title: Bone reconstruction of the maxillary alveolus for subsequent insertion of a dental implant in patients with cleft lip and palate.
abstract: Bone grafting of maxillary alveolus cleft defect followed by insertion of dental implant may be a good alternative to conventional prosthetic treatment. The principle is the formation of stable alveolar crest with a sufficient three-dimensional volume. The problems are lack and quality of mucoperiosteum for the reconstruction of shell and bone gap characteristics for bone graft intake. The procedure was carried out by a single surgeon (MD) in 45 patients between 29 August 2001 and 30 June 2006, with an 86.7% success rate. The success was defined as completed process with dental implant insertion and its loading by a prosthetic suprastructure without a failure for at least 15 months from that last step. The success rate mainly depends on 1) good alveolar arch flow of maxilla segments in both horizontal and vertical planes; 2) the height of osseous poles of at least 12 mm and onlay augmentation of built-up section does not work; 3) adequate volume of cancellous bone graft, 3.7 cm on average. On the basis of histologic verification and clinical findings, the bone graft is matured enough to ensure a primary stability of a fixture in 12.5 weeks after reconstruction. Early load may prevent bone resorption. Prediction of complications are as follows: 1) graft resorption increases according to gap size and low possibility of revascularization; 2) a higher number of complications are linked to presence of oronasal fistula and to scarring of soft tissues; 3) because of more gracile skeleton and female metabolism, the risk is higher in women.
authors.affiliation: Department of Plastic Surgery, Charles University, Prague, Czech Republic. duskova@fnkv.cz
authors.forename: Marketa
authors.initials: M
authors.lastname: Duskova
authors.forename: Magdalena
authors.initials: M
authors.lastname: Kotova
authors.forename: Kristina
authors.initials: K
authors.lastname: Sedlackova
authors.forename: Eva
authors.initials: E
authors.lastname: Leamerova
authors.forename: Jiri
authors.initials: J
authors.lastname: Horak
mesh_terms: D000293:Adolescent; D000328:Adult; D000540:Alveolar Ridge Augmentation / Q000379:methods*; D001862:Bone Resorption / Q000517:prevention & control; D016025:Bone Transplantation / Q000379:methods*; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D003724:Dental Arch / Q000601:surgery; D003758:Dental Implantation, Endosseous; D015921:Dental Implants; D019094:Dental Prosthesis, Implant-Supported; D019232:Dental Restoration Failure; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008297:Male; D008437:Maxilla / Q000601:surgery*; D009668:Nose Diseases / Q000150:complications; D016155:Oral Fistula / Q000150:complications; D019651:Plastic Surgery Procedures; D016156:Respiratory Tract Fistula / Q000150:complications; D013314:Stress, Mechanical; D016896:Treatment Outcome
chemical_list: D015921:Dental Implants