To identify factors of oral health important for the final outcome, after secondary alveolar bone grafting in patients born with unilateral cleft lip and palate and compare occlusal radiographs with cone beam computed tomography (CBCT) in assessment of alveolar bone height.
Design:
Observational follow-up study.
Setting:
Cleft Lip and Palate Team, Craniofacial Center, Uppsala University Hospital, Sweden.
Patients:
40 nonsyndromic, Caucasian patients with unilateral complete cleft lip and palate.
Interventions:
Clinical examination, CBCT, and occlusal radiographs.
Main Outcome Measurements:
Alveolar bone height was evaluated according to Bergland index at a 20-year follow-up.
Results:
The alveolar bone height in the cleft area was significantly reduced compared to a previously reported 10-year follow-up in the same cohort by total (P = .045) and by subgroup with dental restoration (P = .0078). This was positively correlated with the gingival bleeding index (GBI) (r = 0.51, P = .0008) and presence of dental restorations in the cleft area (r = 0.45, P = .0170). There was no difference in the Bergland index generated from scoring the alveolar bone height on occlusal radiographs as with the equivalent index on CBCT.
Conclusion:
Patients rehabilitated with complex dental restoration seems to be at higher risk for progression of bone loss in the cleft area. Supportive periodontal therapy should be implemented after complex dental restorations in cleft patients. Conventional occlusal radiographs provide an adequate image for evaluating postoperative bone height in clinical follow-up.
AbyholmFEBerglandOSembG. Secondary bone grafting of alveolar clefts. A surgical/orthodontic treatment enabling a non-prosthodontic rehabilitation in cleft lip and palate patients. Scand J Plast Reconstr Surg. 1981;15:127–140.
2.
AinamoJBayI. Problems and proposals for recording gingivitis and plaque. Int Dent J. 1975;25:229–235.
3.
BajajAKWongworawatAAPunjabiA. Management of alveolar clefts. J Craniofac Surg. 2003;14:840–846.
4.
BerglandOSembGAbyholmFE. Elimination of the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment. Cleft Palate J. 1986;23:175–205.
5.
BertzJE. Bone grafting of alveolar clefts. J Oral Surg. 1981;39:874–877.
6.
BoloorVThomasB. Comparison of periodontal status among patients with cleft lip, cleft palate, and cleft lip along with a cleft in palate and alveolus. J Indian Soc Periodontol. 2010;14:168–172.
7.
BrattstromVMcWilliamJ. The influence of bone grafting age on dental abnormalities and alveolar bone height in patients with unilateral cleft lip and palate. Eur J Orthod. 1989;11:351–358.
8.
da Silva FilhoOGTelesSGOzawaTOFilhoLC. Secondary bone graft and eruption of the permanent canine in patients with alveolar clefts: literature review and case report. Angle Orthod. 2000;70:174–178.
9.
EngelLDPageRC. The normal and diseased periodontium and periodontal disease activity. Curr Opin Dent. 1991;1:4–11.
10.
FeichtingerMMossbockRKarcherH. Evaluation of bone volume following bone grafting in patients with unilateral clefts of lip, alveolus and palate using a CT-guided three-dimensional navigation system. J Craniomaxillofac Surg. 2006;34:144–149.
11.
GagglASchultesGKarcherHMossbockR. Periodontal disease in patients with cleft palate and patients with unilateral and bilateral clefts of lip, palate, and alveolus. J Periodontol. 1999;70:171–178.
12.
GlavindLLoeH. Errors in the clinical assessment of periodontal destruction. J Periodontal Res. 1967;2:180–184.
13.
HamadaYKondohTNoguchiKIinoMIsonoHIshiiHMishimaAKobayashiKSetoK. Application of limited cone beam computed tomography to clinical assessment of alveolar bone grafting: a preliminary report. Cleft Palate Craniofac J. 2005;42:128–137.
14.
HelmsJASpeidelTMDenisKL. Effect of timing on long-term clinical success of alveolar cleft bone grafts. Am J Orthod Dentofac Orthop. 1987;92:232–240.
15.
Huynh-BaGBraggerUZwahlenMLangNPSalviGE. Periodontal disease progression in subjects with orofacial clefts over a 25-year follow-up period. J Clin Periodontol. 2009;36:836–842.
16.
JabbariFSkoogVReiserEHakeliusMNowinskiD. Optimization of dental status improves long-term outcome after alveolar bone grafting in unilateral cleft lip and palate. Cleft Palate Craniofac J. 2015;52:210–218.
17.
KalaajiALiljaJFriedeHElanderA. Bone grafting in the mixed and permanent dentition in cleft lip and palatepatients: long-term results and the role of the surgeon’s experience. J Craniomaxillofac Surg. 1996;24:29–35.
18.
LagesEMMarcosBPordeusIA. Oral health of individuals with cleft lip, cleft palate, or both. Cleft Palate Craniofac J. 2004;41:59–63.
19.
LeeCCrepeauRJWilliamsHBSchwartzS. Alveolar cleft bone grafts: results and imprecisions of the dental radiograph. Plast Reconstr Surg. 1995;96:1534–1538.
20.
LiljaJKalaajiAFriedeHElanderA. Combined bone grafting and delayed closure of the hard palate in patients with unilateral cleft lip and palate: facilitation of lateral incisor eruption and evaluation of indicators for timing of the procedure. Cleft Palate Craniofac J. 2000;37:98–105.
21.
LindheJHaffajeeADSocranskySS. Progression of periodontal disease in adult subjects in the absence of periodontal therapy. J Clin Periodontol. 1983;10:433–442.
22.
LoeHSilnessJ. Periodontal disease in pregnancy, I: Prevalence and severity. Acta Odontol Scand. 1963;21:533–551.
23.
LongREJrPaternoMVinsonB. Effect of cuspid positioning in the cleft at the time of secondary alveolar bone grafting on eventual graft success. Cleft Palate Craniofac J. 1996;33:225–230.
24.
MeyerSMolstedK. Long-term outcome of secondary alveolar bone grafting in cleft lip and palate patients: a 10-year follow-up cohort study. J Plast Surg Hand Surg. 2013;47:503–508.
25.
NagappanNJohnJ. Periodontal status among patients with cleft lip (CL), cleft palate (CP) and cleft lip, alveolus and palate (CLAP) in Chennai, India. A comparative study. J Clin Diagn Res. 2015;9:Zc53–Zc55.
26.
NewlandsLC. Secondary alveolar bone grafting in cleft lip and palate patients. Br J Oral Maxillofac Surg. 2000;38:488–491.
27.
NishiharaKNozoeEMaedaAHiraharaNOkawachiTMiyawakiSNakamuraN. Outcome following secondary autogenous bone grafting before and after canine eruption in patients with unilateral cleft lip and palate. Cleft Palate Craniofac J. 2014;51:165–171.
28.
PapapanouPNWennstromJLGrondahlK. A 10-year retrospective study of periodontal disease progression. J Clin Periodontol. 1989;16:403–411.
29.
PerdikogianniHPapaioannouWNakouMOulisCPapagiannoulisL. Periodontal and microbiological parameters in children and adolescents with cleft lip and /or palate. Int J Paediatr Dent. 2009;19:455–467.
30.
RamstadT. Periodontal condition in adult patients with unilateral complete cleft lip and palate. Cleft Palate J. 1989;26:14–20.
31.
RantaR. A review of tooth formation in children with cleft lip/palate. Am J Orthod Dentofac Orthop. 1986;90:11–18.
32.
SafiiSHPalmerRMWilsonRF. Risk of implant failure and marginal bone loss in subjects with a history of periodontitis: a systematic review and meta-analysis. Clin Implant Dent Relat Res. 2010;12:165–174.
33.
SalviGEBraggerULangNP. Periodontal attachment loss over 14 years in cleft lip, alveolus and palate (CLAP, CL, CP) subjects not enrolled in a supportive periodontal therapy program. J Clin Periodontol. 2003;30:840–845.
34.
Schultze-MosgauSNkenkeESchlegelAKHirschfelderUWiltfangJ. Analysis of bone resorption after secondary alveolar cleft bone grafts before and after canine eruption in connection with orthodontic gap closure or prosthodontic treatment. J Oral Maxillofac Surg. 2003;61:1245–1248.
35.
StecMSzczepanskaJPypecJHirschfelderU. Periodontal status and oral hygiene in two populations of cleft patients. Cleft Palate Craniofac J. 2007;44:73–78.
36.
StreckfusCFParsellDEStreckfusJEPenningtonWJohnsonRB. Relationship between oral alveolar bone loss and aging among African-American and Caucasian individuals. Gerontology. 1999;45:110–114.
37.
SuzukiANakanoMYoshizakiKYasunagaAHaruyamaNTakahashiI. A longitudinal study of the presence of dental anomalies in the primary and permanent dentitions of cleft lip and/or palate patients. Cleft Palate Craniofac J. 312016.
38.
SuzukiATakahamaY. Maxillary lateral incisor of subjects with cleft lip and/or palate: part 1. Cleft Palate Craniofac J. 1992;29:376–379.
39.
TejaZPerssonROmnellML. Periodontal status of teeth adjacent to nongrafted unilateral alveolar clefts. Cleft Palate Craniofac J. 1992;29:357–362.
40.
Theologie-LygidakisNChatzidimitriouKTzerbosFKolomvosNIatrouI. Development of surgical techniques of secondary osteoplasty in cleft patients following 12 years experience. J Craniomaxillofac Surg. 2014;42:839–845.
41.
ToscanoDBacilieroUGraccoASicilianiG. Long-term stability of alveolar bone grafts in cleft palate patients. Am J Orthod Dentofac Orthop. 2012;142:289–299.
42.
WongFWKingNM. The oral health of children with clefts—a review. Cleft Palate Craniofac J. 1998;35:248–254.
