Secondary alveolar bone grafting in cleft lip and palate patients

Abstract

Introduction. After the primary surgeries cleft lip and palate patients need a recovery of the alveolar process defect with osteoplasty using autogenous bone grafts also combined with xenogeneic and alloplastic materials. The primary objective of secondary alveolar bone grafting in patients with cleft lip and palate is to provide bone tissue for the cleft site. That later will permit the placement of osseointegrated implants into the cleft area.

Methods and Materials. In our clinic the preferred donor sites for the secondary grafting of alveolar clefts defect are: iliac crest, symphysis and mandibular ramus. In the period from 2011-2015, 30 bone grafting procedures were done to 25 patients with lip and palate cleft by the age 15-25. In 8 operations was used iliac crest bone graft, in 14 cases from symphysis and in 6 from mandibular ramus. By our protocol the bone was divided in to cortical mini-plates, the rest was crashed by the bone-cruncher and mixed 1:1 with xenocollagen and hydroxyapatite granules. The grafted bone side was covered with a collagen membrane only in the cases of periosteum deficiency. To evaluate the bone volume CBCT 3- D examination was performed pre-operative and 6 month post-operative.

Results. According to CBCT 3-D results the necessary bone volume was present in 25 patients and implants were successfully installed. But in 5 cases after 6 month additional bone grafting was needed, because of the complications: graft exposure -2 patients, oro-nasal fistula -2 patients, insufficient formation of bone -1 patient.

Conclusion. Bone grafts from iliac crest, mandibular ramus and symphysis can be used with success in osteoplasty of alveolar congenital defects. There were no significant difference between this three graft sites, important is the recipient bone place. To gain more relevant conclusion in time the study is continuing.