Volumetric Assessment of Secondary Alveolar Bone Grafting Using Cone Beam Computed Tomography

Center for Craniofacial Anomalies, Department of Orofacial Sciences, University of California at San Francisco, 94143, USA.
The Cleft Palate-Craniofacial Journal (Impact Factor: 1.2). 09/2009; 46(5):503-11. DOI: 10.1597/08-153.1
Source: PubMed


To assess the radiographic outcome of secondary alveolar bone grafting in individuals with nonsyndromic unilateral or bilateral cleft lip and palate using cone beam computed tomography.
This prospective study was conducted at the University of California at San Francisco Center for Craniofacial Anomalies on 21 consecutive nonsyndromic complete cleft lip and palate individuals between 8 and 12 years of age who required alveolar bone grafting. Seventeen unilateral and four bilateral cleft lip and palate individuals had preoperative and postoperative cone beam computed tomography scans that were analyzed using Amira 3.1.1 software.
The average volume of the preoperative alveolar cleft defect in unilateral cleft lip and palate was 0.61 cm(3), and the combined average volume of the right and left alveolar cleft defects in bilateral cleft lip and palate was 0.82 cm(3). The average percentage bone fill in both unilateral cleft lip and palate and bilateral cleft lip and palate was 84%. The outcome of alveolar bone grafting was assessed in relation to (1) type of cleft, (2) size of preoperative cleft defect, (3) presence or absence of lateral incisor, (4) root development stage of the maxillary canine on the cleft side, (5) timing, and (6) surgeon. None of these parameters significantly influenced the radiographic outcome of alveolar bone grafting.
Secondary alveolar bone grafting of the cleft defect in our center was successful, based on radiographic outcome using cone beam computed tomography scans. Volume rendering using cone beam computed tomography and Amira software is a reproducible and practical method to assess the preoperative alveolar cleft volume and the adequacy of bone fill postoperatively.

1 Follower
79 Reads
    • "Previous studies have indicated that eruption of teeth into the grafted area can increase the bone volume (Feichtinger et al., 2008; Oberoi et al., 2009), whereas nonstimulated grafted areas seem to degenerate (Kearns et al., 1997; Schultze-Mosgau et al., 2003). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: The aims of this study were (1) to determine the three-dimensional anatomical boundaries of the alveolar bone defect in cleft lip and palate (CLP) patients, (2) to precisely translate these anatomical boundaries into reliable cephalometric landmarks and planes that can be used for cone beam computed tomography (CBCT) analysis, (3) to standardize image acquisition and reconstruction parameters, and (4) to test the reproducibility of the proposed protocol for measuring the predefined alveolar bone defect, using a third-party software. Methods: The alveolar bone defect volume of 10 randomly selected patients with unilateral CLP (UCLP) aged 8 years and 6 months to 11 years and 2 months was evaluated on preoperative and 1-year postoperative CBCT scans using a semiautomatic, standardized protocol. The alveolar bone graft outcome was calculated as a percentage of the bone fill using the formula (VOLpre - VOLpost)/VOLpre) × 100. Intra- and interobserver reliability was assessed. Results: Intra- and interobserver reproducibility was excellent for volumes and bone fill as no statistically significant difference (P < .001) was seen between the different sets of measurements, and Pearson correlation coefficients were large (intraobserver: r > .9849, interobserver: r > .8784). The Bland-Altman plots indicated that the differences between the plots were not patterned. Conclusions: Volume determination using CBCT, third-party medical image processing software, and the presently defined image acquisition and reconstruction parameters, including anatomical boundaries, is a reproducible and practical method for assessing the volumetric outcome of secondary alveolar bone grafting in patients with UCLP.
    The Cleft Palate-Craniofacial Journal 02/2015; 52(3). DOI:10.1597/13-287 · 1.20 Impact Factor
  • Source
    • "It is indicated for most patients with an alveolar cleft, the best stage for this procedure is in the mixed dentition when the canine adjacent to the cleft has completed half to three quarters of its root formation [2]. Its major benefit is to restore alveolar integrity to induce spontaneous migration of permanent teeth adjacent to the cleft in the newly formed bone [3] [4]. The outcome of the surgery is considered satisfactory when sufficient volume of normally remodeled bone tissue is obtained [5]. "

    Open Journal of Stomatology 01/2013; 03(09):31-36. DOI:10.4236/ojst.2013.39A005
  • Source
    • "CBCT has been shown to be effective in localization of impacted teeth and in assessing the outcome of alveolar bone grafting and the eruption path of the canine in grafted alveolar clefts [20], [21], [22]. Previous studies have shown that 3D imaging using CBCT is a simple and effective method to accurately analyze the airway [23], [24]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Children with cleft lip and palate (CLP) are known to have airway problems. Previous studies have shown that individuals with CLP have a 30% reduction in nasal airway size compared to non-cleft controls. No reports have been found on cross-sectional area and volume of the pharyngeal airway in clefts. Introduction of Cone-Beam CT (CBCT) and imaging software has facilitated generation of 3D images for assessment of the cross-sectional area and volume of the airway. To assess the pharyngeal airway in individuals with CLP using CBCT by measuring volume and smallest cross-sectional areas and compare with 19 age- and sex-matched non-cleft controls. Retrospective study of CBCT data of pre-adolescent individuals (N = 19, Mean age = 10.6, 7 females, 12 males, UCLP = 6, BCLP = 3) from the Center for Craniofacial Anomalies. Volumetric analysis was performed using image segmentation features in CB Works 3.0. Volume and smallest cross-sectional were studied in both groups. Seven measurements were repeated to verify reliability using Pearson correlation coefficient. Volume and cross-sectional area differences were analyzed using paired t-tests. The method was found to be reliable. Individuals with CLP did not exhibit smaller total airway volume and cross sectional area than non-CLP controls. 3D imaging using CBCT and CB Works is reliable for assessing airway volume. Previous studies have shown that the nasal airway is restricted in individuals with CLP. In our study, we found that the pharyngeal airway is not compromised in these individuals.
    PLoS ONE 08/2012; 7(8):e43405. DOI:10.1371/journal.pone.0043405 · 3.23 Impact Factor
Show more