Mono-Cortical Mandibular Bone Grafting for Reconstruction of Alveolar Cleft

Abstract

Objective: Alveolar bone grafting is well-established procedure for the management of patients with alveolar cleft. Grafting of the alveolar cleft is usually accomplished with cancellous bone from the ilium. However, the harvesting from the ilium show several physical impediments, so that we usually harvest the bone grafts from the mandibular symphyseal region as mono-cortical bone grafts. This study aims to assess and develop a mono-cortical bone grafting procedure for reconstruction of alveolar cleft.

Material & Methods: Eighty-eight clefts of 75 consecutive Japanese patients who had been treated according to a strict clinical protocol. Mean age at bone grafting was 7 years 1 months. Bone grafting was performed by harvesting lateral cortical bone plates from the symphysis without particulate bone and then placing them on the labial and palatal openings of the alveolar process defect. Mean follow-up after bone grafting was more than 4 years. Status of the grafted area and eruption of cleft-adjacent teeth were assessed prospectively using computed tomography (CT) and periapical radiography.

Results: At 6 months postoperatively, CT showed sufficient bone bridge formation at the cleft site in 83.0% of clefts. Periapical radiography showed ³75% of the root surfaces of cleft-adjacent teeth were covered with spanning bone in 93.2% of clefts. In 86.4% of clefts in which the cleft-adjacent canine was uncovered with bone during follow-up, the canines erupted spontaneously.

Conclusion: The procedure is advantageous in that the quantity of bone required per unit volume of cleft defect is relatively reduced, and larger clefts can thus be treated.