Alveolar Clefts Reconstruction: a Comparison of Autogenous Bone Graft versus Autogenous Combined with Alloplasts

Alveolar cleft reconstruction is a major challenge in cleft lip and/or palate (CLP) patients and golden standard protocol is to perform bone grafting (BG) before canine eruption and subsequent orthodontic closure. Objective of this study was to compare the post operative morbidity of two procedures in terms of complications i.e. the average operation time, intra-operative blood loss, postoperative pain and to demonstrate the surgical procedure and clinical outcome in terms of preservation of the grafted alveoli. This was a prospective comparative study conducted at the Department of Oral & Maxillofacial Surgery, Children Hospital, Lahore on twenty patients with residual alveolar clefts. The patients were randomly divided into two groups A & B. In group A, the cancellous bone graft was harvested from the anterior iliac crest while in group B, the cancellous bone was harvested from the anterior iliac crest and mixed with Synthetic bone substitutes in 1:1 by volume. The patients in group B recovered from walking uncomfortably statistically faster than those in group A. The duration of the hospital stay was significantly shorter in group B than in group A. The average bone graft densities of both groups significantly reduced within 6 months after grafting then seemed to be stable until month 24. The bone graft heights gradually decreased with time, in both groups by 24 months postoperatively. It was concluded that efficacy of hydroxylapatite is comparable with that of autogenous bone alone in terms of bone remodeling and tooth eruption, either spontaneous or orthodontically assisted.