Bone grafting in the mixed and permanent dentition in patients with unilateral cleft lip and palate

Abstract

Secondary and late secondary bone grafting of the residual alveolar cleft has become a well-established procedure with several advantages in the habilitation of patients with cleft lip and palate. These advantages can be summarized as follows: stabilizing of the dental maxillary arch; facilitating eruption of the canine; providing bony support to teeth neighboring the cleft; augmenting of the alar base of the nose; and facilitating closure of an oronasal fistula. However, little attention has been paid to the following issues: to benefits of these bone grafts in patients with clefts of the lip and alveolus only; to a possible role of the experience of the surgeon on the outcome; to a specific group of patients treated with delayed closure of the hard palate combined with bone grafting at the mixed dentition; to facilitation of the lateral incisor eruption as a main indication for the bone-grafting procedure; to indicatorís criteria for optimal timing of the bone grafting; and to the tibia as a donor site for the bone-grafting procedure.In Göteborg, the treatment of patients with cleft lip and palate including bone grafting has been ongoing since 1958. Patients with cleft lip and primary palate and patients with complete unilateral cleft lip and palate from the Göteborg cleft lip palate archive were studied. Bone grafting was performed in these patients secondarily at the stage of mixed dentition or late secondarily at the stage of permanent dentition. Clinical, radiographic, photographic, and dental cast follow-ups were performed with regard to cleft type, residual alveolar cleft morphology, success rate for bone grafting, indications for bone grafting, and indicators for optimal timing for the procedure. Furthermore, alveolar bony height, and means for closure of the residual cleft space in the alveolus, either orthodontically or prosthodontically, was investigated in the different parts of the studies. Results showed benefits from bone grafting to the cleft of the lip and primary palate and also benefits in facilitating the eruption of the lateral incisor, if present, in order to achieve orthodontic space closure. Furthermore, the results indicated the importance of surgical experience in performing the procedure; the advantage of using a new indicator for timing of the procedure, i.e., the remaining thickness of bone surrounding the erupting tooth, rather than the root formation ratio of the tooth; and the advantages of the tibia as a donor site for the bone-grafting procedure. In addition, no disadvantages in combining the bone-grafting procedure with delayed closure of the hard palate were found.