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      Secondary bone grafting for alveolar clefts: surgical timing, graft materials, and evaluation methods

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          Abstract

          Alveolar cleft belongs to the spectrum of cleft lip and/or palate, affecting 75% of cleft lip/palate patients. The goals of alveolar cleft treatment are stabilizing the maxillary arch, separating the nasal and oral cavities, and providing bony support for both erupting teeth and the nasal base via the piriform aperture. Secondary alveolar bone grafting is a well-established treatment option for alveolar cleft. Secondary alveolar bone grafting is performed during the period of mixed dentition using autologous bone from various donor sites. There are several issues relevant to maximizing the success of secondary alveolar bone grafting, including the surgical timing, graft material, and surgical technique. In this study, we reviewed issues related to surgical timing, graft materials, and evaluation methods in secondary alveolar bone grafting.

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          The biology of bone graft repair.

          H Burchardt (1983)
          Cancellous and cortical autografts histologically have three differences: (1) cancellous grafts are revascularized more rapidly and completely than cortical grafts; (2) creeping substitution of cancellous bone initially involves an appositional bone formation phase, followed by a resorptive phase, whereas cortical grafts undergo a reverse creeping substitution process; (3) cancellous grafts tend to repair completely with time, whereas cortical grafts remain as admixtures of necrotic and viable bone. Physiologic skeletal metabolic factors influence the rate, amount, and completeness of bone repair and graft incorporation. The mechanical strengths of cancellous and cortical grafts are correlated with their respective repair processes: cancellous grafts tend to be strengthened first, whereas cortical grafts are weakened. Bone allografts are influenced by the same immunologic factors as other tissue grafts. Fresh bone allografts may be rejected by the host's immune system. The histoincompatibility antigens of bone allografts are presumably the proteins or glycoproteins on cell surfaces. The matrix proteins may or may not elicit graft rejection. The rejection of a bone allograft is considered to be a cellular rather than a humoral response, although the humoral component may play a part. The degree of the host response to an allograft may be related to the antigen concentration and total dose. The rejection of a bone allograft is histologically expressed by the disruption of vessels, an inflammatory process including lymphocytes, fibrous encapsulation, peripheral graft resorption, callus bridging, nonunions, and fatigue fractures.
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            Secondary bone grafting of residual alveolar and palatal clefts.

            P J Boyne, N R Sands (1972)
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              Elimination of the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment.

              G Semb, F Abyholm, Alan O. Bergland (1986)
              A combined surgical/orthodontic procedure to eliminate the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment is described. The operations have been carried out on 378 patients: 240 males and 138 females. Seventy-two patients had bilateral clefts, making a total of 450 grafted clefts. The optimal age for this secondary bone grafting has been found to be 9 to 11 years. In 292 of the cases, the canine had reached its final position in the arch, which allowed a four-group semiquantitative assessment of the newly obtained interdental septum on dental radiographs. The best results have been achieved in cases where the bone graft was carried out prior to the eruption of the canine. In this group, a normal (category I) interdental septal height was achieved in 64 percent and a slightly lower (category II) interdental septum in 32 percent. Interdental septa classified as type I and II are considered to be acceptable. The cleft space was closed in 90 percent of the cases. No significant difference between unilateral and bilateral cases was found. When the same procedure was carried out after eruption of the canine, the results were less favorable.
              Article 0 comments Cited 64 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Arch Craniofac Surg
                Journal ID (iso-abbrev): Arch Craniofac Surg
                Journal ID (publisher-id): ACFS
                Title: Archives of Craniofacial Surgery
                Publisher: Korean Cleft Palate-Craniofacial Association
                ISSN (Print): 2287-1152
                ISSN (Electronic): 2287-5603
                Publication date (Print): April 2022
                Publication date (Electronic): 20 April 2022
                Volume: 23
                Issue: 2
                Pages: 53-58
                Affiliations
                Department of Plastic and Reconstructive Surgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea
                Author notes
                Correspondence: Woonhyeok Jeong Department of Plastic and Reconstructive Surgery, Keimyung University School of Medicine, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea E-mail: psjeong0918@ 123456gmail.com

                This work was supported by a National Research Foundation of Korea (NRF) grant from the Korean government (MSIT) (No. 2021R1G1A1004556) and a Korea Medical Device Development Fund grant from the Korean government (Ministry of Science and ICT, Ministry of Trade, Industry and Energy, Ministry of Health & Welfare, and Ministry of Food and Drug Safety) (Project Number: KMDF_PR_20200901_0307-2021-03).

                Author information
                http://orcid.org/0000-0002-1061-6832
                http://orcid.org/0000-0002-0221-3347
                Article
                Publisher ID: acfs-2022-00115
                DOI: 10.7181/acfs.2022.00115
                PMC ID: 9081425
                PubMed ID: 35526839
                SO-VID: 5d909ac7-d785-4176-b083-0e1f44e64d07
                Copyright © Copyright © 2022 Korean Cleft Palate-Craniofacial Association
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 12 March 2022
                Date revision received : 12 March 2022
                Date accepted : 19 April 2022
                Categories
                Subject: Review Article

                Keywords: alveolar bone grafting,cleft lip,cleft palate,donor selection,surgical timing
                Data availability:
                Keywords: alveolar bone grafting, cleft lip, cleft palate, donor selection, surgical timing

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