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Objective The primary goals for alveolar cleft grafting are to gain and maintain bone in the cleft area that provides continuity for the maxillary segments, allowing the stability of the maxilla and building the bony foundation for the erupting cleft teeth and closure of the oronasal communication. The current study compared the effectiveness of the double iliac corticocancellous bone blocks technique versus the particulate autogenous spongy bone graft from the anterior iliac crest in alveolar cleft grafting in the mixed dentition stage. Patients and methods The current randomized clinical study included 18 patients with unilateral alveolar clefts. They were divided into two equal groups according to the technique used for grafting; group (1) included nine patients in whom grafting with double iliac corticocancellous bone blocks with cancellous bone particulates in between was used (study group), and group (2) included nine patients in whom conventional cancellous particulate bone grafting from anterior iliac crest was used (Control group). Results Nine months postoperatively, the study group showed superior results regarding graft width, height, and volume compared to the control group in the current study. Conclusion Regarding the graft success factors represented by the maintained graft labio-palatal width, graft height, and total graft volume, the technique of double iliac corticocancellous bone blocks was markedly effective in reconstructing alveolar clefts when compared with the conventional grafting technique that utilized cancellous particulate bone alone from the anterior iliac crest. Clinical relevance. The double iliac corticocancellous bone blocks technique maintained the grafted bone volume, width, and height.

Presurgical orthodontic treatment before secondary alveolar bone grafting (SABG) is widely performed for cleft lip/palate patients. However, no randomized controlled trial has been published comparing SABG outcomes in patients with and without, presurgical orthodontic treatment. This randomized, prospective, single-blinded trial was conducted between January 2012 and April 2015 to compare ABG volumes 6 months postoperatively between patients with and without presurgical orthodontic treatment. Twenty-four patients were enrolled and randomized and 22 patients completed follow-up. Patients who had presurgical orthodontics before SABG had significantly improved inclination (p < 0.001) and rotation (p < 0.001) of the central incisor adjacent to the defect, significantly improved ABG fill volume (0.81 ± 0.26 cm 3 at 6 months compared to 0.59 ± 0.22 cm 3 ; p < 0.05) and less residual alveolar bone defect (0.31 ± 0.08 cm 3 at 6 months compared to s 0.55 ± 0.14 cm 3 ; p < 0.001) compared to patients who did not have presurgical orthodontic treatment. In conclusion, orthodontic treatment combined with SABG results in superior bone volume when compared with conventional SABG alone.

This study aimed to develop and implement a standardized 3D workflow for surgical planning and outcome assessment in secondary alveolar bone grafting (SABG) using cone-beam computed tomography (CBCT). A 3D protocol was developed using medically certified software for semiautomatic segmentation, mirroring, voxel-based alignement of the maxilla and volumetric analysis of cleft and graft regions. This workflow was applied on a retrospective cohort of patients with unilateral cleft lip and alveolus (CLA) and/or cleft lip and palate (CLP) who received iliac bone mixed with synthetic biphasic calcium phosphate for bone grafting. CBCT scans (preoperative, immediate postoperative, and six-months follow-up) from 23 patients with unilateral clefts were analysed. The non-cleft side was mirrored to serve as reference for symmetric reconstruction. Measured parameters included alveolar cleft volume, grafted bone volume, integrated bone volume and missing volume. The workflow enabled reliable volumetric quantification. The preoperative cleft volume averaged 1505 mm 3 (SD 425 mm 3 ) and graft volume 1983 mm 3 (SD 407 mm 3 ). After six months, the mean integrated bone volume was 851 mm 3 (SD 294 mm 3 ), corresponding to a mean graft resorption of 57% (SD 13%) and alveolar cleft restoration of 58% (SD 19%). This 3D CBCT-based protocol provides a robust methodological framework for assessing SABG outcomes. It enhances quantification of cleft morphology and graft integration, supporting improved surgical planning, follow-up, and cross-study comparability.

Background Alveolar cleft is a common developmental malformation in the maxillofacial region, often occurring with cleft lip or palate. The traditional “gold standard” iliac bone grafting implants only cancellous bone in the alveolar cleft region. However, this approach provides insufficient initial mechanical support and is prone to structural collapse and accelerated bone resorption. This study used digital guide plate assisted cortico-cancellous iliac crest bone grafting to repair alveolar clefts, aiming to provide better structural support while reducing bone resorption. Method This study retrospectively reviewed 39 patients with unilateral alveolar clefts, including 21 cases in the autogenous iliac cancellous bone grafting group (cancellous bone group, mean age 15.33 ± 5.36 years) and 18 cases in the digitally guided autogenous iliac cortical-cancellous composite bone grafting group (composite bone group, mean age 14.17 ± 4.05 years). Preoperative and 6-month postoperative assessments were performed using CBCT for three-dimensional evaluation. The study compared the bone graft volume, new bone fill rate, alveolar width in the grafted area, and bone density between the two groups. Result Postoperatively, the composite bone group exhibited markedly greater bone graft volume (698.58 ± 197.43 mm³ versus 378.23 ± 176.65 mm³, P  < 0.01) and significantly higher new bone fill rate for volume, area, and height relative to the cancellous bone group. The composite bone has a clear advantage in maintaining alveolar ridge width compared to cancellous bone. Conclusion Compared with the traditional “gold standard” grafting, digital guide plate assisted cortico-cancellous iliac crest bone grafting for alveolar cleft repair significantly increased the bone graft volume. The surgical method introduced in this study provides a new option for the precise repair and functional reconstruction of alveolar clefts and has a broad application prospect.

Alveolar cleft is the most common congenital bone defect. Autologous iliac crest bone graft (ICBG) is the most widely adopted procedure for alveolar cleft repair, but the condition is associated with door-site morbidities. For the first time, this study used bone marrow mononuclear cells (BMMNCs) combined with beta-tricalcium phosphate (β-TCP) granules to repair alveolar bone defect. The effectiveness of this technique was compared with autologous ICBG after 12 months of follow-up. The bone formation volume was quantitatively evaluated by three-dimensional computed tomography and computer aided engineering technology. BMMNCs/β-TCP granule grafting was radiographically equivalent to ICBG in alveolar cleft repair. Although considerable resorption was observed up to 6 months after surgery, no significant differences were noted in the Chelsea score and bone formation volume between groups. These finding indicate that BMMNCs/β-TCP grafting is a safe and effective approach for alveolar bone regeneration.

The purpose of treating alveolar bone cleft is to restore a normal maxilla structure. Multiple factors have been identified that can affect the success of alveolar bone grafting. However, with consistent treatment modifications, the surgical outcomes have been improved, but alveolar bone loss still exists. Thus, a new aspect should be found to solve this problem. As alveolar bone belongs to the periodontal tissues, the mechanism of the alveolar bone loss after bone grafting in patients with alveolar bone cleft may be similar to the development of alveolar bone loss in periodontitis. Cell-free DNA (cfDNA) has been demonstrated as a key promoter of alveolar bone loss during periodontal inflammation. We hypothesized that cfDNA-related innate immune responses could be a major inducement for postoperative bone loss after alveolar bone grafting. In this perspective, we preliminarily proved the potential association between cfDNA, TLR9 pathway, and alveolar bone grafting operation, and it might verify that surgical trauma could accumulate cfDNA, which can further activate cellular TLR9 signaling.

Objectives To quantify longitudinal bone changes in the maxilla after secondary alveolar bone grafting (SABG) in patients with unilateral cleft lip and/or cleft palate (CL/P), and to describe the maxillary dimensions before and after SABG in all orthogonal planes using a Cone Beam Computed Tomography (CBCT)-based methodology. Methods Ethical approval was obtained to retrospectively analyze CBCT scans of children treated for unilateral alveolar clefts. Inclusion criteria encompassed individuals who underwent SABG before the eruption of the cleft-side permanent lateral incisor or, if absent, the permanent ca-nine, and had both preoperative and postoperative CBCT scans. A total of seven measurements of maxillary dimensions in all orthogonal planes, as well as in panoramic reconstruction, were conducted in the CBCT images. The normality of the data was confirmed with the Shapiro-Wilk test. A paired t-test was applied to assess significant differences between the preoperative and postoperative measurements ( p  < 0.05). The impact of age, gender, and their interrelation was evaluated by two-way ANOVA ( p  < 0.05). Results A total of 47 patients, comprising 32 males and 15 females, were selected based on the specified criteria. Notably, we observed a significant increase in sagittal, vertical, and transverse dimensions between the preoperative scans and those taken one year postoperatively ( p  < 0.05), irrespective of the patients’ ages and genders. When considering gender, data indicated that male patients exhibited wider transverse dimensions in both the preoperative and postoperative measurements. Conclusions This study introduced a CBCT-based method to quantitatively assess maxillary changes in unilateral CL/P patients after SABG. The approach demonstrated continuous dimensional changes in all orthogonal planes. In addition, it described the maxillae dimensions in all planes. Future research can utilize this method for precise measurement of maxillary alterations and dimensions.

Alveolar cleft is present in 75% of cleft patients. Alveolar bone grafting can be divided according to time of the procedure into primary, early secondary, secondary and tertiary. A retrospective analysis of 41 children with early secondary alveolar bone grafting was performed. Qualification for autologous bone grafting (ABG) was performed during orthodontic consultation. The presence of a symptomatic oronasal fistula and/or a bone defect within the alveolar process that could hinder orthodontic treatment and prosthetic rehabilitation in the cleft area was also assessed. Prior to the procedure, a dental examination was required, and, if necessary, treatment of carious lesions or inflammatory conditions within the oral cavity completed. In children over the age of 5, qualification for surgery was based on an orthodontic assessment of Cone Beam Computed Tomography (CBCT) imaging of the cleft area. Early secondary autologous bone grafting (eSABG) was carried out in 7 children with cleft lip (3 with left-sided cleft lip, 2 with right-sided cleft lip, and 2 with bilateral cleft lip) and in 34 children with cleft lip and palate (20 with left- sided cleft lip and palate, 8 with right-sided cleft lip and palate, and 6 with bilateral cleft lip and palate). In 1 case, loss of bone graft was observed. No other serious complications were reported. The results suggest that early secondary alveolar bone grafting using iliac crest bone in alveolar cleft associated with cleft lip or cleft palate, is a safe procedure with a low rate of serious complications.

Background Machine learning based auto-segmentation of 3D images has been developed rapidly in recent years. However, the application of this new method in the research of patients with unilateral cleft lip and palate (UCLP) is very limited. In this study, a machine learning algorithm utilizing 3D U-net was used to automatically segment the maxilla, fill the cleft and evaluate the alveolar bone graft in UCLP patients. Cleft related factors and the surgery impact on the development of maxilla were analyzed. Methods Preoperative and postoperative computed tomography images of 32 patients (64 images) were obtained. The deep-learning-based protocol was used to segment the maxilla and defect, followed by manual refinement. Paired t-tests and Mann-Whitney tests were performed to reveal the changes of the maxilla after surgery. Two-factor, two-level analysis for repeated measurement was used to examine the different trends of growth on the cleft and non-cleft sides of the maxilla. Pearson and Spearman correlations were used to explore the relationship between the defect and the changes of the maxillary cleft side. Results One-year after the alveolar bone grafting surgery, different growth amount was found on the cleft and non-cleft sides of maxilla. The maxillary length (from 34.64 ± 2.48 to 35.67 ± 2.45 mm) and the alveolar length (from 36.58 ± 3.21 to 37.63 ± 2.94 mm) increased significantly only on the cleft side while the maxillary anterior width (from 11.61 ± 1.61 to 12.01 ± 1.41 mm) and posterior width (from 29.63 ± 2.25 to 30.74 ± 2.63 mm) increased significantly only on the non-cleft side after surgery. Morphology of the cleft was found to be related to the pre-surgical maxillary dimension on the cleft side, while its correlation with the change of the maxilla after surgery was low or not statistically significant. Conclusion The auto-segmentation of the maxilla and the cleft could be performed very efficiently and accurately with the machine learning method. Asymmetric growth was found on the cleft and non-cleft sides of the maxilla after alveolar bone graft in UCLP patients. The morphology of the cleft mainly contributed to the pre-operation variance of the maxilla but had little impact on the maxilla growth after surgery.

Alveolar bone grafting (ABG) is broadly performed for cleft lip and palate patients. The rate of canine impaction post-ABG is much higher than the prevalence of canine impaction in non-cleft patients. This pilot study was designed to investigate factors involved in canine eruption failure after ABG and to predict the possibility of canine impaction in unilateral cleft lip and palate (UCLP) patients. This retrospective observational study examined 45 patients with UCLP (mean age 7.9 years) classified into an impacted group (n = 9) and a spontaneously erupted group (n = 36). From 3D images, we measured lateral incisor presence or absence, lateral incisor position on the cleft side, canine position, movement change, cleft volume, and canine and first premolar overlap-area. Multivariate logistic regression analysis using independent variables indicated significant differences in results, selecting highly relevant items. Multivariate analysis indicated a significant association between the overlap-area between the canine and the first premolar at pre-ABG (p = 0.038) and the distance between the cleft side cusp tips of canine and the lateral cleft margin of pre-ABG (p = 0.005). Results suggest that canine impaction is predictable at an early stage in pre-ABG and show the possibility of comprehensive diagnosis of canine impaction using computed tomography.