Comparison on the Success of Secondary Alveolar Bone Grafting Performed Below 12 Years and On or After 12 Years of Age for Patients With Cleft Alveolus: A Systematic Review and Meta-Analysis

Abstract

Aim

The aim of this systematic review and meta-analysis was to compare the outcomes of secondary alveolar bone grafting (SABG) performed before and after 12 years of age in patients with nonsyndromic cleft alveolus.

Method

All relevant studies from database untill September 2024 were identified through all relevant databases. Randomized Controlled Trials (RCTs), Controlled Clinical Trials (CCTs), prospective, and retrospective studies were included.

Population

Patients with cleft alveolus who underwent SABG using iliac crest bone graft.

Intervention

Early SABG performed below 12 years.

Comparison

SABG performed on or after 12 years of age.

Primary outcome

Bone fill assessed through radiographic imaging techniques. Secondary outcomes included skeletal relationship, canine eruption, Asher-Mcdade index, Goslon yardstick index, presence of oronasal fistula, and revision surgeries. All articles were screened for the title, abstract, and full text by 2 reviewers independently and in duplicate. Risk of bias was assessed for RCT using Cochrane's risk of bias tool and the CCT was assessed using the ROBINS-I tool.

Results

Of the 3545 records identified, 9 studies met the inclusion criteria for qualitative and quantitative synthesis. Eight of the 9 included studies were rated as having moderate to serious risk of bias, and one judged as critical risk of bias. There is very low-quality evidence in favor of secondary grafting performed below 12 years of age compared to secondary grafting performed on or after 12 years.

Conclusion

Future high-quality RCTs with standardized protocols are necessary to determine the most effective timing for SABG in cleft care.