A novel method for alveolar bone grafting assessment in cleft lip and palate patients: cone-beam computed tomography evaluation.
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ABSTRACT: Objectives
This retrospective cross-sectional study aimed to present a new method for secondary alveolar bone grafting (SABG) assessment and to qualitatively evaluate the SABG results in unilateral cleft lip and palate patients.Materials and methods
Research was conducted according to the STROBE guidelines. The study group consisted of 21 patients with a mean age of 16 years. High-resolution cone-beam computed tomography (CBCT) was performed at least 1 year after grafting. The experimental side was the cleft side, and the contralateral side without a congenital cleft was the control. Measurements were performed at four levels of the maxillary central incisors' roots according to the new scale with scores from 0 to 3. The sum of the scores provided a general assessment of bone architecture. The Wilcoxon signed-rank test was used for intergroup comparisons, and a Kappa coefficient was used for reproducibility measurements.Results
High individual variability was found, and the bone architecture was significantly worse on the cleft side than on the noncleft side. The results showed 28.57% failure, 33.33% poor, 19.05% moderate, and 19.05% good results from the surgical procedure. Kappa coefficients produced results from 0.92 to 1.00 for intra-rater and from 0.81 to 1.00 for inter-rater reproducibility.Conclusions
CBCT provides detailed information about alveolar bone morphology. The new assessment method is useful at every treatment stage and provides excellent repeatability. SABG did not provide good bone morphology, in most cases.Clinical relevance
This research presents a new universal alternative for the assessment of SABG by utilizing CBCT.
SUBMITTER: Stasiak M
PROVIDER: S-EPMC7966225 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:PurposeThe aims of this retrospective cross-sectional study were to measure and compare labial and palatal alveolar bone heights of maxillary central incisors in unilateral cleft lip and palate patients, following STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines.Patients and methodsThe study group consisted of 21 patients with a mean age of 16 years. High-resolution cone-beam computed tomography was performed at least one year after secondary alveolar bone grafting. The experimental side was the cleft side and the contralateral side without congenital cleft was the control. Measurements were performed on incisors' midsagittal cross-sections. The Wilcoxon signed-rank test was used for intergroup comparisons.ResultsThe labial and palatal distances between alveolar bone crests and cementoenamel junctions were significantly greater on the cleft side than on the noncleft side. Mean differences were 0.75 and 1.41 mm, respectively. The prevalence of dehiscences at the cleft side maxillary central incisors was 52% on the labial surface and 43% on the palatal surface. In the controls, it was 19% and 14%, respectively.ConclusionThe cleft-adjacent maxillary central incisors had more apically displaced alveolar bone crests on the labial and palatal sides of the roots than the controls. Higher prevalence of dehiscences was found on the cleft side. Bone margin differences predispose to gingival height differences of the central incisors. These differences could increase the demands of patients to obtain more esthetic treatment results with orthodontic extrusion and periodontal intervention on the cleft side.
| S-EPMC8076140 | biostudies-literature
Project description:In this study, we sought to investigate the oral microbiota structure of children with cleft lip and palate (CLP) and explore the pre-operative oral bacterial composition related to the prognosis of alveolar bone grafting. In total, 28 patients (19 boys, 9 girls) with CLP who were scheduled to undergo alveolar bone grafting for the first time were recruited. According to the clinical examination of operative sites at the third month after the operation, the individuals were divided into a non-inflammation group (n = 15) and an inflammation group (n = 13). In all, 56 unstimulated saliva samples were collected before and after the operation. The v3-v4 hypervariable regions of the 16S rRNA gene were sequenced using an Illumina MiSeq sequencing platform. Based on the beta diversity of the operational taxonomic units (OTUs) in the inflammation and non-inflammation samples, the microbial variation in the oral cavity differed significantly between the two groups before and after the operation (P < 0.05). Analysis of the relative abundances of pre-operative OTUs revealed 26 OTUs with a relative abundance higher than 0.01%, reflecting a significant difference of the relative abundance between groups (P < 0.05). According to a principal component analysis of the pre-operative samples, the inflammation-related OTUs included Tannerella sp., Porphyromonas sp., Gemella sp., Moraxella sp., Prevotella nigrescens, and Prevotella intermedia, most of which were enriched in the inflammation group and showed a significant positive correlation. A cross-validated random forest model based on the 26 different OTUs before the operation was able to fit the post-operative status of grafted sites and yielded a good classification result. The sensitivity and specificity of this classified model were 76.9% and 86.7%, respectively. These findings show that the oral microbiota profile before alveolar bone grafting may be related to the risk of post-operative inflammation at grafted sites.
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Project description:European and Northern American healthcare authorities increasingly encourage the use of Patient Reported Outcome Measures (PROMs) that complement clinical and laboratory assessments to help holistically evaluate reconstructive outcomes. This is the first study to evaluate PROMs in cleft lip/palate patients who have, or have not, undergone secondary alveolar bone grafting (SABG).A PROMs study was conducted; 40 consecutive consenting cleft lip/palate children between 8 and 14 years old were included. Twenty patients did, and 20 patients did not, have SABG. PROMs scores from children and parents in the 2 groups were compared.Forty patients completed the trial. No significant differences in total score from the Chang Gung Short Form-15 (CGSF-15) were found between children and their parents. Children with SABG reported no more oral-nasal regurgitation than children without SABG, but tended to report more nasal obstruction. There were no statistically significant differences in parent reported outcomes between the 2 groups.Cleft lip/palate patients who underwent SABG reported significantly less nasal regurgitation and more nasal obstruction compared to those patients who did not undergo SABG.
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Project description:PurposeAnastomosis between posterior superior alveolar artery and infraorbital artery can go through bony canal in the lateral wall of the maxilla. This artery is called alveolar antral artery. It can complicate lateral sinus lift procedure by bleeding and hemosinus formation or bone graft wash out. The artery can also go in soft tissues where is not visible on cone beam computed tomography. In previous studies, the relation of this artery to sinus floor or alveolar process was measured. These structures are highly unstable during lifetime and after tooth loss. The aim of this study is to study presence and relations of bony canal in the lateral maxillary wall, to characterize the group of patients which is more likely to have bone canal in the lateral maxilla. The aim and the novelty of this study is the describing of the relationship of the bony canal to the more stable structure of hard palate and describing the relation of presence of bony canal on width of maxillary sinus, and to facilitate the prediction of presence of the alveolar antral artery.MaterialsThe cone beam computed tomography scans of the patients (251 in number) of the university hospital were examined for presence of alveolar antral artery (148 was fulfilled inclusion criteria), patient were characterized by gender, age, and sinus type (wide, average, narrow). The diameter of the bony canal and its relation to the level of sinus floor and hard palate were measured.ResultsThe cone beam computed tomography scans of 148 patients, out of it 55 man (37,2%) and 93 women (62,8%). Bony canal containing alveolar anastomosis was found in 69 cases (57,0%). Presence of the bony canal in the lateral wall of maxillae showed statistical probability depending on age with p = 0, 064 according to Mann-Whitney test. The older patients have more likely the bony canal. The presence of the alveolar antral artery was found more likely in the wide sinuses. The hard palate level can serve as a prediction point of alveolar antral artery only in first molar and second premolar region. In accordance with previous studies the width of bony canal is significantly higher in group of man (p = 0, 015). There was found a correlation between smaller distance of bony canal from sinus floor in the presence of teeth (p = 0, 067). After tooth loss the distance between sinus floor and bony canal increases, but the distance of bony canal to hard palate level stays constant. This can be explained hypothetically so that periodontal ligaments and root surface acts as a barrier for sinus pneumatization.ConclusionLateral sinus lifting in some cases can be unenviable, the knowledge about alveolar antral artery anatomy can reduce the risk of arterial bleeding. The cone-beam computed tomography is a routine examination prior to augmentation surgery and therefore the data obtained from it has an impact on clinical practice.
| S-EPMC10693819 | biostudies-literature
Project description:AimThe objective of this research was to measure the labial bone thickness (LBT) in relation to the 6 anterior maxillary teeth at different levels along the long axis and the distance between cementoenamel junction and bone crest (CEJ-BC) based on cone beam computed tomography (CBCT) scans retrieved from patients of Arab ethnicity and identify any association with patients' characteristics.Materials and methodsA total of 100 CBCT scans were evaluated by one calibrated examiner. The thickness of the labial bone was measured perpendicular to the long axis of the tooth at 1, 3, and 5 mm from the alveolar crest (LBT-1, LBT-3, and LBT-5, respectively) and CEJ-BC using a medical imaging viewer.ResultsCBCT scans of 58 female patients and 42 male patients with a mean age of 39.7 ± 9.5 years were included. A high variation of CEJ-BC was observed (range, 0.55-3.90 mm). Statistically significant higher CEJ-BC values were associated with men and increased age (>50 years). The overall means of LBT-1 were 0.76 ± 0.26, 0.79 ± 0.26, and 0.83 ± 0.37 mm; LBT-3: 0.92 ± 0.36, 1.05 ± 0.46, and 1.03 ± 0.48 mm; LBT-5: 1.17 ± 0.52, 0.80 ± 0.45, and 0.81 ± 0.40 mm for central incisors, lateral incisors, and canines, respectively. The LBT was <1 mm in 74.2% of all maxillary anterior teeth, with central incisors showing the highest predilection (85% with LBT <1 mm). No significant association between LBT and patient characteristics was observed.ConclusionsThe CEJ-BC distance is greater in men and increases with age, particularly in those aged 50 years and older. The LBT in the 6 maxillary anterior teeth is predominantly thin (<1 mm) and has no correlation to age or sex. An increased LBT was observed at a 3-mm level when compared with LBT-1 and LBT-5. Such variability should be taken into consideration when planning for implant placement.
| S-EPMC10023538 | biostudies-literature
Project description:BackgroundA systematic review assessing autologous versus alloplastic bone for secondary alveolar bone grafting in patients with cleft lip and palate was published in 2011 and included only one randomized controlled trial comparing traditional iliac bone graft to recombinant human bone morphogenetic protein-2 (rh-BMP2).ObjectivesTo perform a systematic review with meta-analysis on the use of secondary alveolar bone grafting (autologous bone and rh-BMP2 graft) in order to improve bone volume and height in patients with cleft lip and palate.Data sourcesAn electronic search was conducted via PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CONTROL) via Cochrane Library, EMBASE via Ovid, and LILAC for studies published between January 2008 and September 2018. The systematic review registration number at PROSPERO was 42018085858.Eligibility criteriaOnly RCTs were included. Inclusion criteria were patients with the diagnosis of unilateral cleft lip and palate older than 5 years of age, radiographic evaluation (CT and/or CBCT) of the cleft area, and at least a 6-month follow-up.Main outcome measuresBone formation and bone height by radiographic CT evaluation (preoperatively, after 6 months and after 1 year of follow-up) and length of hospital stay were assessed.ResultsFour studies met strict inclusion criteria. Autologous bone graft showed statistically significant higher bone formation after 6-month follow-up (MD - 14.410; 95% CI - 22.392 to - 6.428; p = 0.000). No statistically significant difference was noted after a 1-year follow-up (MD 6.227; 95% CI - 15.967 to 28.422; p = 0.582). No statistically significant difference in bone height was noted after 6-month (MD - 18.737; 95% CI - 43.560 to 6.087; p = 0.139) and 1-year follow-up (MD - 4.401; 95% CI - 30.636 to 21.834; p = 0.742). Patients who underwent rh-BMP2 graft had a statistically significant reduced hospital stay (MD - 1.146; 95% CI - 2.147 to - 0.145; p = 0.025).LimitationsThe main limitation is the high risk of bias among included studies.ConclusionAutologous bone and rh-BMP2 graft showed a similar effectiveness in maxillary alveolar reconstruction in patients with unilateral cleft lip and palate assessing bone graft volume and height although rh-BMP2 graft showed a relative shorter length of hospital stay (high uncertainty level).
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Project description:Background and objectives Analyzing the anatomical and morphometric information of the hard palate is crucial in prosthodontics, orthodontics, maxillofacial surgery, implant dentistry, and forensic anthropology. No data exist in the literature regarding the morphometric analysis of the hard palate using 3D imaging techniques in Saudi Arabia. Therefore, this study aimed to evaluate the dimensions and types of hard palates using 3D geometric morphometrics and the existence of gender-related differences in a selected Saudi population. Material and methods This cross-sectional study was performed by radiological evaluation of arbitrarily collected Cone Beam computed Tomography (CBCT) images includes 130 male and 45 female individuals from our department’s archives, radiology department, Dental Hospital, Qassim University. The Galileos® Comfort Plus System (Sirona 3D, Germany) was used to obtain the CBCT images while standardizing the parameters. Images were linearly measured using Galileos software. Measurements of palatal length, palatal breadth, and palatal height, as well as the calculation of the palatine index and palatal height index, were noted and statistically analyzed. Results The mean palatal length, breadth, height, palatine index, and height index were 48.8 ± 3.9 mm, 36.2 ± 3.8 mm, 11.6 ± 2.4 mm, 74.7 ± 8.9, and 32.4 ± 7.1, respectively. The mean palatal length, breadth, and height were greater in men than in women. The majority of the palatine index values corresponded to leptostaphyline (76.6%), followed by mesostaphylline (12%) and brachystaphylline (11.4%), distribution among males and females were not statistical significance (p > 0.05). Palatal height index analysis revealed that the majority were orthostaphyline (59.4%), followed by chamestaphyline (26.3%), and hypsistaphyline (14.3%) these distributions were not significant statistically among males and females(p > 0.05). Conclusion The palatine index and palatine height index are useful in prosthodontics, orthodontics, and forensic anthropology for identifying races on the basis of the skull.
| S-EPMC10114141 | biostudies-literature
Project description:Background and objectiveThe current methods to image alveolar bone in humans include intraoral 2D radiography and cone-beam computed tomography (CBCT). However, these methods expose the subject to ionizing radiation. Therefore, ultrasound imaging has been investigated as an alternative technique, as it is both non-invasive and free from ionizing radiation. In order to assess the validity and reliability of ultrasonography in visualizing alveolar bone, a systematic review was conducted comparing ultrasound imaging to CBCT for examination of the alveolar bone level.Study designSeven databases were searched. Studies addressing examination of alveolar bone level via CBCT and ultrasound were selected. Risk of bias under Cochrane guidelines was used as a methodological quality assessment tool.ResultsAll the four included studies were ex vivo studies that used porcine or human cadaver samples. The alveolar bone level was measured by the distance from the alveolar bone crest to certain landmarks such as cemento-enamel junction or gingival margin. The risk of bias was found as low. The mean difference between ultrasound and CBCT measurements ranged from 0.07 mm to 0.68 mm, equivalent to 1.6% - 8.8%.ConclusionsThere is currently preliminary evidence to support the use of ultrasonography as compared to CBCT for the examination of alveolar bone level. Further studies comparing ultrasound to gold standard methods would be necessary to help validate the accuracy of ultrasonography as a diagnostic technique in periodontal imaging.
| S-EPMC6169851 | biostudies-literature
Project description:A comprehensive assessment of the treatment outcome in cleft lip and palate involves evaluating speech and the impact of speech-correcting surgical interventions. This retrospective case-control study compared the speech outcomes of 37 boys and 19 girls with unilateral cleft lip and palate (UCLP) who underwent one-stage cleft repair at an average age of 8.1 months and alveolar bone grafting either before or after 6 years of age, with a non-cleft control group at an average age of 10 years. Two experienced speech and language pathologists conducted perceptual speech assessments using a specialized test of 27 sentences designed for Polish-speaking cleft patients. The results revealed that 5.3% had severe hypernasality, 1.8% had severely impaired speech intelligibility, 10.7% exhibited retracted compensatory articulations, and 7.1% displayed facial grimacing. Mild hyponasality was observed in 12.3% of patients, while 16.1% exhibited voice abnormalities. Additionally, 12.5% of patients required orofacial fistula repairs, 3.6% underwent pharyngoplasties, and 28.6% received ear ventilation tube insertions. The study indicates that speech abnormalities in UCLP patients were relatively infrequent and not highly severe, suggesting that the primary UCLP repair method presented effectively reduced the need for further surgical interventions, leading to positive speech outcomes.
| S-EPMC10489147 | biostudies-literature
Project description:BackgroundOsteotome sinus floor elevation (OSFE) is used to increase the bone volume at the site of the maxillary sinus through the transalveolar approach. However, there is uncertainty regarding the necessity of the use of grafting material in order to maintain the space for new bone formation.ObjectiveThis study aimed to evaluate new bone formation 6 months after osteotome sinus floor elevation without grafting and to evaluate the correlations between residual bone height (RBH), implant protrusion length (IPL), and endo-sinus bone gain (ESBG).Material and methodsThirty-one implants (27 patients) from area 14-17 and 24-27 were included in the study. All implants had a history of OSFE without grafting, with cone beam computed tomography (CBCT) taken prior to the surgery. The clinical examination and radiographic examination using CBCT were performed again 6 months after implantation. The RBH, new bone level, ESBG, and IPL were measured. Paired sample t test and Pearson correlation were used to analyze the data.ResultsThe average RBH before surgery was 7.14 ± 1.07 mm and 6 months after surgery was 8.95 ± 1.17 mm. There was a significant increase in new bone formation in the 6 months following surgery (p < 0.05). The average ESBG and IPL were 1.8 ± 0.79 mm and 2.02 ± 0.73 mm, respectively. There was a significant positive correlation between the IPL and ESBG (p < 0.05) while there was a negative correlation between RBH and ESBG. This study also demonstrates a decrease in the percentage of bone formation in relation to IPL as the IPL increases. The survival rate of the implant was 100%.ConclusionSignificant new bone formation can be detected around the implant site 6 months after implantation using OSFE technique without grafting. There is a negative correlation between the RBH and ESBG. While IPL is correlated to ESBG and appears to be the influencing factors of bone formation changes in the maxillary sinus. The preliminary radiographic results suggest that OSFE technique without grafting in combination with optimal IPL can provide sufficient bone height for implant support with a 100% implant survival rate.
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