Abstract
Objective
This study investigates the effectiveness of demineralized bone matrix (DBX) to close alveolar clefts in patients previously treated with bone morphogenic protein-2 (BMP-2) who remained with bone nonunion.
Design
This is an IRB-approved retrospective, single-center study.
Setting
This study was conducted at a tertiary academic center
Patients/Participants
We searched for all surgical encounters with the Current Procedural Terminology (CPT) code 42210 from the years 2013–2019. Included patients were diagnosed with cleft alveolus, previous BMP-2 exposure and required revision bone grafting during mixed dentition for persistent alveolar defects.
Interventions
17 patients underwent revision alveolar bone grafting (ABG) with either DBX (n = 10) or autograft (n = 7) to repair persistent bony cleft.
Main Outcome Measure(s)
The primary study outcome measured was alveolar bone graft revision failure described as continued alveolar nonunion.
Results
The median age at revision ABG was 13.1 ± 3.3 years, with a mean follow-up time of 4.9 years (1.1–9.2 years). Patients were 53% male, 47% had a unilateral cleft lip and alveolus. 58.8% of patients were treated with DBX in the cleft, 41.2% treated with autograft from iliac crest. Overall, 11.8% (n = 2) of all revisions failed, requiring a second revision. The average time to reoperation was 2.06 years, and both were re-grafted with autograft. There was no statistically significant difference between the type of bone graft source used and the failure rate obtained (P = .1544).
Conclusions
DBX and autologous iliac crest bone grafts achieve similar alveolar union rates during revision ABG in patients treated with previous BMP-2 to the alveolar cleft.
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