The effectiveness of mineralized plasmatic matrix in the closure of alveolar clefts with volumetric assessment

The Use of Platelet Concentrates in the Reconstruction of the Alveolar Cleft Defect: A Systematic Review and Meta-Analysis

ObjectiveEvaluate quantitative and qualitative outputs when comparing the incidence of platelet concentrates (PCs) combined with autogenous bone grafts to an autograft control group for the reconstruction of alveolar cleft defects.DesignSystematic review and meta-analysis.Patients/ParticipantsRandomized and nonrandomized controlled clinical trials where PCs were used in the reconstruction of alveolar cleft defects.InterventionsUse of PCs in combination with autogenous bone graft in the experimental group and autogenous bone graft alone in the control group.Main Outcome Measure(s)Average bone formation and bone density were evaluated, mean differences were calculated and pooled by a meta-analysis technique. Additionally, clinical outcomes such as wound dehiscence, closure of the oronasal fistula, pain, swelling, discharges, infections, and bleeding were considered in the qualitative synthesis.ResultsAfter an evaluation of forty-nine articles, nineteen were considered for the review. The qualitative assessment of bone density, bone formation, and clinical outcomes showed no differences between groups in most of the included studies. The meta-analysis showed no statistical differences between PCs groups when compared to the control group in bone density at three months (mean difference 45.67 HU, P = .23) and six months (mean difference 48.57 HU, P = .64). Neither were statistical differences in the percentage of regenerated bone volume at six months (mean difference 6.39%, P = .15) and the volume of newly formed bone at 12 months (mean difference 0.37 mm3, P = .99).ConclusionsThere were no significant differences in terms of bone formation, bone density, and clinical outputs between groups.

Validation and comparison of 2D grading scales and 3D volumetric measurements for outcome assessment of bone-grafted alveolar clefts in children

BACKGROUND

Several methods have been proposed to assess outcome of bone-grafted alveolar clefts on cone beam computed tomography (CBCT), but so far these methods have not been compared and clinically validated.

OBJECTIVES

To validate and compare methods for outcome assessment of bone-grafted clefts with CBCT and provide recommendations for follow-up.

METHODS

In this observational follow-up study, two grading scales (Suomalainen; Liu) and the volumetric bone fill (BF) were used to assess the outcome of 23 autogenous bone-grafted unilateral alveolar clefts. The mean age at bone grafting was 9 years. The volumetric BF was assessed in five vertical sections. The bone-grafted cleft outcome was based on a binary coding (success or regraft) on a clinical multidisciplinary expert consensus meeting. Grading scales and volumetric assessment were compared in relation to the bone-grafted cleft outcome (success or regraft). Reliability for the different outcome variables was analyzed with intra-class correlation and by calculating kappa values.

LIMITATIONS

The study had a limited sample size. Clinical CBCT acquisitions had a varying tube current and exposure time.

RESULTS

Volumetric 3D measurements allowed for outcome assessment of bone-grafted alveolar clefts with high reliability and validity. The two grading scales showed highly reliable outcomes, yet the validity was high for the Suomalainen grading scale but low for the Liu grading scale.

CONCLUSIONS

Volumetric 3D measurement as well as the Suomalainen grading can be recommended for outcome assessment of the bone-grafted cleft. Yet, one must always make a patient-specific assessment if there is a need to regraft.

Effect of adjuvant autologous platelet concentrates on secondary repair of alveolar clefts: A systematic review and meta-analysis

OBJECTIVE

To review the existing evidence on the adjuvant use of autologous platelet concentrates (APCs) with iliac crest bone graft (ICBG) in the reconstruction of the secondary alveolar cleft.

METHODS

Electronic databases were searched systematically until November 2022. Clinical trials comparing the three-dimensional radiological outcomes of patients who underwent secondary alveolar bone grafting (SABG) with ICBG and APCs to those with ICBG alone and the radiological outcomes assessed 6 months after surgery were included. Two authors performed the study selection and the assessment of the risk of bias. Meta-analysis was performed using the random-effects model to determine the risk ratio (RR) for developing wound dehiscence and the mean difference (MD) with a 95% confidence interval (CI) for the percentage of newly formed bone.

RESULTS

Nine studies (seven RCT and two CCT) were included with a low to high risk of bias. At the 6-month follow-up, the study group revealed insignificant results regarding the percentage of newly formed bone (MD = 6.49; 95% CI: -0.97, 13.94; p = .09; χ2  = 0.01; I2  = 71%). In addition, the overall risk of developing wound dehiscence was lower in the study group (RR = 0.34; 95% CI: 0.15, 0.78; p = .01; χ2  = 0.67; I2  = 0%).

CONCLUSION

Currently, there is insufficient evidence to support the adjuvant use of APCs with ICBG on enhanced bone regeneration following secondary alveolar bone grafting. However, combining ICBG and APCs might be beneficial in reducing the risk of developing wound dehiscence.

Alveolar cleft reconstruction utilizing a particulate autogenous tooth graft and a novel split-thickness papilla curtain flap - A retrospective study

During secondary alveolar cleft grafting, the use of autogenous cancellous bone harvested from the iliac crest is still considered the gold standard. Due to the risk of donor-site morbidity and excessive graft resorption, alternative grafting materials (e.g. intraoral bone, xenografts) have been tested. Autogenous tooth bone graft (ATB) is a novel material derived from extracted teeth. ATB has successfully been used in pre-prosthetic and periodontal surgery for hard-tissue reconstruction. Seven patients with unilateral cleft lip and palate were treated with ATB, using their own deciduous teeth for grafting. Defects were accessed utilizing a novel split-thickness papilla curtain flap. Cone-beam computed tomography scans were taken prior to and 3 months following cleft surgery to assess graft integration, graft stability, and the volume of the newly formed hard tissues. Hard-tissue gain, as measured at the 3-month follow-up, averaged 0.65 cm3 ± 0.26 cm3. Results showed acceptable graft integration and stability at the 3-month follow-up, with no adverse effects or excessive resorption of the graft. The use of ATB might be a feasible alternative for alveolar cleft grafting. However, long-term studies using a large sample size are required to derive further conclusions.

Immuno-histopathologic evaluation of mineralized plasmatic matrix in the management of horizontal ridge defects in a canine model (a split-mouth comparative study)

Our research aimed to investigate the effect of combining biphasic calcium phosphate (BCP) alloplast with mineralized plasmatic matrix (MPM) as compared with platelet-rich fibrin (PRF) on the quality and quantity of bone formation and maturation at surgically created horizontal critical-sized ridge defects (HRDs) in a canine model. We used a split-mouth design using the third and fourth mandibular premolars of the mongrel dogs. Twelve defects on the left side (experimental group, I) were managed with MPM composite mixed with BCP alloplast, MPM compact layer. On the right side (control group, II), another 12 defects were managed with PRF mixed with BCP alloplast, followed by the application of PRF compact strips. Finally, both were covered by a collagen membrane. Dogs were euthanized at 4, 8, and 12 weeks, and the studied defects were processed to evaluate treatment outcome, including mean percentage of bone surface area, collagen percentage, and osteopontin (OPN) immunoreaction. Our results revealed that the mean percentage of bone surface area was significantly increased in the experimental group treated with MPM at all time intervals as compared with the PRF group. Decreased collagen percentage and increased OPN immunoreactivity showed significant results in the MPM group as compared with PRF at 4 and 8 weeks postoperatively, respectively. In conclusion, MPM accelerates the formation of superior new bone quality when used in the treatment of HRDs.