title: Alveolar reconstruction in cleft patients:  decreased morbidity and improved outcomes with supplemental demineralized bone matrix and cancellous allograft.
abstract: BACKGROUND
  The safety and efficacy of supplemental allograft combined with iliac crest autograft as a treatment for cleft alveolus defects is poorly characterized. The authors report the safety and efficacy of supplemental demineralized bone matrix and cancellous allograft with iliac crest bone autograft in cleft alveolar bone defects.
  
  
  METHODS
  A retrospective review of one institution's experience with cleft alveolar bone defects treated with traditional open iliac crest bone graft alone (group 1) or minimal access iliac crest bone graft plus demineralized bone matrix and cancellous allograft (group 2) was performed. All patients (n = 36) were treated with alveolar fistula repair with primary closure.
  
  
  RESULTS
  Twenty-two patients [17 unilateral and five bilateral clefts (n = 27)] were treated in group 1 and 14 [six unilateral clefts and eight bilateral clefts (n = 22)] in group 2. The average operative time per alveolus was 147 minutes in group 1 and 111 minutes in group 2. Average engraftment (Enemark Scale) was 1.96 in group 1 and 1.20 in group 2. In group 1, canine eruption was complete in 71.4 percent, partial in 21.4 percent, and unerupted in 3.5 percent; in group 2, canine eruption was complete in 22 percent, partial in 55 percent, and unerupted in 18 percent. Bone graft extrusion occurred in six patients in group 1. There were no wound infections or deaths.
  
  
  CONCLUSIONS
  The addition of supplemental demineralized bone matrix and cancellous allograft in cleft alveolar defects is safe and effective. The authors' allograft supplemental surgical technique is associated with low morbidity, shorter operative times, and higher rates of bone graft survival.
authors.affiliation: Pittsburgh, Pa. From the Division of Pediatric Plastic and Reconstructive Surgery, University of Pittsburgh, Cleft/Craniofacial Center, Children's Hospital of Pittsburgh.
authors.forename: Zoe M
authors.initials: ZM
authors.lastname: MacIsaac
authors.forename: S Alex
authors.initials: SA
authors.lastname: Rottgers
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Davit
authors.forename: Matthew
authors.initials: M
authors.lastname: Ford
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Losee
authors.forename: Anand R
authors.initials: AR
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D018775:Bone Demineralization Technique; D001857:Bone Matrix / Q000637:transplantation*; D016025:Bone Transplantation / Q000379:methods; D002648:Child; D002972:Cleft Palate / Q000601:surgery*; D005260:Female; D006801:Humans; D007085:Ilium / Q000166:cytology; D007902:Length of Stay; D008297:Male; D008334:Mandible / Q000002:abnormalities* / Q000601:surgery*; D008437:Maxilla / Q000002:abnormalities* / Q000601:surgery*; D061646:Operative Time; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D016896:Treatment Outcome