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
85 Reads
  • Source
    • "Several studies have confirmed CBCT efficiency to assess the grafted area using software capable of measuring the real volume of the graft (Hamada et al., 2005;Feichtinger et al., 2006;Zhang et al., 2012;Amirlak et al., 2013). A filling percentage of approximately 85% was found for UCLP one year after the bone graft surgery (Oberoi et al., 2009) with a stability of 70% of the bone volume one year after ABG (Van derMeij et al., 2001). Other studies using CBCT axial and coronal reconstructions showed that grafted bone was successful on filling the labial side in most cases, even though some bone deficiencies were found on the palatal or apical aspects (Suomalainen et al., 2014). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To demonstrate the feasibility of rapid maxillary expansion (RME) after alveolar bonegrafting (ABG) in complete unilateral cleft lip, alveolus and palate (UCLP) without damage to the grafted area. Setting: Hospital for Rehabilitation of Craniofacial Anomalies (HRAC), University of São Paulo. Department of Orthodontics. Patient: A case report of a 10-year-old boy with a complete UCLP who was treated with rapid maxillary expansion (RME) after secondary alveolar bone graft procedure (ABG). RME was performed 1.3 years after the bone grafting with rhBMP-2 in collagen membrane. Result: Postexpansion CBCT axial and coronal sections demonstrated the opening of the midpalatal suture in the premaxilla without damages to the alveolar bone grafting region. Postretention CBCT images showed bone formation at the split midsuture of the premaxilla. Conclusion: Rapid maxillary expansion performed after ABG with rH-BMP2 led to complete opening of the premaxillary midline suture without compromising the integrity of the grafted alveolar cleft.
    Full-text · Article · Jan 2016 · The Cleft Palate-Craniofacial Journal
  • 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]. "

    Full-text · Article · Jan 2013 · Open Journal of Stomatology
  • 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.
    Preview · Article · Aug 2012 · PLoS ONE
Show more