Alveolar bone grafting in patients with complete clefts: a comparative study between secondary and tertiary bone grafting.
OBJECTIVE
This investigation evaluated the results of alveolar bone grafting in patients with complete clefts, comparing secondary alveolar bone grafting (during the mixed stage of dentition) versus tertiary bone grafting (after completion of the second stage of dentition).


METHODS
This was a retrospective study. Of 140 osteoplasties, which all were operated according to the same standardized surgical technique, a clinical and roentgenological follow-up investigation was carried out in a collective of 85 osteoplasties. Clinically we searched for oronasal fistulae, assessed the periodontal status, determined the extent of the gingival attachment in the area of the osteoplasty, and searched for vertical growth disturbances in the area of the osteoplasty. Roentgenologically the height of the alveolar bone in the former clefted area was ascertained.


METHODS
Records were obtained from a clinical and radiological study of the Department of Oral and Maxillofacial Surgery of the Medical University of Hannover (Germany).


METHODS
All patients were operated with the same standardized surgical method. The osteoplastic bridging of the alveolar cleft was performed via a vestibular gingival marginal incision and exclusively by grafting of cancellous bone from the iliac crest.


RESULTS
The best results of alveolar bone grafting in cases of secondary osteoplasty were obtained when the lateral incisor or canine had grown into the transplant and had led to a functional stress of the transplanted bone. Approximately good results were to be found in tertiary osteoplasty when the transplanted bone had been stressed functionally through a dental implant. Comparing the secondary with the tertiary osteoplasty, there was a trend of lower resorption in secondary osteoplasty.


CONCLUSIONS
Secondary osteoplasty should represent an integral component of any concept for the comprehensive treatment of patients with cleft lip and palate.
Dempf
Rupert
R
Department of Oral and Maxillofacial Surgery, Medical University of Hannover, Hannover, Germany. Dempf.Rupert@mh-hannover.de
Teltzrow
Thomas
T
Kramer
Franz-Josef
FJ
Hausamen
Jarg-Erich
JE
D000328:Adult; D000539:Alveolar Process / Q000000981:diagnostic imaging; D000543:Alveoloplasty / Q000009:adverse effects / Q000379:methods*; D001862:Bone Resorption / Q000209:etiology; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002972:Cleft Palate / Q000000981:diagnostic imaging / Q000601:surgery*; D003481:Cuspid / Q000473:pathology; D015921:Dental Implants; D003818:Dentition, Mixed; D005500:Follow-Up Studies; D005881:Gingiva / Q000473:pathology; D006801:Humans; D007180:Incisor / Q000473:pathology; D009668:Nose Diseases / Q000209:etiology; D016155:Oral Fistula / Q000209:etiology; D010510:Periodontal Diseases / Q000209:etiology; D011859:Radiography; D016156:Respiratory Tract Fistula / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D014078:Tooth Eruption
D015921:Dental Implants