The Optimal Timing of Secondary Alveolar Bone Grafting: A Literature Review

Bone fill following secondary alveolar bone grafting for children with cleft of the alveolus in New Zealand

OBJECTIVE

To investigate the amount of bone fill post-secondary alveolar bone grafting for children with cleft in New Zealand.

SETTINGS AND SAMPLE POPULATION

Retrospective analysis of post-operative intra-oral periapical and upper anterior occlusal radiographs of 45 grafted sites where all grafting was undertaken within the New Zealand public hospital service.

MATERIALS AND METHODS

A modified Kindelan Index and a 100 mm visual analogue scale (VAS) were used to assess the amount of bone fill using intra-oral radiographs by 4 orthodontists experienced in cleft care and who were blind to the patient's identity. Fourteen duplicated radiographs were randomly selected and added to the sample for reliability assessment.

RESULTS

The Kindelan Index rated 37.8% Grade 1 (Good), 31.1% rated Grade 2 (Satisfactory), 22.2% rated Grade 3 (Unsatisfactory) and 8.9% Grade 4 (Failure), a combined unsatisfactory/failure rate of 31.1%. The average VAS score was 50 mm ± 24 mm, and there was a strong relationship between Kindelan and VAS assessments. Those patients aged 10-11 years had significantly better outcomes using both assessments compared to those aged <10 and >11. The VAS assessment found that higher caseload surgeons had better outcomes, although the difference was of borderline statistical significance (mean VAS 56 mm vs 44 mm P = 0.07).

CONCLUSIONS

Contemporary secondary alveolar bone grafting bone fill outcomes in New Zealand are poor when compared to contemporary international studies. These findings indicate a review of secondary bone grafting is required to improve outcomes for New Zealand children with cleft.