.P.The chin as a donor site in early secondary osteoplasty: a retrospective clinical and radiological evaluation. J Craniomaxillofac Surg.1992; 20: 119–124.
26.
KearnsG., PerrottD.H., SharmaA., KabanL.B., VargervikK.Placement of endosseous implants in grafted alveolar clefts. Cleft Palate Craniofac J.1997; 34: 520–525.
27.
KimK.R., KimS., BaekS.H.Change in grafted secondary alveolar bone in patients with UCLP and UCLA. A three-dimensional computed tomography study. Angle Orthod.2008; 78: 631–640.
28.
KooleR.Ectomesenchymal mandibular symphysis bone graft: an improvement in alveolar cleft grafting?Cleft Palate Craniofac J.1994; 31: 217–223.
29.
KooleR., BoskerH., van der DussenF.N.Late secondary autogenous bone grafting in cleft patients comparing mandibular (ectomesenchymal) and iliac crest (mesenchymal) grafts. J Craniomaxillofac Surg.1989; 17(suppl 1): 28–30.
30.
KooleR., VisserW.J., KleinW.R., SuikerA.M.A comparative investigation on autologous mandibular and iliac crest bone grafts. An experimental study in sheep. J Craniomaxillofac Surg.1991; 19: 133–143.
31.
LinderupB.W., KüselerA., JensenJ., CattaneoP.M.A novel semiautomatic technique for volumetric assessment of the alveolar bone defect using cone beam computed tomography. Cleft Palate Craniofac J.2015; 52: e47–e55.
32.
LongREJr., SpanglerB.E., YowM.Cleft width and secondary alveolar bone graft success. Cleft Palate Craniofac J.1995; 32: 420–427.
33.
LudlowJ.B.Comment on “effective dose range for dental cone beam computed tomography scanners.”Eur J Radiol.2012; 81: 4219–4220, author reply 4221-4224.
34.
LudlowJ.B., Davies-LudlowL.E., WhiteS.C.Patient risk related to common dental radiographic examinations: the impact of 2007 international commission on radiological protection recommendations regarding dose calculation. J Am Dent Assoc.2008; 139: 1237–1243.
35.
MikoyaT., InoueN., MatsuzawaY., TotsukaY., KajiiT.S., HirosawaT.Monocortical mandibular bone grafting for reconstruction of alveolar cleft. Cleft Palate Craniofac J.2010; 47: 454–468.
36.
MurthyA.S., LehmanJ.A.Evaluation of alveolar bone grafting: a survey of ACPA teams. Cleft Palate Craniofac J.2005; 42: 99–101.
37.
OberoiS., ChigurupatiR., GillP., HoffmanW.Y., VargervikK.Volumetric assessment of secondary alveolar bone grafting using cone beam computed tomography. Cleft Palate Craniofac J.2009; 46: 503–511.
38.
OberoiS., GillP., ChigurupatiR., HoffmanW.Y., HatcherD.C., VargervikK.Three-dimensional assessment of the eruption path of the canine in individuals with bone-grafted alveolar clefts using cone beam computed tomography. Cleft Palate Craniofac J.2010; 47: 507–512.
39.
OzawaT., OmuraS., FukuyamaE., MatsuiY., TorikaiK., FujitaK.Factors influencing secondary alveolar bone grafting in cleft lip and palate patients: prospective analysis using CT image analyzer. Cleft Palate Craniofac J.2007; 44: 286–291.
40.
PinholtE.M., SolheimE., TalsnesO., LarsenT.B., BangG., KirkebyO.J.Revascularization of calvarial, mandibular, tibial, and iliac bone grafts in rats. Ann Plast Surg.1994; 33: 193–197.
RawashdehM.A., TelfahH.Secondary alveolar bone grafting: the dilemma of donor site selection and morbidity. Br J Oral Maxillofac Surg.2008; 46: 665–670.
43.
RosensteinS.W., LongREJr., DadoD.V., VinsonB., AlderM.E.Comparison of 2-D calculations from periapical and occlusal radiographs versus 3-D calculations from CAT scans in determining bone support for cleft-adjacent teeth following early alveolar bone grafts. Cleft Palate Craniofac J.1997; 34: 199–205.
44.
Schultze-MosgauS., NkenkeE., SchlegelA.K., HirschfelderU., WiltfangJ.Analysis of bone resorption after secondary alveolar cleft bone grafts before and after canine eruption in connection with orthodontic gap closure or prosthodontic treatment. J Oral Maxillofac Surg.2003; 61: 1245–1248.
45.
SembG.Alveolar bone grafting. Front Oral Biol.2012; 16: 124–136.
SheskinD.J.Handbook of Parametric and Nonparametric Statistical Procedures.Boca Raton, FL: Chapman & Hall/CRC;2011.
48.
ShirotaT., KurabayashiH., OguraH., SekiK., MakiK., ShintaniS.Analysis of bone volume using computer simulation system for secondary bone graft in alveolar cleft. Int J Oral Maxillofac Surg.2010; 39: 904–908.
49.
Sindet-PedersenS., EnemarkH.Mandibular bone grafts for reconstruction of alveolar clefts. J Oral Maxillofac Surg.1988; 46: 533–537.
50.
Sindet-PedersenS., EnemarkH.Reconstruction of alveolar clefts with mandibular or iliac crest bone grafts: a comparative study. J Oral Maxillofac Surg.1990; 48: 554–558, discussion 559-560.
51.
Spin-NetoR., MarcantonioEJr., GotfredsenE., WenzelA.Exploring CBCT-based DICOM files. A systematic review on the properties of images used to evaluate maxillofacial bone grafts. J Digit Imaging.2011; 24: 959–966.
52.
TaiC.C., SutherlandI.S., McFaddenL.Prospective analysis of secondary alveolar bone grafting using computed tomography. J Oral Maxillofac Surg.2000; 58: 1241–1249, discussion 1250.
53.
van der MeijA., BaartJ.A., Prahl-AndersenB., KostenseP.J., van der SijpJ.R., TuinzingD.B.Outcome of bone grafting in relation to cleft width in unilateral cleft lip and palate patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2003; 96: 19–25.
54.
World Medical Association.World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA.2013; 310: 2191–2194.
55.
ZhangW., ShenG., WangX., YuH., FanL.Evaluation of alveolar bone grafting using limited cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol.2012; 113: 542–548.
