title: Radiographic assessment of secondary autogenous alveolar bone grafting in cleft lip and palate patients.
abstract: OBJECTIVE
  To assess if a 4-point, radiographically based scale could be used between operators to reliably assess the success of secondary alveolar bone grafting.
  
  
  METHODS
  The study was retrospective with the clinicians blind to patient identity. Radiographs were examined twice by two clinicians with 1 week between assessments.
  
  
  METHODS
  The research was carried out in a hospital-based orthodontic/oral and maxillofacial unit.
  
  
  METHODS
  All patients who had secondary alveolar bone grafting in this unit between February 1992 and March 1995 were included in this study. There were 38 patients with a total of 48 grafted sites.
  
  
  METHODS
  The bone graft site was radiographed following orthodontic expansion prior to grafting. The radiograph was repeated postoperatively at a mean of 4 months after surgery.
  
  
  METHODS
  The degree of bony fill in the cleft area was assessed using a 4-point scale: Grade 1 > 75% bony fill; Grade 2 50-75% bony fill; Grade 3 < 50% bony fill; Grade 4 no complete bony bridge.
  
  
  RESULTS
  Overall, 50% of grafts achieved grade 1, 23% were grade 2, 22% grade 3, and 5% grade 4. Levels of intra- and inter-observer agreement were highly variable (.33 to .72 kappa statistic).
  
  
  CONCLUSIONS
  The 4-point scale described could be used to assess the success of autogenous secondary alveolar bone grafting. It showed moderate to substantial intra-observer agreement, and fair-to-moderate inter-observer agreement.
authors.affiliation: Leeds Dental Institute, United Kingdom.
authors.forename: J D
authors.initials: JD
authors.lastname: Kindelan
authors.forename: R R
authors.initials: RR
authors.lastname: Nashed
authors.forename: M R
authors.initials: MR
authors.lastname: Bromige
mesh_terms: D000293:Adolescent; D000328:Adult; D000539:Alveolar Process / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D000543:Alveoloplasty / Q000379:methods*; D016025:Bone Transplantation / Q000000981:diagnostic imaging*; D002648:Child; D002971:Cleft Lip / Q000150:complications / Q000601:surgery; D002972:Cleft Palate / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D017063:Outcome Assessment, Health Care; D011859:Radiography; D012189:Retrospective Studies; D016037:Single-Blind Method