Alveolar bone grafting: a review of 115 patients
[Original Abstract] ((Collins, ed M., diagnosis James, D.R., Mars, M. (1998) Alveolar bone grafting: a review of 115 patients. European Journal of Orthodontics 20 (1998) 115-120. Accessed at http://ejo.oxfordjournals.org [verified 22 March 2007]))
The results of alveolar bone grafting carried out at The Hospital for Sick Children, Great Ormond Street (GOS), London, UK between January 1982 and January 1989 were assessed. Cancellous bone from the iliac crest was grafted to alveolar cleft defects in 115 patients (63 male and 52 female). Eighty-seven unilateral (58 left and 29 right) and 28 bilateral clefts were operated on. The mean age at the time of operation was 11.5 years, with a range of 8.08-18.75 years. The cleft canine had erupted prior to bone grafting in 58.4%. At the time of this study the cleft had erupted in 96.35% and was unerupted in 3.65% of sites. Radiographs were taken at regular intervals and assessed according to previously reported criteria. Eighty-six per cent were clinically successful (Type I and II). In Type III 10.95% had less than three-quarters of the normal interdental septal height and 2.18% failed (Type IV). In addition, 3.6% of sites showed cervical root resorption affecting the adjacent incisor and 1.4% internal resorption of the cleft canine.
Type I: Septum height approximately normal
Type II: Septum height at least three-quarters of normal
Type III: Septum height less than three-quarters of normal
Type IV: Absence of a continuous bony ridge across the cleft
Type I and II are clinically acceptable
Extracts from the research article;
- Nine per cent of unilateral clefts were Type III or IV compared with 21.4% of bilateral clefts.
- Of the canines which erupted prior to surgery, 19.3% ended up with a Type III or IV bone graft. By contrast only 8.7% of canines which were unerupted prior to surgery ended up in this group.
- The mean age of patients with Type I and II bone grafts was 10.5 years. However, the mean age for those with Type III and IV grafts was 11.7 and 12.8 years, respectively.
- Eighty three per cent of Types III and IV had reports of poor oral hygiene.
Bilateral alveolar bone grafting: a report of 55 consecutively-treated patients
[Original Abstract] ((YL Jia, DR James and M Mars. Bilateral alveolar bone grafting: a report of 55 consecutively-treated patients. Great Ormond Street Hospital for Children NHS Trust, London, UK. The European Journal of Orthodontics, Volume 20, Issue 3: Pages 299-307. June 1998. Accessed at http://ejo.oxfordjournals.org [verified 22 March 2007]))
A retrospective study was undertaken to evaluate the long-term results of bilateral alveolar bone grafting carried out at Great Ormond Street Hospital from 1983 to 1993. Fifty-five consecutive complete bilateral cleft lip and palate patients (36 males and 19 females) who had the operation were included in this study. The total number of cleft sites was 110. At the time of alveolar bone grafting, the mean age of the patients was 12.3 years with a range of 8.4-19.9 years. Cancellous bone from the iliac crest was grafted into the alveolar cleft areas. The cleft sites were studied in two groups according to whether the cleft canine had erupted prior to bone grafting or not. The erupted canine group was composed of 43 cleft sites and the unerupted canine group of 67 sites. At the time of this study, the cleft canine had subsequently erupted at 101 sites. Anterior occlusal radiographs were taken before and after bone grafting. The minimum period of observation after alveolar bone grafting was one year. Criteria described previously were utilized to assess the height of the interdental septum.
The results show that bone grafting before canine eruption has a higher clinical success rate compared with that carried out after canine eruption. The critical variable affecting the quality of bilateral alveolar bone grafting is the timing of the surgery.