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At least 415 records · Page 23Linked to original sources
PubMed2006

Five-year experience comparing resorbable to titanium miniplate osteosynthesis in cleft lip and palate orthognathic surgery.

OBJECTIVE: To evaluate 5-year outcome stability and complications in orthognathic surgery using resorbable versus titanium osteofixation. PATIENTS, METHODS: Twenty-two cleft lip and palate maxillary retrognathia cases were operated on using either poly (70L-lactide-co-30DL-lactide) or titanium miniplate osteofixation. All had two-piece Le Fort I maxillary advancement osteotomy, 11 had simultaneous mandibular setback, and 13 had alveolar bone grafts. RESULTS: Average operative movement and postoperative instability recorded for maxillary horizontal movement (A-point-Nasion) were 2.5 mm and 2.1 mm for the study group, compared with 6.3 mm and 1.9 mm for the control group. For maxillary vertical movement (ANS-Nasion), measured values were 4.9 and 1.3 mm for the study group and 2.3 and 0.9 mm for the controls. For mandibular horizontal movement, measured values were 10.7 mm and 2.8 mm for the study group and 1.9 mm and 0.8 mm for the controls. Gonial angle measures were 7.1 degrees and 3.5 degrees for the study group and 6.7 degrees and 3.1 degrees for the controls. Foreign body granuloma and fistulation occurred in 1 (9%) member of the study group, but was treated successfully with debridement; implant palpability subsided after 24 months. Three (27%) controls required plate removal, but the remaining plates were palpable. CONCLUSION: In the study group, horizontal maxillary stability appeared inferior to vertical stability, but mandibular stability was more reliable. Because groups were not matched for magnitude or direction of movement, the results of this study are preliminary and should be interpreted cautiously.

Absorbable Implants↗
PubMed2006

Excessive rapid palatal expansion with Latham appliance for distal repositioning of protruded premaxilla in bilateral cleft lip and alveolus.

OBJECTIVE: This article reports a case of bilateral cleft lip and alveolus (BCLA) for which excessive rapid palatal expansion with a Latham appliance was performed for preoperative alignment of the protruded premaxilla. Postoperative changes of maxillary width were investigated with serial plaster casts. PATIENT AND RESULTS: A 3-month-old girl presented with complete BCLA in which the premaxilla was markedly protruded. Preoperative alignment of the protruded premaxilla with a Latham appliance was planned to facilitate primary lip repair. The appliance was placed when the patient was 4.5 months old. The necessary palatal expansion was estimated to be 7.0 mm in order to move the premaxilla backward into the ideal position. After palatal expansion and posterior repositioning of the protruded premaxilla, the primary operation, including cheiloplasty and gingivoperiosteoplasty, was performed when the patient was 7 months old. Excessive maxillary expansion might be a cause of transverse maxillomandibular discrepancy. Measurement with serial plaster casts demonstrated that maxillary widths increased from 42.3 mm pretreatment to 49.0 mm after orthopedic treatment but relapsed markedly to 43.5 mm at 3 months after the primary operation. Therefore, the net change of maxillary widths was only 1.2 mm. After alignment of the protruded premaxilla, tension-free soft tissue repairs were performed, and a harmonious alveolar arch was obtained without change in maxillary width. CONCLUSION: These results indicate that this method is useful for preoperative management of BCLA with protruded premaxilla.

Alveolar Process↗
PubMed1990

An evaluation of calvarial and iliac donor sites in alveolar cleft grafting.

A clinical study evaluating the use of calvarial (two different techniques of harvest) versus iliac donor bone in secondary unilateral alveolar cleft reconstruction based on clinical and radiographic assessment was conducted. Both iliac bone and the Hudson brace harvested calvarial bone resulted in high rates of radiographic evidence of osseous continuity between the maxillary segments and clinical resolution of the alveolar cleft defect. Calvarial bone obtained with the craniotome had a lower rate of success that was statistically different from the other two groups. The utilization of calvarial bone and the implications of harvest technique on graft transfer biology are discussed.

Alveolar Process↗
PubMed1992

Mandibular morphology and spatial position in patients with clefts: intrinsic or iatrogenic?

Lateral cephalometric films of operated (Op) and non-operated (Nop) patients with cleft lip and alveolus, cleft lip and palate or cleft palate only, were compared to determine whether the shape or position of the mandible is affected by lip and/or palate surgery. The sample included 204 adult cleft patients, Caucasians of both sexes with one of the following three cleft types: complete unilateral lip and alveolus (n = 50), complete unilateral lip and palate (n = 68), and isolated palate (n = 86). The comparison involved 113 cleft patients operated at the conventional timing and 91 cleft patients who had received no surgical or orthodontic treatment. Comparison was done in order to ascertain if the surgery performed had had any influence upon mandibular growth. The results indicated that, in all three cleft types, the surgery did not induce significant changes in the mandibular growth.

Adult↗
PubMed1992

Early and late treatment of unilateral cleft nasal deformity.

Surgical techniques have been developed to correct nasal deformity associated with unilateral cleft lip, alveolus, and palate. This deformity can be significantly corrected during the primary cleft lip repair, as performed by the technique described by the author. Secondary corrective procedures focus mostly on skeletal support and lining distortions as well as on rearrangements of lower lateral cartilages. At the final stage, esthetic appearance can be significantly improved by contour remodeling with the addition of cartilage and/or bony implants. Choice of surgical technique depends upon the severity of the deformity and the experience and proficiency of the surgeon. At the present time, correction of the nasal deformity associated with a unilateral cleft is an integral part of primary cleft lip repair and part of multidisciplinary management of cleft deformities.

Adult↗
PubMed1994

Effects of primary alveolar bone grafting on maxillofacial development in the rabbit.

Unilateral maxillary clefts were created in 4-week-old rabbits by removing premaxillary-maxillary sutures. Four groups, five animals per group, were formed. Control animals (Group I, no clefts) helped determine normal values for facial growth. In Group II the clefts were unrepaired. In Group III each had a rib graft harvested and placed into the alveolar defect only. In Group IV the cleft was completely grafted with multiple ribs to the nose. At six months postoperatively skeletons of all animals were directly measured and an orthogonal coordinate analysis compared maxillary and palatal growth among groups. Greatest deviations in growth were seen when the entire cleft was grafted; shortened maxillary development and nasal deflection to the clefted side occurred. Unrepaired clefts and grafts limited to the alveolus had maxillofacial development similar to that in unoperated controls. The location of grafts in clefts in infancy appears critical to avoid retarded maxillary growth.

Alveolar Process↗
PubMed1994

Ectomesenchymal mandibular symphysis bone graft: an improvement in alveolar cleft grafting?

Bone grafting the alveolar cleft in cleft lip and palate (CLP) patients is widely accepted. A traditional graft is the iliac crest. Other bone graft donor sites are briefly discussed. The ratio for an ectomesenchymal bone graft in alveolar cleft repair is explained. Aspects of the embryology, bone graft physiology, and reports on mandibular symphysis bone grafting are discussed.

Alveoloplasty↗
PubMed1995

Periodontal and prosthetic treatment of a cleft lip and palate patient: a case report.

Although cleft lip and palate patients are usually treated by a multidisciplinary team involving physicians and dentists, their periodontal condition may be over-looked. Crowded or malpositioned teeth, hypertrophic gingiva, orthodontic appliances, and prosthetic replacements can impede proper plaque removal and thus perpetuate periodontal disease. It is important to incorporate periodontal treatment into the comprehensive treatment as early as possible. This case report discusses the periodontal surgical procedures involved in eliminating a residual ridge defect and the fitting of the final prosthetic reconstruction. Also, the importance of the identification and management of periodontal conditions characteristic of cleft lip and palate patients before and after surgical, orthodontic, and prosthetic rehabilitation will be emphasized.

Adult↗
PubMed1996

Secondary alveolar bone grafting--five-year periodontal and radiographic evaluation in 100 consecutive cases.

A prospective study of secondary alveolar bone grafting based on the Norwegian (Oslo) team approach has been conducted by the CLP Unit at the Princess Margaret Hospital for Children in Perth, Australia, since 1982. The 5-year results of 100 consecutive cases of uni- and bilateral cases are presented according to periodontal and radiographic parameters of tooth support. The vast majority of cases grafted (98%) resulted in the eventual eruption of the cleft side cuspid/lateral incisor within acceptable parameters of tooth support. The results confirm the predictability of this safe procedure when utilized within a strict clinical protocol involving the whole CLP team.

Adolescent↗
PubMed1997

Gingivoperiosteoplasty and midfacial growth.

The objective of this study was to report the effect of gingivoperiosteoplasty on growth of the midfacial skeleton 6 years following primary surgical repair. Patients with complete unilateral cleft lip and palate who underwent primary cleft lip and nose repair with and without gingivoperiosteoplasty (GPP) were retrospectively compared by means of a lateral cephalogram. Mean age at the time of evaluation was 5.7 years. All patients were treated at the Institute of Reconstructive Plastic Surgery, New York University Medical Center. All surgery and presurgical orthopedics was performed by the same surgeon and the same orthodontist. Twenty-five consecutively treated patients who presented with complete unilateral clefts of the primary and secondary palate were included in the study. Of these, 20 patients were available for 6-year follow-up cephalometric documentation and review. All patients received preoperative orthopedics with passive molding appliances, followed by repair of the lip, alveolus, and nose in a single stage at the age of 3 months. The repair was performed using the rotation/advancement technique. The difference between the two groups was whether or not gingivoperiosteoplasty was performed. The reason for not performing gingivoperiosteoplasty was incomplete approximation of the alveolar segments usually due to a late start in beginning therapy. Lateral cephalograms (68.5 months post primary surgery) were obtained and traced. Cranial base (S-N), maxilla (ANS-PNS), and mandible (Go-Pg) were digitized for shape coordinate analysis. No significant difference in the mean position of ANS-PNS was found between groups (with or without gingivoperiosteoplasty). There was, however, a significant difference in the variance of position for the points ANS-PNS between the groups (p < .002). We were unable to observe any difference (anteroposterior or supero-inferior) in the average position of the hard palate (ANS-PNS) between groups. We conclude that gingivoperiosteoplasty results in a more uniform position of the hard palate (ANS-PNS) relative to patients that did not receive gingivoperiosteoplasty. We were unable to demonstrate any clear impairment of maxillary growth in the patients treated with gingivoperiosteoplasty when compared to patients treated without gingivoperiosteoplasty.

Alveoloplasty↗
PubMed1997

Radiographic assessment of secondary autogenous alveolar bone grafting in cleft lip and palate patients.

OBJECTIVE: To assess if a 4-point, radiographically based scale could be used between operators to reliably assess the success of secondary alveolar bone grafting. DESIGN: The study was retrospective with the clinicians blind to patient identity. Radiographs were examined twice by two clinicians with 1 week between assessments. SETTING: The research was carried out in a hospital-based orthodontic/oral and maxillofacial unit. PATIENTS: All patients who had secondary alveolar bone grafting in this unit between February 1992 and March 1995 were included in this study. There were 38 patients with a total of 48 grafted sites. INTERVENTIONS: The bone graft site was radiographed following orthodontic expansion prior to grafting. The radiograph was repeated postoperatively at a mean of 4 months after surgery. MAIN OUTCOME MEASURE: The degree of bony fill in the cleft area was assessed using a 4-point scale: Grade 1 > 75% bony fill; Grade 2 50-75% bony fill; Grade 3 < 50% bony fill; Grade 4 no complete bony bridge. RESULTS: Overall, 50% of grafts achieved grade 1, 23% were grade 2, 22% grade 3, and 5% grade 4. Levels of intra- and inter-observer agreement were highly variable (.33 to .72 kappa statistic). CONCLUSIONS: The 4-point scale described could be used to assess the success of autogenous secondary alveolar bone grafting. It showed moderate to substantial intra-observer agreement, and fair-to-moderate inter-observer agreement.

Adolescent↗
PubMed1997

Comparison of 2-D calculations from periapical and occlusal radiographs versus 3-D calculations from CAT scans in determining bone support for cleft-adjacent teeth following early alveolar bone grafts.

OBJECTIVE: This investigation was conducted to determine the agreement between three-dimensional (3-D) calculations from CAT scans and two-dimensional (2-D) calculations from standard dental radiographs in evaluating bone support for cleft-adjacent teeth after primary bone grafting. DESIGN: This retrospective study utilized CAT scans and dental radiographs taken of the alveolar cleft in patients an average of 11 years after primary bone grafting. SETTING: The subjects were patients treated by the Cleft Palate Team at Children's Memorial Hospital and Loyola University Medical Center, Chicago, Illinois. PATIENTS: Fourteen UCLP patients (9 males, 5 females) agreed to participate in this study by undergoing CAT scan assessment of their alveolar cleft sites. They also had to have periapical or occlusal radiographs of the grafted cleft site taken within 6 months of the CAT scan. INTERVENTIONS: All patients underwent primary lip repair, placement of a passive palatal plate, primary alveolar bone grafting (mean age 6.4 months), and palatoplasty before 1 year of age. Major tooth movement through final orthodontics was completed by the time of the radiographic assessment. MAIN OUTCOME MEASURES: CAT scan sections were reformatted and reconstructed to three-dimensionally calculate the percentage of root covered by bone support for the 15 teeth adjacent to the graft cleft sites. Dental radiographs of the same teeth were also traced and digitized. Percentages of root supported by bone were also established using the dental radiographs by dividing the amount of root covered by bone, by the anatomic root length. RESULTS: A paired, two-sample t test revealed no significant differences between the two methods of assessment, while linear regression showed a statistically significant correlation between the CAT scan assessment and the percentages found on the radiographs. CONCLUSIONS: Routine dental radiographs were able to estimate the total 3-D bone support for the roots of cleft adjacent teeth as determined by CAT scan to a statistically significant degree when groups where compared. The clinical significance for evaluation of individual cases was less impressive with a wide range of variability and a level of agreement that required acceptance of differences up to 25%.

Adolescent↗
PubMed1997

Use of an osseointegrated implant for dental rehabilitation after cleft repair by periosteoplasty: a case report.

OBJECTIVE: We report here on a patient with unilateral cleft lip and alveolus who underwent dental rehabilitation of cleft alveolus using an osseointegrated implant after cleft repair by periosteoplasty. The patient, whose lateral incisor was congenitally missing, had periosteoplasty, followed by excellent bone formation at the cleft alveolus within 2 years. After the completion of orthodontic alignment of the maxillary dental arch, a Brånemark single-tooth implant was placed into the bone-formed alveolus. CONCLUSION: This treatment procedure offers an option of dental rehabilitation for the alveolar clefts of patients with cleft lip and/or palate.

Alveolar Process↗
PubMed1997

Effect of alveolar bone grafting in the mixed dentition on maxillary growth in complete unilateral cleft lip and palate patients.

OBJECTIVE: This study was conducted to evaluate the effects on facial growth of alveolar bone grafting in the mixed dentition for patients with UCLP. DESIGN: Retrospective cephalometric study. SETTING: Craniofacial Treatment and Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada. PATIENTS: The 58 patients participating in the study had a history of complete unilateral cleft lip and palate, all of which were repaired by the same plastic surgeon. INTERVENTIONS: Twenty-one patients received an iliac-crest alveolar bone graft at a mean age of 10.3 years, while 37 did not receive an alveolar bone graft. Lateral cephalometric radiographs were obtained on all patients at two different times:at a mean age of 9.4 years (prior to bone grafting in the grafted group) and at a mean age of 15.2 years. MAIN OUTCOME MEASURES: All radiographs were traced and digitized by the same person, using cephalometric computer software. Superimposition and cephalometric analysis was undertaken to investigate the differences between the two groups in the 5.6-year experimental period. A two-way analysis of covariance was used for evaluation of the statistical significance of the results. RESULTS: No statistically significant differences were found in 14 of the 15 cephalometric measurements performed. Harvold's maxillary unit length was statistically significantly shorter in the grafted group, although a lack of correlation with angular measurements and inherent problems with this specific measurement raise doubts in this finding. CONCLUSION: Mixed dentition bone grafting does not affect subsequent vertical and A-P development of the maxilla in complete unilateral cleft lip and palate patients during the first several postoperative years.

Adolescent↗
PubMed1997

Placement of endosseous implants in grafted alveolar clefts.

OBJECTIVE: The purpose of this study was to determine the optimal timing for placement and to evaluate short- and long-term outcomes of endosseous implants in bone-grafted alveolar clefts. DESIGN: Fourteen patients who underwent alveolar cleft bone grafting (ACBG) and closure of an oronasal fistula followed by restoration of the missing lateral incisor tooth using endosseous implants (EI) were studied. The oronasal fistulae were closed using local flaps, and the alveolus was grafted with fresh autogenous iliac marrow. Endosseous implants were placed a minimum of 4 months following ACBG. The average age at ACBG was 20.35 years (range, 12-65 yr), and at implant placement 22.2 years (range, 15-66 yr). It was necessary to regraft the alveolar cleft region in six patients to provide adequate bone volume for implant placement. Those who required alveolar regrafting had an increased mean interval between the initial ACBG and planned implant placement compared to the patients with adequate bone available for implant placement 26.4 months (range, 4-46 mo) versus 15.75 months (range, 4-36 mo). RESULTS: Twenty-nine implants were placed in 14 patients, 9 outside of the cleft region and 20 in grafted alveolar clefts. Eighteen of 20 (90%) implants in the bone-grafted alveolar clefts have been successfully restored. The mean follow-up after implant placement was 39.1 months (range, 1-54 mo), and after restoration 28.5 months (range, 1-47 mo). CONCLUSIONS: Endosseous implants can be placed in bone-grafted alveolar clefts. Consideration should be given to the adequacy of graft volume and ridge morphology at the time of ACBG. The interval between ACBG and implant placement is important. The greater the interval beyond 4 months, the more likely there will be inadequate bone volume to accept an implant.

Adolescent↗
PubMed1998

An evaluation of a noninvasive method of assessing alveolar bone levels in an experimental model of cleft lip and palate.

OBJECTIVE: The purpose of this study was to evaluate an ultrasound mucous-membrane-thickness-measuring device as a noninvasive, nonionizing alternative to radiography in the assessment of alveolar bone grafting. DESIGN: This was a prospective experimental study on porcine cadaver models. METHOD: An ultrasound technique (Krupp SDM) was assessed ex vivo on three specially developed porcine cadaver models in comparison to radiography and ridge-mapping. Direct measurement of the mucosal thickness provided a standard for comparison. In each model, 30 measurement sites were identified for comparison of the techniques. RESULTS: All measurement techniques demonstrated clinically acceptable reproducibility. Of the clinical measurement techniques, radiography proved to be the most reliable, showing a small, nonsignificant statistical difference from direct measurement. Both the ultrasound technique and ridge-mapping showed significant tendencies to underestimate mucosal thickness that became greater with increasing mucosal thickness. At sites where mucosal thickness was less than 6 mm, the ultrasound technique underestimated mucosal thickness by 0.6 mm on average. At sites where mucosal thickness exceeded 6 mm, ultrasonic artifacts rendered the ultrasound technique unreliable. CONCLUSION: The ultrasound technique could prove to be a useful clinical adjunct to radiography in the assessment of alveolar bone grafts, but in this particular application, care should be taken when using it to assess deeper alveolar defects.

Alveolar Process↗