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Reconstruction of the alveolar process in cleft patients
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background. The treatment of patients born with cleft lip and palate has been gradually modified over the years as the surgical procedures have developed and improved. Multidisciplinary team care has evolved and provided improved care with enhanced results. Clefts in the alveolus can be reconstructed by alveolar bone grafting or by periosteoplasty. The main goal is to repair and close the alveolar cleft and create a continuous alveolar processes so that the teeth can erupt.

Aims. This thesis has several aims: to investigate the impact of dental status and initial cleft width on the outcome of Secondary alveolar bone grafting (SABG) in patients born with unilateral cleft lip and palate (UCLP) at the 10-year follow-up (Studies I and II); to compare the outcomes of primary periosteoplasty (PPP) with those of SABG in patients born with unilateral cleft lip and alveolus (CLA) (Study III); to evaluate clinical and radiographic conditions and identify factors important for the final treatment outcomes after SABG ( Study IV); to evaluate two radiographic methods, i.e. occlusal radiographs and cone beam tomography (CBCT)) for assessing alveolar bone height ( study IV).

Results. In UCLP patients, SABG achieved excellent results in terms of bone height; tended to reduce with time, correlated with dental status and dental restoration factors. Occlusal radiographs correspond well with the CBCT, for evaluating alveolar bone height in cleft area. The width of the initial cleft does not seem to affect the success of SABG. Finally, patients with CLA treated with PPP at the time of lip repair have inferior bone formation outcomes in the cleft area compared with patients treated with SABG at the time of mixed dentition.

Conclusion.  Poor dental status and malpositioning negatively affect the long-term survival of bone in the alveolar cleft. The initial cleft width affects certain dental status factors. In adults with UCLP, the alveolar bone height in the cleft was correlated to the presence of gingival inflammation and restorations at 20 years follow-up. Specially designed maintenance therapy is beneficial, after complex dental restorations in the cleft area. SABG is preferred to PPP for the reconstruction of alveolar clefts.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. , 84 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1219
Keyword [en]
alveolar bone grafting, dental status, initial cleft size, dental restoration, unilateral cleft lip and palate, cleft lip and alveolus, primary periosteoplasty, facial growth
National Category
Other Medical Sciences
Identifiers
URN: urn:nbn:se:uu:diva-282020ISBN: 978-91-554-9560-2 (print)OAI: oai:DiVA.org:uu-282020DiVA: diva2:916232
Public defence
2016-05-20, Skoogsalen, Akademiska sjukhuset ingång 79-80, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2016-04-28 Created: 2016-04-01 Last updated: 2016-05-12
List of papers
1. Optimization of Dental Status Improves Long-Term Outcome After Alveolar Bone Grafting in Unilateral Cleft Lip and Palate
Open this publication in new window or tab >>Optimization of Dental Status Improves Long-Term Outcome After Alveolar Bone Grafting in Unilateral Cleft Lip and Palate
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2015 (English)In: The Cleft Palate-Craniofacial Journal, ISSN 1055-6656, E-ISSN 1545-1569, Vol. 52, no 2, 210-218 p.Article in journal (Refereed) Published
Abstract [en]

Objective : To evaluate the importance of dental status for long-term outcome after alveolar bone grafting in patients with unilateral cleft lip and palate. Design : Retrospective longitudinal study. Setting : Cleft lip and palate-craniofacial center, Uppsala University Hospital, Sweden. Patients : A total of 67 consecutive patients with unilateral complete cleft lip and palate. Interventions : Secondary alveolar bone grafting, prior to the eruption of the permanent canine, was performed at the average age of 10.0 years (range, 8.5 to 12.0 years). Main Outcome Measures : Alveolar bone height was evaluated with the modified Bergland index at 1 and 10 years after surgery. Results : Of the patients, 97% had modified Bergland index grade I and the remaining 3% had modified Bergland index grade II at 1 year after surgery. At 10 years' follow-up, 43% showed modified Bergland index grade I; 55%, modified Bergland index grade II; and 2% (one patient), modified Bergland index grade III. The degree of dental anomalies in the cleft area, such as enamel hypoplasia, incisor rotation, incisor inclination, canine inclination, and oral hygiene registered preoperatively, all correlated negatively to the modified Bergland index at 10 years after surgery. Enamel hypoplasia (ρ = 0.70195, P < .0001), followed by canine inclination (ρ = 0.55429, P < .0001), showed the strongest correlation to reduced bone height in the cleft area. Conclusions : In patients with unilateral cleft lip and palate, excellent results from secondary alveolar bone grafting in terms of bone height in the alveolar cleft tend to decrease with time. This seems to be correlated with factors that might to some extent be treated preoperatively through adequate planning and execution of the orthodontic treatment.

National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-245024 (URN)10.1597/13-118 (DOI)000352143500013 ()24568558 (PubMedID)
Available from: 2015-02-24 Created: 2015-02-24 Last updated: 2017-12-04Bibliographically approved
2. Corrlations between initial cleft size and dental anomalies in unilateral cleft lip and palate patients after alveolar bone grafting
Open this publication in new window or tab >>Corrlations between initial cleft size and dental anomalies in unilateral cleft lip and palate patients after alveolar bone grafting
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(English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967Article in journal (Refereed) In press
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-282012 (URN)
Available from: 2016-04-01 Created: 2016-04-01 Last updated: 2017-11-30Bibliographically approved
3. Skoog Primary Periosteoplasty versus Secondary Alveolar Bone grafting in Unilateral Cleft Lip and Alveolus: Long.term effects on alveolar Bone Formation and Maxillary Growth
Open this publication in new window or tab >>Skoog Primary Periosteoplasty versus Secondary Alveolar Bone grafting in Unilateral Cleft Lip and Alveolus: Long.term effects on alveolar Bone Formation and Maxillary Growth
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2017 (English)In: Plastic and reconstructive surgery (1963), ISSN 0032-1052, E-ISSN 1529-4242, Vol. 139, no 1, 137-148 p.Article in journal (Refereed) Published
Abstract [en]

Background: Clefts involving the alveolus are treated using one of two strategies: primary periosteoplasty at the time of lip repair or secondary alveolar bone grafting at mixed dentition. Most teams favor secondary alveolar bone grafting because of its high success rate, and concerns have been raised that primary periosteoplasty may interfere with maxillary growth. However, primary periosteoplasty may obviate the need for future bone grafting and is still practiced in some centers. Few studies compare the long-term outcomes of these two strategies.

Methods: Fifty-seven consecutive patients born with unilateral cleft lip and alveolus were studied retrospectively. All patients underwent primary lip repair using Skoog's method; 28 patients underwent primary periosteoplasty at the time of lip repair and the remaining 29 underwent secondary alveolar bone grafting at mixed dentition. Occlusal radiographs obtained at ages 10 and 16 years were analyzed for alveolar bone height. Cephalometric analysis assessed growth at ages 5, 10, and 18 years.

Results: Seventeen of 28 patients treated using primary periosteoplasty required later secondary bone grafting, and the bone height at age 16 years was lower in the primary periosteoplasty group (p < 0.0001). There was a more pronounced decrease in maxillary protrusion from ages 5 to 10 years in the primary periosteoplasty group (p < 0.03). However, at age 18 there was no significant difference in maxillary growth between the two groups.

Conclusion: Primary periosteoplasty did not seem to inhibit long-term maxillary growth but was ineffective as a method of reconstructing the alveolar cleft.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-282017 (URN)10.1097/PRS.0000000000002910 (DOI)000394051100011 ()28027239 (PubMedID)
Available from: 2016-04-01 Created: 2016-04-01 Last updated: 2017-04-20Bibliographically approved
4. Secondary Alveolar Bone Grafting in patients Born with unilateral Cleft Lip and Palate-a 20-years follow-up
Open this publication in new window or tab >>Secondary Alveolar Bone Grafting in patients Born with unilateral Cleft Lip and Palate-a 20-years follow-up
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(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-282018 (URN)
Available from: 2016-04-01 Created: 2016-04-01 Last updated: 2016-04-28

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