title: Management of failed alveolar bone grafts: improved outcomes and decreased morbidity with allograft alone.
abstract: BACKGROUND
  This study demonstrates the safety and efficacy of allograft alone in revision alveolar bone graft surgery.
  
  
  METHODS
  A retrospective review of the authors' institution's alveolar bone graft experience (from 2004 to 2012) with open iliac crest bone graft, minimal-access iliac crest bone graft plus supplemental allograft, and revision allograft alone was performed. All patients (n = 47) were treated with alveolar fistula repair with primary closure.
  
  
  RESULTS
  Group 1 patients (12 male, 10 female; average age, 10 years) received iliac crest bone graft alone; 17 had unilateral and five had bilateral clefts. Group 2 (eight male, six female; average age, 9 years) received an iliac crest bone graft plus allograft; six clefts were unilateral and eight were bilateral. Group 3 (six male, five female; average age, 13 years) received revision allograft alone; seven clefts were unilateral and four were bilateral. Average operative time/alveolus was shortest in group 3 compared with groups 1 and 2 (p < 0.0005). Average engraftment was better in group 3 than in group 1 (p < 0.001) and similar to that in group 2 (p < 0.079). Revision alveolar bone graft with allograft alone improved Enemark scores from 3.7 preoperatively to 1.0 postoperatively (p < 0.0001). Hospital stay was shortest in group 3 compared with groups 1 and 2 (p < 0.0001). Bone graft extrusion occurred in six patients (27.3 percent) in group 1, no complications occurred in group 2, and a single necrotic central incisor was lost at the time of revision bone grafting in group 3 (9.1 percent).
  
  
  CONCLUSIONS
  Allograft alone is safe and effective and provides a reliable alternative when traditional alveolar bone graft with iliac crest bone graft has failed.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Pittsburgh, Pa. From the Department of Pediatric Plastic and Reconstructive Surgery, University of Pittsburgh, Cleft/Craniofacial Center, Children's Hospital of Pittsburgh.
authors.forename: Wesley N
authors.initials: WN
authors.lastname: Sivak
authors.forename: Zoe M
authors.initials: ZM
authors.lastname: MacIsaac
authors.forename: S Alex
authors.initials: SA
authors.lastname: Rottgers
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Losee
authors.forename: Anand R
authors.initials: AR
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D064591:Allografts; D064728:Alveolar Bone Grafting / Q000009:adverse effects / Q000379:methods*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure