Original article
Long-term stability of alveolar bone grafts in cleft palate patients

https://doi.org/10.1016/j.ajodo.2012.04.015Get rights and content

Introduction

Many authors have examined the surgical bone treatment of cleft palate patients, but no study has emphasized the role of orthodontic therapy. The aims of this study were to evaluate the long-term stability of bone grafts when using an orthodontic-surgical protocol, to determine the success of bone grafts in minor vs severe clefts, and to develop a qualitative method for assessing the success of bone grafting.

Methods

Forty-nine patients were included in this study. Occlusal x-rays were taken before (T0), immediately after (T1), and at least 1 year after bone grafting (T2). Two radiographic parameters were analyzed adjacent to the cleft side: the vertical bone level (Bergland scale) and the horizontal bone level (Witherow-derived scale).

Results

The bone graft success at T2 was 91.84% (95% confidence interval, 84.55-96.41). The severity of the cleft before grafting was not statistically correlated with success at T2 (P <0.05). The concordance rate between Bergland and Witherow values was 87.07% (95% confidence interval, 82.69-90.69). The variables analyzed (sex, age, type of cleft, lateral incisor agenesis) were not statistically correlated (P <0.05) with the stability of bone graft. Based on the results, the only factor involved in the stability of the graft seems to be dental age at the time of bone grafting and the orthodontic therapy before and after grafting.

Conclusions

It seems appropriate to recommend early application of a surgical-orthodontic protocol to treat cleft lip and palate patients, prevent postoperative bone resorption, and guarantee correct positioning of the teeth.

Section snippets

Material and methods

In this retrospective clinical trial, we analyzed the records of 446 complete cleft lip and palate patients, recruited from the Regional Hospital of Vicenza (Italy), Cleft Palate Patients National Reference Centre, between 1994 and 2011. There was only 1 data manager (D.T.), and all records were digitized. The study population consisted of white patients matched for sex and age.

Patients were included in the study based on the following criteria: (1) congenital complete cleft lip and palate; (2)

Success rate and grading systems

The success rate at T1 was 70.41% (95% CI, 60.34-79.21). The success rate at T2 was 91.84% (95% CI, 84.55-96.41). The binomial intervals of confidence did not intersect; therefore, the T2 success rate was significantly greater than that at T1.

The correlation between cleft palate severity and success rate at T2 was not statistically significant (P = 0.64).

The Kendall coefficient of concordance was 0.99 for both the Bergland and the Witherow-derived scales (0 < Kendall W < 1), indicating that

Discussion

The main purpose of this study was to evaluate the long-term stability of alveolar bone grafts with an orthodontic-surgical protocol. Our success rates were 70.41% (95% CI, 60.34-79.21) at T1 and 91.84% (95% CI, 84.55-96.41) at T2; these correspond well with results reported in the literature (90%, Bergland et al25 in 378 patients; 83%, Amanat and Langdon35 in 34 patients; 91%, Long et al17 in 43 patients; 73%, Kindelan et al36 in 38 patients; 72%, Da Silva Filho et al37 in 50 patients; 91%,

Conclusions

Based on our data, it seems appropriate to recommend the early application of a surgical-orthodontic protocol to treat cleft lip and palate patients, prevent postoperative bone resorption, and guarantee correct positioning of the teeth.

Our findings indicate the following.

  • 1.

    The success rate of bone grafts at T2 was 91.84 (95% CI, 84.55-96.41), suggesting a high percentage of success with this therapy protocol.

  • 2.

    Cleft severity was not statistically correlated with success at T2, demonstrating the

References (65)

  • G. Paulin et al.

    Intermediate bone grafting of alveolar clefts

    J Craniomaxillofac Surg

    (1988)
  • J.B. Troxell et al.

    A retrospective study of alveolar grafting

    J Oral Maxillofac Surg

    (1982)
  • H.J. Kwon et al.

    The management of alveolar cleft defects

    J Am Dent Assoc

    (1981)
  • L.M. Sigler et al.

    Effect of rapid maxillary expansion and transpalatal arch treatment associated with deciduous canine extraction on the eruption of palatally displaced canines: a 2-center prospective study

    Am J Orthod Dentofacial Orthop

    (2011)
  • T. Baccetti et al.

    Interceptive treatment of palatal impaction of maxillary canines with rapid maxillary expansion: a randomized clinical trial

    Am J Orthod Dentofacial Orthop

    (2009)
  • D. Wang et al.

    Biomechanical analysis of rapid maxillary expansion in the UCLP patients

    Med Eng Phys

    (2009)
  • F.J. Kramer et al.

    Dental implants in patients with orofacial clefts: a long-term follow-up study

    Int J Oral Maxillofac Surg

    (2005)
  • T. Skoog

    The use of periosteal flaps in the repair of clefts of the primary palate

    Cleft Palate Craniofac J

    (1965)
  • A. Rintala et al.

    Primary treatment of cleft lip and palate at the Finnish Red Cross Cleft Palate Center from 1966 to 1980

  • R. Helloquist et al.

    A longitudinal study of delayed periosteoplasty to the cleft alveolus

    Cleft Palate Craniofac J

    (1983)
  • R. Ranta

    Orthodontic treatment alternatives for unilateral cleft lip and palate patients

  • A.M. Kuijpers-Jagtman et al.

    The influence of surgery and orthopaedic treatment on maxillofacial growth and maxillary arch development in patients treated for orofacial clefts

    Cleft Palate Craniofac J

    (2000)
  • K.E. Nordin et al.

    Freie knochentransplantation bei defcten in alveolarkamm nach kieferorthopädischer einstellung der maxilla bei lippen-kiefer-gaumenspalten

  • E. Schmid

    Die annäherung der kieferstümpfe bei lippen-kiefer-gaumenspalten; ihre schadlichen folgen und vermeidung

  • N.R.E. Robertson

    Early treatment—a critique

    Trans Eur Orthod Soc

    (1973)
  • Z. Smahel et al.

    Changes in craniofacial development due to modifications of the treatment of unilateral cleft lip and palate

    Cleft Palate Craniofac J

    (1998)
  • K. Molsted et al.

    A six-center international study of treatment outcome in patients with cleft lip and palate: evaluation of maxillary asymmetry

    Cleft Palate Craniofac J

    (1993)
  • R.B. Ross

    Treatment variables affecting facial growth in complete unilateral cleft lip and palate. Part 3: alveolus repair and bone grafting

    Cleft Palate Craniofac J

    (1987)
  • S. Berkovitz

    A comparison of treatment results in complete bilateral cleft lip and palate using a conservative approach versus Millard-Latham PSOT procedure

    Semin Orthod

    (1996)
  • P.J. Boyne et al.

    Secondary bone grafting of residual alveolar and palatal defects

    J Oral and Maxillofac Surg

    (1972)
  • R.E. Long et al.

    Cleft width and secondary alveolar bone graft success

    Cleft Palate Craniofac J

    (1995)
  • V. Brattström et al.

    Craniofacial development in children with unilateral clefts of the lip, alveolus, and palate treated according to four different regimes. I. Maxillary development

    Scand J Plast Reconstr Surg Hand Surg

    (1991)

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