Sage Journals: Discover world-class research

Abstract

Objective: Different methods are available to evaluate the surgical outcome of secondary alveolar bone grafting (SABG). A standard approach to assess SABG-outcomes might promote informed decision-making in healthcare and contribute to quality improvement and reducing costs. Currently the International Consortium for Health Outcomes Measurement Standard Cleft Set (ICHOMSCS) does not contain a long-term assessment method after SABG. This study aims to provide an overview of the available methods and their reliability for long-term evaluation of SABG in patients with Cleft Lip and/or Palate (CL/P). Methods: This scoping review was conducted following PRISMA guidelines. Four databases were searched for studies meeting the inclusion criteria, like patients with non-syndromic CL/P and evaluations after minimum 3 months. Results: Twentynine studies met the eligibility criteria. The included studies identified various non-radiographic, 2D and 3D radiographic assessment methods, combined with 20 different scoring scales. Most reliable scoring scales per assessment method were: Pocket depth of the teeth adjacent to the cleft for non-radiographic, the Bergland scale for 2D-, and Bone Mineral Density calculations for 3D- radiographic assessment. Conclusions: An overview of available methods evaluating SABG is provided. Though 3D radiographic assessment seems most reproducible due to highest inter-examiner reliability, this method is challenging concerning availability and costs, and might be overtreatment in evaluating SABG for ICHOMSCS. Further research is needed to study validity of the methods and a suitable timepoint for SABG evaluation to be included in an outcomes measurement set like ICHOMSCS.

Keywords

cleft lip/palate alveolar bone grafting scoping review

Introduction

The International Consortium for Health Outcomes Measurement (ICHOM) has developed the ICHOM Standard Cleft Set (ICHOMSCS), a set of standardized outcome measures for Cleft Lip and/or Palate (CL/P) treatment.¹ The current set contains short-term outcome measures for secondary alveolar bone grafting (SABG), like excessive bleeding or infections, dehiscence, fistula or necrosis within 30 days after surgery and it contains long-term Patient Reported Outcome Measures (PROMs) regarding function and esthetics of the jaw. However, ICHOMSCS currently does not contain long term clinician reported SABG outcome measures.¹

Alveolar bone grafting (ABG) is commonly applied to correct the alveolar defect in patients with CL/P. This surgical procedure addresses a variety of goals; oronasal fistula closure, a continuous and stable dental arch, a bone environment that facilitates eruption and orthodontic movement of permanent teeth adjacent to the cleft, an increased bone attachment to the teeth adjacent to the cleft, and eventually it supports, in combination with orthodontic treatment, to facial symmetry, dental rehabilitation and prosthodontic reconstruction.^2,3 Various bone grafts can be used to fill the alveolar defect, including autografts, allografts, xenografts, and synthetic grafts. The ABG can be performed in 3 different stages of tooth development: primary, secondary, or tertiary. Secondary ABG (SABG) is the golden standard for many cleft surgeons and is performed during dental transition and before eruption of the permanent canine, between the ages of 8 and 11 years.^4-9

Clinician reported assessment methods for the long-term evaluation of SABG of patients with CL/P can be either non-radiographical, like probing and intra-oral inspection, or radiographic assessment. Occlusal, periapical and panoramic radiographs are commonly used for 2- dimensional (2D) radiographic evaluation. Computed tomography (CT) and cone-beam computed tomography (CBCT) provide a 3-dimensional (3D) radiographic assessment of SABG. Not only are the assessment methods diverse, different scoring scales are also available.

While there is a large variety of techniques used in SABG surgery by cleft teams worldwide, no long-term outcome measure is yet included in the ICHOMSCS. A uniform, straightforward, accurate, and reliable approach to assess the SABG outcome at the end of the complete cleft treatment, would be useful to promote informed decision-making in cleft care. But also has the potential to improve the quality of cleft care and to reduce costs. Therefore, this scoping review aims to provide an overview of the available methods for long-term evaluation of SABG of patients with CL/P. The secondary aim is to evaluate the reliability of the available long-term SABG assessment methods as the obtained assessment method should be suitable for use in the multiple centers worldwide that are using ICHOMSCS.

Material and Methods

This scoping review followed the guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).¹⁰ There were no human participants in this study and informed consent was not required.

Eligibility Criteria

The studies included in this review were selected according to the participants, concept, and context (PCC) criteria.¹¹ The inclusion criteria were defined according to Participant (P): patients with uni- or bilateral non-syndromic cleft lip and alveolus (CLA) and/or cleft lip, alveolus and palate (CLAP); Concept (C): patients who underwent SABG surgery; Context (C): >3 months evaluation of the SABG outcome assessed with a well-defined assessment method and scoring scale, that was tested on reliability.

Included study designs were controlled clinical trials (CCTs) and both retrospective and prospective observational studies. There were no restrictions regarding the appearance and location of the cleft (uni- or bilateral, left, or right), preoperative status of orthodontic treatment and type of graft used. Only English written studies were included. Animal studies, systematic reviews, meta-analyses, cross-sectional studies, case reports, and in vitro studies were excluded.

Information Sources and Search

A literature search was conducted in the following databases: Medline ALL, EMBASE, Web of Science and Cochrane Library. The first search was conducted on August 25, 2021 and was updated on April 7, 2023. The complete search strategy was prepared with the support of the librarians Wichor Bramer and Christa Niehot of the Erasmus Medical Center, Rotterdam, The Netherlands. The search focused on synonyms and related terms for cleft, alveolar bone grafting, and treatment outcomes, the full search strategy is shown in Supplemental Table 1. The final search results were exported into EndNote, and duplicates were removed by the library technician.

Selection of Sources of Evidence

Two reviewers (L.S.K.K. and A.E.V.) independently screened the publications from the literature search based on titles and abstracts. The Rayyan web application was used to facilitate independent record selection by the scoping team.¹² Publications selected by both reviewers based on title and abstract were included for full text review. Subsequently, full-text articles were retrieved and evaluated for eligibility based on the inclusion and exclusion criteria by both reviewers. In case of discrepancy, a third reviewer was consulted (N.C.W.K.).

Data Charting and Synthesis

Data charting was performed independently by 2 reviewers (L.S.K.K. and A.E.V.). The following data were extracted from the included studies: study design, year of publication, sample size, number of patients, age, cleft type, follow-up time, type of graft used, assessment method, scoring scale, and information on reliability.

Data Analysis

Data were descriptively summarized and analyzed. Additionally, the study characteristics were discussed in the text using a narrative approach. The results about assessment methods were categorized into non-radiographic, 2D radiographic or 3D radiographic. Inter-/intra-rater reliabilities and/or intra-class coefficients (ICC) and/or dice coefficient from the different studies were summarized for each assessment method with mean and range.

Results

Selection of Studies

The study selection process was presented in the PRISMA flow diagram in Figure 1. Initially, a total of 3222 records were identified after duplicate records had been removed. After the title and abstract screening, 75 articles were selected for full text screening. Among these, 46 articles were excluded because no full-text was available (n = 4), no information on reliability of the assessment method was provided (n = 33), Primary ABG or Tertiary ABG was performed (n = 4), different study design was used (n = 2), or the follow-up period was less than 3 months (n = 3; Figure 1). Finally, 29 articles were eligible for inclusion in the study.

Figure 1.

PRISMA (preferred reporting items for systematic reviews and meta-analyses) flow diagram.

Study Characteristics

A summary of the included studies is presented in Tables 1 and 2. The dates of publication ranged from 1997 to 2023. The 29 included studies had a follow-up time ranging from 3 months to 6 years postoperatively. The total number of participants per included study varied between 10 and 618 patients. The included studies identified 20 different scoring scales among various non-radiographic, 2D and 3D radiographic assessment methods.

Table 1.

Characteristics of Included Studies.

Reference	Study design	Number of patients	Type of cleft: number of clefts	Type of graft material	Follow-up	Scoring system	Assessment method
Chen et al.¹³	Retrospective study	40	UCLP	Group A: IC; Group B: IC combined with PRP	6	CAE software	HCT
Chen et al.¹⁴	Retrospective study	40	UCLP: 33; BCLP: 7	IC	6-24 m	Bone mineral density (BMD) measurement	CBCT
Dobbyn et al.¹⁵	Retrospective study	90	Mixture of UCLP, BCLP	NS	6 m (3-12 m)	Kindelan	OR
Felstead et al.¹⁶	Retrospective study	53	UCLP: 46; BCLP: 7	Proximal tibia	6-9 m	Kindelan	OR; PAR
Feng et al.¹⁷	Retrospective study	18	UCLP	IC	1 y	New method	CBCT
Fowler et al.¹⁸	Retrospective study	53	UCLP: 48; BCLP: 5	IC	>3 m	VAS	OPG; IOR
Fowler et al.¹⁸	Retrospective study	53	UCLP: 48; BCLP: 5	IC	>3 m	Kindelan	OPG; IOR
Janssen et al.¹⁹	Retrospective study	11	UCL(P)	MS	1 y	Preoperative CBCT superimposed on postoperative CBCT	CBCT
Keribin et al.²⁰	Retrospective study	101	UCLP: 51; BCLP:30; UCLA: 18; BCLA: 2	IC	3 y	Bergland	PAR
						Kindelan
						SWAG
Kindelan et al.²¹	Retrospective study	38	UCLP: 28; BLCP: 10	IC	4 m (1-11 m)	Kindelan	PAR
Kindelan et al.²²	Retrospective study	109	UCLP: 83; BCLP: 26	IC	>3 m	Kindelan	OR; OPG
Linderup et al.²³	Retrospective study	10	UCLP	MS	1 y	Cephalometric landmarks	CBCT
Liu et al.²⁴	Retrospective study	14	UCLA	IC	1 y	CAE	CT
Lonic et al.²⁵	Retrospective study	74	UCLP	Group 1: IC + Scarpa fascia; Group 2: IC	>1 y	Bergland scale	OR
Lonic et al.²⁵	Retrospective study	74	UCLP	Group 1: IC + Scarpa fascia; Group 2: IC	>1 y	Witherow derived scale	OR
McIntyre et al.²⁶	Retrospective study	115	UCL(P): 80; BCL(P): 35	IC	>3 m	Kindelan	OR
Mikoya et al.²⁷	Prospective study	42	UCLA: 9; UCLP: 27; BCLP: 6	MS + MB	6 m	Chelsea, eruption stage	PAR
Nagashima et al.²⁸	Controlled clinical trial	29	UCLA: 10; UCLP: 19	IC	6 m	CAE	MDCT
Oberoi et al.²⁹	Prospective study	21	UCLP: 17; BCLP: 4	IC	1 y	CAE	CBCT
Oh et al.³⁰	Retrospective study	40	UCLA	IC	≥4 m	Bergland scale	CT
Padwa et al.³¹	Retrospective case series	618	UCL(P): 453; BCL(P): 165	IC	>4 m (median: 9.7 m)	Ordinal scale (1-4)	CBCT
Resende Leal et al.³²	Retrospective study	28	BCLP	rhBMP-2G: 14; IC: 14	1 y	Modified Bergland scale	PAR; OR
Resende Leal et al.³²	Retrospective study	28	BCLP	rhBMP-2G: 14; IC: 14	1 y	SWAG	PAR; OR
Ruppel et al.³³	Retrospective study	78	Center 1:UCLP: 43; Center 2: UCLP:31; BCLP: 4	IC	6 y	SWAG	PAR; OR
Russell et al.³⁴	Retrospective study	152	UCLP: 144; BCLP 8	NS	3-18 m	SWAG	OR
Shaheen et al.³⁵	Prospective study	10	UCLP	NS	6 m	New method	CBCT
Stoop et al.³⁶	Retrospective study	12	UCLP	IC	12 m	New method	CBCT
Suomalainen et al.³⁷	Retrospective study	35	UCLP	IC	6.3 m	New method	CBCT
Toscano et al.³⁸	Retrospective study	49	UCLP: 45; BCLP: 4	IC	>1 y	Bergland scale	OR
Toscano et al.³⁸	Retrospective study	49	UCLP: 45; BCLP: 4	IC	>1 y	Witherow derived scale	OR
Wangsrimongkol et al.³⁹	Retrospective study	37	UCLP: 28; BCLP: 9	NS	6-9 m	Probing depth	NRM; OR
						Residual defects at alveolar bone graft site
						Bergland scale
						Chelsea scale
Wangsrimongkol et al.⁴⁰	Retrospective study	20	UCLP: 14; BCLP: 6	NS	3-6 m	New method	CBCT
Witherow et al.⁴¹	Retrospective study (80%), Prospective study 10%	66	UCLP: 62; BCLP: 4	IC	6 m	Witherow derived scale	OR

Note. ; = and; NS = not stated; UCLP = unilateral cleft lip and palate; UCL(P) = unilateral cleft lip and/or palate; UCLA = unilateral cleft lip and alveolus; BCLA = bilateral cleft lip and alveolus; BCLP = bilateral cleft lip and palate; BCL(P) = bilateral cleft lip and/or palate; IC = iliac crest; CCB = calvarial cancellous bone; MS = mandibular symphysis; MB = mandibular body; IOR = intra-oral radiographs; PAR = periapical radiographs; NRM = non-radiographic method; OR = occlusal radiographs; MDCT = multi-detector row computed tomography; CBCT = cone beam computed tomography; ACT = axial computed tomography; HCT = helical computed tomography; OPG = orthopantogram; CAE = computer-aided engineering software.

Table 2.

Information on Reliability of the Used Methods in the Included Studies.

Reference	Information on reliability
Chen et al.¹³	Preoperative alveolar defect volume (DV) and postoperative formed bone volume (FV) calculated by Computer-Aided Engineering software (CAE) using pre and postsurgical CT data
	The high intraclass correlation coefficient (99.3% and 97.4%), with significance level < 0.01, represented the minimum intra-observer errors in the volumetric evaluations of DV and FV. The study presents a fast and accurate method for assessing the effect of PRP in alveolar grafting.
Chen et al.¹⁴	Three CBCT evaluation methods for bone mineral density (BMD) measurements of alveolar defect
	Method A: circular zone located 1 mm from adjacent teeth, interrater reliability: 0.997
	Method B: largest circular zone that exactly transects the two adjacent teeth or is tangent tot the surrounding cortical bone, interrater reliability: 0.999
	Method C: circle drawn with a diameter of 2 mm, interrater reliability: 0.996
	The correlation among all three methods was high (ICCs > 0.99), indicating that all three measurement methods can be applied in clinical settings.
Dobbyn et al.¹⁵	Intra-examiner agreement using one postoperative occlusal radiograph: 0.77 (0.71-0.82)
	Inter-examiner agreement using one postoperative occlusal radiograph: 0.64 (0.60-0.67)
	Intra-examiner agreement using two occlusal radiographs (pre-/postoperative): 0.65 (0.63-0.67)
	Inter-examiner agreement using two occlusal radiographs (pre-/postoperative): 0.57 (0.53-0.61)
	Kindelan score
	Intra-examiner agreement: 0.61-0.83
	Inter-examiner agreement: 0.60-0.66
	Intra-examiner agreement ranged from good to very good using one or two radiographs, and inter-examiner agreement ranged from moderate to good for both systems. Reliability when scoring with either one or two radiographs, was similar, and ranged from good to very good.
Felstead et al.¹⁶	Reliability Kindelan score based on periapical radiographs and occlusal radiographs
	Intra-rater agreement Kappa statistics mean: 0.56 (0.33-0.90)
	Inter-rater agreement Kappa statistic mean: 0.44 (0.34-0.53)
	These demonstrate moderate to very good levels of agreement. Kindelan assessment provides a reliable method of early assessment for alveolar bone grafting. Both periapical radiographs and occlusal radiographs were used, but not compared.
Feng et al.¹⁷	Kappa statistics volumetric assessment based on CBCT
	Intra-observer reproducibility: r ≥ .953
	inter-observer reproducibility: r ≥ .859
	These results demonstrated intra-and inter-observer reproducibility was good for volume calculation with this method. This method was practical and valuable for quantitatively assessment of alveolar bone grafting.
Fowler et al.¹⁸	Kappa statistics based on intra-oral radiographs and OPG
	Kindelan intra-rater scoring median: 0.46 range −0.22 to 0.79 (moderate agreement)
	Kindelan inter-rater median: 0.25 (fair agreement)
	VAS intra-rater median: 0.89 (range 0.62-0.98), almost perfect agreement
	VAS inter-rater median: 0.49, moderate agreement
	The use of a visual analog scale (VAS) produced better intra- and inter-examiner reliability than the categorical Kindelan Index and was more consistent despite the level of clinical experience.
Janssen et al.¹⁹	Postoperative alveolar bone volume assessment based on CBCT
	The ICC between the measured volumes of the observers was 0.98 (95% confidence interval 0.91-0.99).
	Dice coefficient: 0.89 (SD 0.03)
	This study showed that even when a semi-automated segmentation protocol is used, accurate assessment of postoperative alveolar bone volume on CBCT images in a reproducible manner is difficult.
Keribin et al.²⁰	Kappa statistics based on periapical radiographs
	Intra-rater reliability Bergland weighted Kappa: 0.92, very good
	Intra-rater reliability Kindelan weighted Kappa: 0.84, very good
	Intra-rater reliability SWAG weighted Kappa: 0.77, good
	The high intra-rater reliability obtained is reassuring in terms of credibility of the results.
Kindelan et al.²¹	The four-point radiographic assessment scale reliability based on periapical radiographs
	Inter-examiner weighted kappa: 0.33-0.42 (fair to moderate agreement)
	Intra-examiner: 0.59-0.72 (moderate to substantial agreement)
Kindelan et al.²²	The four-point radiographic assessment scale reliability based on OPG and occlusal radiographs
	Inter-examiner weighted kappa = 0.622-0.715
	Intra-examiner = 0.818-0.943.
	The four-point radiographic scale described demonstrates substantial inter-examiner agreement and almost perfect intra-examiner agreement as assessed by the weighted kappa statistic. Both OPG and occlusal radiographs were used, but not compared.
Linderup et al.²³	Volumetric assessment based on CBCT
Linderup et al.²³	Intra- and inter-observer reproducibility was excellent for volumes and bone fill as no statistically significant difference (P < .001) was seen between the different sets of measurements, and Pearson correlation coefficients were large (intra-observer: r > .9849, inter-observer: r > .8784). Volume determination using CBCT is a reproducible and practical method for assessing the volumetric outcome of secondary alveolar bone grafting in patients with UCLP.
Liu et al.²⁴	Volumetric assessment based on CT
	Interobserver correlation coefficient: 0.923 (almost perfect agreement)
	Intra-observer mean: 0.94 (0.939-0.948), P < .001 (almost perfect agreement)
	A Computer-Aided Engineering method for calculating the bone formation ratio is clinically practical, provides accurate measurement, and has good reproducibility for evaluating the outcomes of alveolar cleft reconstruction.
Lonic et al.²⁵	Kappa values based on occlusal radiographs
	Intra-rater reliability Bergland scale kappa: 0.890, P < .001
	Intra-rater reliability Witherow scale kappa: 0.905, P < .001
	The Spearman correlation between Bergland and Witherow scales: 0.964, P < .001
McIntyre et al.²⁶	Kappa values based on occlusal radiographs
	Intra-observer reliability Kindelan: 0.93-0.97 (almost perfect agreement)
	Inter-observer reliability Kindelan: 0.83-0.85 (almost perfect agreement)
Mikoya et al.²⁷	Eruption stage
	Intra-observer agreement eruption stage: 0.84 (0.66-0.95)
	Inter-observer agreement eruption stage: 0.71 (0.62-0.89)
	25 successful canine eruptions of the 27 clefts (92.6%)
	Kappa values based on periapical radiographs
	Intra-observer agreement Chelsea scale: 0.84 (0.82-0.90)
	Inter-observer agreement Chelsea scale: 0.75 (0.65-0.88)
	Chelsea scale demonstrates success in 83.3% of cases
	All kappa values indicated substantial to good agreement.
Nagashima et al.²⁸	3D reconstruction of bone grafts using Computer-Aided Engineering (CAE) based on MDCT provides a valuable objective assessment of graft volume. Operators did not participate in the evaluation system using CAE, and thus excellent consistency was obtained with this method. Compared with previous evaluation methods, the evaluation method using CAE appears to be the most reliable.
Oberoi et al.²⁹	Volume rendering based on CBCT
Oberoi et al.²⁹	There was good agreement between the two raters and within a single rater with Lin’s concordance and Pearson correlation coefficient of above 0.9 for both. Volume rendering using CBCT and Amira software is a reproducible and practical method to assess outcome of secondary alveolar bone grafting.
Oh et al.³⁰	Kappa values simulation software based on CT
	Intra-observer variabilities: 0.915
	Inter-observer variabilities: 0.758
	Measurement of an alveolar bone defect using a simulation program based on 3D CT is reliable and reproducible.
Padwa et al.³¹	Kappa values postoperative vertical bone height of cleft-adjacent teeth, labiopalatal bone thickness and nasal piriform symmetry from CBCT
	Intra-rater agreement mean: 0.972-0.998
	Inter-rater agreement mean: 0.866-0.896
	There was good-to-excellent intra-rater and inter-rater agreement for measurements with ICC ≥ 0.95. Inter-rater and intra-rater analyses showed that this is a reliable and valid assessment tool.
Resende Leal et al.³²	Kappa values modified Bergland scale and SWAG scale based on periapical radiographs and occlusal radiographs
	Intra-examiner reliability: 0.55-0.71 (moderate to strong agreement)
	Inter-examiner reliability: 0.51-0.94 (moderate to excellent agreement)
	Agreement between scales was also almost perfect (agreement rate = 96.4%; K = 0.85).
Ruppel et al.³³	Kappa values SWAG scale based on periapical radiographs and occlusal radiographs
	Mean intra-rater agreement: 0.790 and 0.805
	Mean inter-rater agreement: 0.701 and 0.713
	All of these kappa averages fall in the good to very good range. The Americleft Project’s SWAG scale appears to be a valid and reliable method of assessing groups of alveolar bone graft outcomes. Both periapical radiographs and occlusal radiographs were used, but not compared.
Russell et al.³⁴	Kappa values SWAG scale based on occlusal radiographs
	Mean intra-rater kappa: 0.760 (good agreement)
	Inter-rater range kappa: 0.468-0.718 (moderate to good agreement)
	The SWAG scale presented here that uses routinely taken clinical records evaluated by simple visual inspection has been shown to be a feasible and reliable valid method to rate ABG outcomes and to provide additional details of graft site morphology when compared with previously published methods. The SWAG method was validated for ABG assessments in mixed and permanent dentitions.
Shaheen et al.³⁵	This study assessed the final bone grafted region (FBGR) and bone graft after resorption (BGAR) based on CBCT scans. The ICC indicated excellent reliability for both inter-and intra-observer tests and for both steps ≥ 0.95. The presented method proved to be reliable for the volumetric assessment of the alveolar bone graft in patients with UCLP
Stoop et al.³⁶	Interobserver reliability of the segmentation of the cleft was assessed by calculating the dice-coefficient between the segmentations of the clefts based on the preoperative CBCT scan. The dice-coefficient was 0.81. This study demonstrates a reliable and practical semi-automatic 3-dimensional volumetric assessment method for unilateral clefts using CBCT.
Suomalainen et al.³⁷	Kappa values vertical bone support, horizontal bone support and nasal floor assessment based on CBCT
	Inter-examiner agreement: 0.53-0.96
	Intra-examiner agreement: 0.82-0.96
	The kappa values indicated excellent agreement except for the inter-examiner horizontal bone support measurements in the middle third of the root, which indicated fair agreement.
Toscano et al.³⁸	Intra-examiner variability by calculating the Kendall coefficient based on occlusal radiographs
	Bergland scale and Witherow derived values: 0.98 (0 < Kendall W < 1; high degree of repeatability).
	Interexaminer variability by the Kendall coefficient of concordance for the 3 series of values
	Bergland scale and Witherow derived values: 0.99 (0 < Kendall W < 1; high degree of reproducibility).
	Spontaneous canine eruption at T2 (at least 1 y after bone grafting) was not significantly associated with cleft severity at T0 (before bone grafting). The concordance rate between the Bergland and the Witherow-derived scales was 87.07% (95% CL, 82.69-90.69), indicating that this is a simple and reliable 2-dimensional method for assessing the success of bone grafts as a useful clinical and experimental too.
Wangsrimongkol et al.³⁹	Reliability of the radiographic assessments based on occlusal radiographs
	Intra-examiner Bergland scale and Chelsea scale: 0.88-1.00 (very good agreement).
	Inter-examiner Bergland scale and Chelsea scale: 0.85-1.00 (very good agreement).
	Reliability of the non-radiographic assessments
	Intra-examiner: 0.85-1.00 (very good agreement).
	Inter-examiner: 0.84-1.00 (very good agreement).
	Visual inspection and pocket depth probing are easy to use and produced good agreement with the commonly used Bergland and Chelsea radiographic methods for the assessment of the quality of alveolar cleft bone grafting. Thus, it provides an acceptable method without the need of radiographic confirmation of bone graft quality at least for cases that will be followed with orthodontic space closure at the graft site.
Wangsrimongkol et al.⁴⁰	Reliability alveolar bone graft outcomes based on CBCT (Kappa value at 95% confidence interval)
	Mean intra-examiner: 0.88 (0.53-1.00; very good agreement).
	Mean inter-examiner: 0.78 (0.60-0.85; very good agreement).
	The presently tested CBCT method of scoring alveolar bone graft outcomes produced good agreement among four clinical assessors and offers potential benefit for both patients and clinician to evaluate the success of alveolar bone graft.
Witherow et al.⁴¹	Kappa statistics alveolar bone graft 8-point matrix scores based on occlusal radiographs
	Intra-observer agreement: 0.47-0.90
	Inter-observeragreement: 0.53-1.0
	Kappa statistics alveolar bone graft 6-letter scale based on occlusal radiographs
	Intra-observer agreement: 0.81 (0.69-0.92)
	Inter-observeragreement: 0.80 (0.64-0.95)
	A new scale is presented, which is easy to use and differentiates the position of the bone radiologically within the alveolar cleft.

Non-radiographic Assessments

In 1 included study a non-radiographic assessment method was used to evaluate SABG.³⁹ Wangsrimongkol et al. evaluated probing depth of the teeth adjacent to the cleft (ICC in both mesial and distal teeth ranging from 0.88 to 1.00) and a visual inspection of residual defects at the alveolar bone graft site (ICC ranging 0.89-1.00) as non-radiographic methods for assessing the SABG results 6 to 9 months post SABG.³⁹

Radiographic Assessments

In 15 of the included studies, 2D radiography was used to evaluate the outcome of SABG. They obtained occlusal radiographs (OR), periapical radiographs (PAR), orthopantomograms (OPG), or no further specified intra-oral radiographs (IOR). Seven different scoring scales plus 2 modifications were used within the 2D radiographic assessment methods. The inter and intra reliability of the scales are presented in Table 2. In descending order of mean inter rater reliability the Bergland scale,^20,25,38,39 the Chelsea scale,^27,39 the Witherow-derived scale,^25,38,41 the eruption stage scale,²⁷ the Standardized Way to Assess Grafts (SWAG) scale,^20,32-34 the modified Bergland scale,³² the Kindelan scale,^{15,16,18,20-22,26} and the Visual Analog Scale (VAS)¹⁸ were described in the included studies. For the Bergland scale a mean inter- rater reliability of Κ = 0.93 (range: 0.86-1.00) and mean intra-rater reliability of Κ = 0.91 (range: 0.89-0.92)^20,25,38,39 was reported. Of the VAS scale an inter- rater reliability of Κ = 0.49 and intra-rater reliability of Κ = 0.89¹⁸ was reported. In Table 3 the scoring scales applied to 2D radiographs are outlined.

Table 3.

Short Description of Scoring Scales Applied to 2D Radiographs.

Scoring scale	Short description
Bergland^a	A four-point scale to compare the interdental height (vertical bone level) of the bone graft with the unaffected side and categorized from grade I to IV. The permanent canine adjacent to the cleft must be erupted.
	Grade I—Bone septum of approximate normal height, up to the cementoenamel junction
	Grade II—Septum height at least 3/4 of normal height
	Grade III—Septum height less than 3/4 of the normal height
	Grade IV—No continuous bony bridge across the cleft
Chelsea	To evaluate the success rate of the bone graft, the position of the bone tissue in relation to the teeth adjacent to the cleft was analyzed by separating the radiographic images into 6 categories: type A: the presence of bone tissue at the cementoenamel junction of the teeth adjacent to the cleft and at least 75% of both roots covered by bone; type B: the presence of bone tissue at the cementoenamel junction of the teeth adjacent to the cleft and at least 25% of both roots covered by bone; type C: the presence of bone tissue surrounding at least 75% of the roots in the cleft area with an apical direction; type D: the presence of bone tissue surrounding at least 50% of both roots in the cleft area with an apical to coronal direction; type E: the presence of bone tissue bridge in an area of the cleft, except in the apical and coronal directions; type F: the presence of 25% or less of bone tissue in both roots in the apical direction.
Eruption stage	To categorize the eruption stage of the tooth adjacent to the cleft into (1) no movement; (2) movement located at the superior border of the graft; (3) movement in the midgraft; (4) movement through the inferior border of the graft; and (5) tooth clinically erupted into the oral cavity.
Kindelan	A 4-point scale that measures the degree of bony filling in the cleft area when compared to its initial bone graft site. Grade I (more than 75% bony filling), grade II (50%-75% bony filling), grade III (less than 50% bony filling), grade IV (no complete bony bridge).
VAS	Assessment using a 100 mm visual analog scale (VAS) with the left extreme representing the worst graft outcome (0 mm) and the right extreme representing the best graft outcome (100 mm).
SWAG	The SWAG scale assigns a score from 0 to 6 to a grafted cleft site in which 0 represents a failed graft with a poor regraft prognosis and 6 represents a completely bone-filled cleft site with clinically normal alveolar bone height. The scale visually divides the cleft into apical, middle, and coronal thirds, and each third is rated.
Witherow	An 8-point scale to describe horizontal bone level of bone graft after secondary alveolar grafting in relation to the cleft roots. The cleft is bisected vertically by an imaginary line and the roots of the teeth adjacent to the cleft are divided into four. Each of the root quarters is allocated a score: 0 when no bone is present from the root surface to the midline of the cleft, 0.5 if some bone is present but fails to reach the midline, and 1 if bone extends from the root surface to midline.

VAS = Visual Analog Scale, SWAG = standardized way to assess grafts.

The scoring scale is also used in included studies on 3D radiographs.

In 14 of the included studies, 3D radiography was used. Of these, the majority used CBCT (n = 10)^{14,17,19,23,29,31,35-37,40} and 4 studies used CT.^13,24,28,30 To assess the SABG outcome on CT, Chen et al. used Computer Aided Engineering (CAE) with high reliability (ICC = 0.98).¹³ Nagashima et al.²⁸ stated the operators did not participate in the evaluation due to using CAE, still excellent consistency was obtained with this method. Also, Liu et al.²⁴ found an ICC = 0.94 between the observers and an ICC = 0.92 for test-retest of the CAE scoring scale. Oh et al.³⁰ used the Bergland score to assess SAGB outcomes on CT with inter-rater reliability Κ = 0.76 and intra-rater reliability Κ = 0.92.

For CBCT, 10 scoring scales were described to assess SABG outcome. Chen et al.¹⁴ reported a high correlation of 3 methods of Bone Mineral Density (BMD) measurement by the same scorer with ICC > .99. Janssen et al.¹⁹ used a superimposition technique revealing an ICC between observers of 0.98 and a dice coefficient of 0.89. Linderup et al.²³ examined cephalometric landmarks based on CBCT and discovered strong correlation coefficients (inter-observer: r > .88, intra-observer: r > .98). Padwa et al.³¹ evaluated SABG outcomes using an ordinal scale based on CBCT with an inter- Κ = 0.87 and intra-rater reliability Κ = 0.98. Oberoi et al.²⁹ performed CAE on CBCT with an inter- rater reliability Κ = 0.97 and intra-rater reliability Κ = 0.98. The following authors did research on new CBCT assessment methods evaluating SABG with reliability ranging from fair to excellent: Wangsrimongkol et al.⁴⁰ (mean inter-rater reliability Κ = 0.78 (range: 0.60-0.85) and a mean intra-rater reliability Κ = 0.88 (range: 0.53-1.00)), Feng et al.¹⁷ (intra-observer reproducibility: r > .953, inter-observer reproducibility: r > .859), Shaheen et al.³⁵ (inter-and intra-observer tests ≥ 0.95), Stoop et al.³⁶ (dice-coefficient = 0.81), and Suomalainen et al.³⁷ (inter-examiner agreement: 0.53-0.96, intra-examiner agreement: 0.82-0.96).

Discussion

In this scoping review 29 studies were analyzed to provide an overview of the available methods for evaluating the outcome of SABG in patients with CL/P from a clinician point of view. Additionally, information on reliability was provided. The 3D assessment method was most consistent between examiners, but it has his drawbacks. The higher costs, increased radiation exposure, the need to have either a medical CT or CBCT scanning device, and the need for specialized training and expertise to handle the device and interpret the scans make this method less accessible and potentially even harmful for the patient. As for the higher radiation levels, the European guidelines on CBCT state that the radiation dose from a single CBCT scan is equivalent to 3 to 30 times the dose from an OPG.⁴² Further, the costs for a CBCT examination are approximately 4 times the costs for panoramic imaging.⁴³ The radiation and price ratio’s can vary depending on the specific machine used, the settings, and the area being scanned.⁴⁴ For 3D evaluations, the included studies used several scoring scales to calculate volume. Although the scoring scales differed, the majority was digitalized, which explains the high reliability compared to the non-automated non-radiographic and 2D radiographic assessments. BMD is calculated with the highest reliability, suggesting this is the most reliable technique for evaluation after SABG.¹⁴

The least described assessment method in the included studies is the non-radiographic assessment of SABG. The downside of the non-radiographic assessment, is that it seems less accurate and more subjective. However, it is the least invasive technique, due to low costs, easy accessibility and no potential negative side-effects and reliability scores are still notable. Wangsrimongkol et al.³⁹ found that both probing depth as visual inspection correlated well with the Bergland method and Chelsea method on 2D radiographs. They suggest that the non-radiographic evaluation can be a viable alternative, reducing the need for radiographic confirmation.

Most frequently used in the included studies were the 2D radiographic assessment methods. For 2D radiographic assessments, the primary limitations are their inability to provide depth information and the potential for distortion and overlapping of anatomical structures, compared to 3D radiographs. Moreover, the performance of 2D radiograph to assess the SABG outcomes on the long term, also depends on the scoring scale applied to the images. The Bergland and the Kindelan scale were most frequently used, but the Bergland resulted in higher inter- and intra-rater reliability than the Kindelan. With this finding, the Bergland scale is suggested to be a valuable, accessible, and cost-effective scoring scale for evaluating SABG outcomes. However, the Bergland scale does have its shortcomings, it is only applicable when the permanent canine has fully erupted, making earlier evaluations unfeasible. Further, the Bergland scale cannot evaluate vertical bone loss or the lack of bone in the cleft’s most apical region.⁴⁵ Consequently, cases with an apical bone defect but normal interdental bone height could be incorrectly judged as successful.

Seven included studies combined different assessment methods and/or scoring scales within their resea-rch.^{18,20,25,27,32,38,39} These comparisons generally did not result in conflicting evaluations of SABG outcomes, nor was there consensus on 1 method being superior to another.

Limitations

A scoping review is a suitable research technique for providing an overview, however there are some limitations to consider in the current study. Within the 2D radiographic assessment group, several types of 2D radiographs were available: occlusal, peri-apical or OPG, but this was often not exactly described and never actually compared, making it impossible to provide conclusions on a preference for a specific type of 2D radiograph. Then, a follow-up period of at least 3 months was chosen in the inclusion criteria, but the actual length of follow-up was not further evaluated in the current study. Feichtinger et al.⁴⁶ observed that 1 year after SABG the volume of the bone might be enlarged due to the eruption of the lateral incisor or canine. This implies that evaluating SABG before eruption of the teeth adjacent to the cleft might be too soon for certain assessment methods and/or scoring scales and may lead to false indications for additional surgeries. Feichtinger indicated that the best time for postoperative assessment is still uncertain.⁴⁶ Finally, the included studies only provided reliability scores regarding the raters that used the assessment methods, validity of methods to assess success of SAGB has not been described yet, most likely because there is no consensus about when SAGB can be considered successful. However, inter and intra-rater reliabilities are indeed important for a set like ICHOMSCS, as a long-term assessment method after SABG needs to be applicable on many different places worldwide and a high reliability also indicates that a method might be simple to be adopted.

Future Research

Though the goals of SABG seem to be clear, no strict requirements are available that define when these goals are successfully accomplished. Moreover, the criteria for defining the success of SABG have not yet been consistently established. Future research is required to define success of SABG, for example via a DELPHI study. Only then, validation of the several long-term assessment methods is possible. Future research should also be done on evaluating and comparing the different assessment methods and scoring scales on costs effectiveness, patient burden, accuracy and accessibility worldwide, which will require high quality longitudinal research. Finally, future research should be done on ideal timing of SABG evaluation.

Interpretations

The current scoping review showed that the 3D radiographic automated assessment method for the evaluation of SABG of patients with CL/P is most reliable. However, in our opinion, 3D radiographs should only be considered in difficult cases as costs are higher, radiation load is higher and accessibility is lower. Further, we think that 2D radiographs are indispensable during the treatment process. However, the non-radiographic assessment method, with a visual inspection and probing depth of the teeth adjacent to the cleft, appears to address the primary objectives of SABG with the smallest burden, highest accessibility, has still notable reliability and might be verysuitable for long-term evaluation purposes in ICHOMSCS. We could imagine a yes/no checklist that is filled out by a clinician in the final phase of ICHOMSCS, at the end of the complete cleft treatment around age 20. The checklist should at least consider canine eruption, periodontal health and fistula within the dental arch.

Conclusions

The ABG addresses a variety of goals; oronasal fistula closure, a continuous and stable dental arch, a bone environment that facilitates eruption and orthodontic movement of permanent teeth adjacent to the cleft, an increased bone attachment to the teeth adjacent to the cleft, and eventually it supports, in combination with orthodontic treatment, to facial symmetry, dental rehabilitation and prosthodontic reconstruction.^2,3 Within this list of diverse goals, it remains difficult to strictly define success of SABG. However, to assess the long-term outcome of SABG in ICHOMSCS these goals should be taken into consideration. There is a wide variety of available assessment methods and scoring scales provided in the current scoping review, none of them obtained low scores on reliability. But unfortunately, none of the provided assessment methods seems to be able to evaluate all goals in 1 method. Future research is necessary to determine a suitable assessment method and timing for long-term clinician reported evaluation of SABG in ICHOMSCS.

Supplemental Material

sj-docx-1-fac-10.1177_27325016251338530 – Supplemental material for A Scoping Review on Long-Term Assessment Methods After Secondary Alveolar Bone Grafting of Patients with Cleft, Lip and/or Palate

Supplemental material, sj-docx-1-fac-10.1177_27325016251338530 for A Scoping Review on Long-Term Assessment Methods After Secondary Alveolar Bone Grafting of Patients with Cleft, Lip and/or Palate by Laura S. van der Knaap-Kind, Nicoline C.W. van der Kaaij, Anne E. Verkolf, Eppo B. Wolvius and Lea Kragt in FACE

Footnotes

Acknowledgements

We thank Wichor Bramer and Christa Niehot, information specialists from the Erasmus MC Medical Library, for developing and updating the search strategies.

Data Availability Statement

All data is accessible upon request.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical Approval

Institutional Review Board approval was not required.

Informed Consent

Informed consent was not required.

ORCID iD

Laura S. van der Knaap-Kind

Supplemental Material

Supplemental material for this article is available online.

References

ICHOM. Value Based Healthcare, Improving Patient Outcomes. ICHOM;2022. https://www.ichom.org/

Abyholm

Bergland

Semb

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(2):127-140. doi:10.3109/02844318109103425

Newlands

LC.

Secondary alveolar bone grafting in cleft lip and palate patients. Br J Oral Maxillofac Surg. 2000;38(5):488-491. doi:10.1054/bjom.2000.0300

Dissaux

Ruffenach

Bruant-Rodier

George

Bodin

Rémond

Cleft alveolar bone graft materials: literature review. Cleft Palate Craniofac J. 2021;59(3):336-346. doi:10.1177/10556656211007692

Boyne

Sands

NR.

Combined orthodontic-surgical management of residual palato-alveolar cleft defects. Am J Orthod. 1976;70(1):20-37. doi:10.1016/0002-9416(76)90258-x

Kim

Jeong

Secondary bone grafting for alveolar clefts: surgical timing, graft materials, and evaluation methods. Arch Craniofac Surg. 2022;23(2):53-58. doi:10.7181/acfs.2022.00115

Dempf

Teltzrow

Kramer

Hausamen

JE.

Alveolar bone grafting in patients with complete clefts: a comparative study between secondary and tertiary bone grafting. Cleft Palate Craniofac J. 2002;39(1):18-25. doi:10.1597/1545-1569_2002_039_0018_abgipw_2.0.co_2

Koberg

WR.

Present view on bone grafting in cleft palate (a review of the literature). J Maxillofac Surg. 1973;1:185-193. doi:10.1016/s0301-0503(73)80039-6

Fahradyan

Tsuha

Wolfswinkel

Mitchell

Hammoudeh

Magee

3rd . Optimal timing of secondary alveolar bone grafting: a literature review. J Maxillofac Oral Surg. 2019;77(4):843-849. doi:10.1016/j.joms.2018.11.019

10.

Tricco

Lillie

Zarin

, et al PRISMA extension for scoping reviews (PRISMA-SCR): checklist and explanation. Ann Intern Med. 2018;169(7):467-473. doi:10.7326/m18-0850

11.

Peters

MDJ

Marnie

Tricco

, et al Updated methodological guidance for the conduct of scoping reviews. JBI Evidence Synthesis. 2020;18(10):2119-2126. doi:10.11124/jbies-20-00167

12.

Rayyan Systems. Rayyan - AI Powered Tool for Systematic Literature Reviews. Rayyan. 2023. https://www.rayyan.ai/

13.

Chen

Liu

Yin

Wang

Assessment of bone formation after secondary alveolar bone grafting with and without platelet-rich plasma using computer-aided engineering techniques. J Craniofac Surg. 2020;31(2):549-552. doi:10.1097/scs.0000000000006256

14.

Chen

Lin

Pai

Tseng

Chou

PY.

Progressive comparison of density assessment of alveolar bone graft in patients with unilateral and bilateral cleft. J Clin Med. 2021;10(21):5143. doi:10.3390/jcm10215143

15.

Dobbyn

Gillgrass

Devlin

MF.

Reliability of the Kindelan scoring system for alveolar bone grafting with and without a pre-graft occlusal radiograph in patients with cleft lip and palate. Br J Oral Maxillofac Surg. 2012;50(7):617-620. doi:10.1016/j.bjoms.2011.10.007

16.

Felstead

Deacon

Revington

PJ.

The outcome for secondary alveolar bone grafting in the South West UK region Post-CSAG. Cleft Palate Craniofac J. 2010;47(4):359-362. doi:10.1597/09-052.1

17.

Feng

Jiang

A new method of volumetric assessment of alveolar bone grafting for cleft patients using cone beam computed tomography. J Oral Med Oral Surg Oral Pathol Oral Radiol. 2017;124(2):e171-e182. doi:10.1016/j.oooo.2017.04.003

18.

Fowler

Al-Ani

Thompson

JMD

. Comparison of reliability of categorical and continuous scales for radiographic assessments of bone infill following secondary alveolar bone grafting. Cleft Palate Craniofac J. 2017;55:269-275. doi:10.1177/1055665617723922

19.

Janssen

Schreurs

Bittermann

GKP

, et al A novel semi-automatic segmentation protocol for volumetric assessment of alveolar cleft grafting procedures. J Craniomaxillofac Surg. 2017;45(5):685-689. doi:10.1016/j.jcms.2017.02.018

20.

Keribin

Nicholls

Walters

Tan

McAlpine

Gillett

A review of 30 years of alveolar bone grafting in the mixed dentition using a standardized protocol in Western Australia. Plast Reconstr Surg. 2020;145(2):391e-400e. doi:10.1097/prs.0000000000006494

21.

Kindelan

Nashed

Bromige

MR.

Radiographic assessment of secondary autogenous alveolar bone grafting in cleft lip and palate patients. Cleft Palate Craniofac J. 1997;34(3):195-198. doi:10.1597/1545-1569_1997_034_0195_raosaa_2.3.co_2

22.

Kindelan

Roberts-Harry

A 5-year post-operative review of secondary alveolar bone grafting in the Yorkshire region. Br J Orthod. 1999;26(3):211-217. doi:10.1093/ortho/26.3.211

23.

Linderup

Küseler

Jensen

Cattaneo

PM.

A novel semiautomatic technique for volumetric assessment of the alveolar bone defect using cone beam computed tomography. Cleft Palate Craniofac J. 2015;52(3):e47-e55. doi:10.1597/13-287

24.

Liu

Chen

Xiao

Wang

YQ.

A novel accurate volumetric analysis protocol for evaluating secondary alveolar cleft reconstruction. J Craniomaxillofac Surg. 2020;48(7):632-637.

25.

Lonic

Yamaguchi

Chien-Jung Pai

LJ.

Reinforcing the mucoperiosteal pocket with the scarpa fascia graft in secondary alveolar bone grafting: A retrospective controlled Outcome Study. Plast Reconstr Surg. 2017;140(4):568e-578e. doi:10.1097/prs.0000000000003696

26.

McIntyre

Devlin

MF.

Secondary alveolar bone grafting (CLEFTSIS) 2000–2004. Cleft Palate Craniofac J. 2010;47(1):66-72. doi:10.1597/08-165.1

27.

Mikoya

Inoue

Matsuzawa

Totsuka

Kajii

Hirosawa

Monocortical mandibular bone grafting for reconstruction of alveolar cleft. Cleft Palate Craniofac J. 2010;47(5):454-468. doi:10.1597/09-172

28.

Nagashima

Sakamoto

Ogata

Miyamoto

Yazawa

Kishi

Evaluation of bone volume after secondary bone grafting in unilateral alveolar cleft using computer-aided engineering. Cleft Palate Craniofac J. 2014;51(6):665-668. doi:10.1597/13-045

29.

Oberoi

Chigurupati

Gill

Hoffman

Vargervik

Volumetric assessment of secondary alveolar bone grafting using cone beam computed tomography. Cleft Palate Craniofac J. 2009;46(5):503-511. doi:10.1597/08-153.1

30.

Park

Choi

Kwon

Koh

KS.

Risk factor analysis of bone resorption following secondary alveolar bone grafting using three-dimensional computed tomography. J Plast Reconstr Aesthet Surg. 2016;69(4):487-492. doi:10.1016/j.bjps.2015.11.002

31.

Padwa

Tio

Garkhail

Nuzzi

LC.

Cone beam computed tomographic analysis demonstrates a 94% radiographic success rate in 783 alveolar bone grafts. J Maxillofac Oral Surg. 2022;80(4):633-640. doi:10.1016/j.joms.2021.12.004

32.

Resende Leal

Rocha

Carvalho

, et al Evaluation of radiographic outcomes of alveolar graft associated with premaxillary osteotomy performed with rhBMP-2. Cleft Palate Craniofac J. 2023;61:1195-1201. doi:10.1177/10556656231160396

33.

Ruppel

Long

Oliver

, et al The AmeriCleft Project: a comparison of short-and longer-term secondary alveolar bone graft outcomes in two centers using the standardized way to assess grafts scale. Cleft Palate Craniofac J. 2016;53(5):508-515. doi:10.1597/15-030

34.

Russell

Long

Jr Daskalogiannakis

, et al Reliability of the SWAG—the standardized way to assess grafts method for alveolar bone grafting in patients with cleft lip and palate. Cleft Palate Craniofac J. 2017;54(6):680-686. doi:10.1597/14-214

35.

Shaheen

Danneels

Doucet

, et al Validation of a 3D methodology for the evaluation and follow-up of secondary alveolar bone grafting in unilateral cleft lip and palate patients. Orthod Craniofac Res. 2021;25(3):377-383. doi:10.1111/ocr.12546

36.

Stoop

Janssen

Ten Harkel

Rosenberg

AJWP

. A novel and practical protocol for three-dimensional assessment of alveolar cleft grafting procedures. Cleft Palate Craniofac J. 2022;60(5):601-607. doi:10.1177/10556656221074210

37.

Suomalainen

Åberg

Rautio

Hurmerinta

Cone beam computed tomography in the assessment of alveolar bone grafting in children with unilateral cleft lip and palate. Eur J Orthod. 2014;36(5):603-611. doi:10.1093/ejo/cjt105

38.

Toscano

Baciliero

Gracco

Siciliani

Long-term stability of alveolar bone grafts in cleft palate patients. Am J Orthod Dentofacial Orthop. 2012;142(3):289-299. doi:10.1016/j.ajodo.2012.04.015

39.

Wangsrimongkol

Manosudprasit

Pirmsinthavee

Comparison of a clinical method with two radiographic methods for assessing quality of alveolar bone grafts. PubMed. 2011;94 Suppl 6:S1-S8.

40.

Wangsrimongkol

Manosudprasit

Pisek

Sutthiprapaporn

Somsuk

Alveolar bone graft evaluation agreement using cone beam computed tomography in cleft lip and palate patients: a pilot study. PubMed. 2013;96 Suppl 4:S36-S43.

41.

Witherow

Cox

Jones

Carr

Waterhouse

A new scale to assess radiographic success of secondary alveolar bone grafts. Cleft Palate Craniofac J. 2002;39(3):255-260. doi:10.1597/1545-1569_2002_039_0255_anstar_2.0.co_2

42.

European Commission, Directorate-General for Energy. Cone Beam CT for Dental and Maxillofacial Radiology: Evidence-Based Guidelines. European Commission; 2023.

43.

Petersen

Olsen

Christensen

Wenzel

Image and surgery-related costs comparing cone beam CT and panoramic imaging before removal of impacted mandibular third molars. Dentomaxillofac Radiol. 2014;43(6):20140001. doi:10.1259/dmfr.20140001

44.

Pauwels

Beinsberger

Collaert

, et al Effective dose range for dental cone beam computed tomography scanners. Eur J Radiol. 2012;81(2):267-271. doi:10.1016/j.ejrad.2010.11.028

45.

Lorenzoni

Janson

Bastos

, et al Evaluation of secondary alveolar bone grafting outcomes performed after canine eruption in complete unilateral cleft lip and palate. Clin Oral Investig. 2016;21(1):267-273. doi:10.1007/s00784-016-1786-3

46.

Feichtinger

Mossböck

Kärcher

Assessment of bone resorption after secondary alveolar bone grafting using three-dimensional computed tomography: a three-year study. Cleft Palate Craniofac J. 2007;44(2):142-148.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.03 MB

A Scoping Review on Long-Term Assessment Methods After Secondary Alveolar Bone Grafting of Patients with Cleft,Lip and/or Palate

Abstract

Keywords

Introduction

Material and Methods

Eligibility Criteria

Information Sources and Search

Selection of Sources of Evidence

Data Charting and Synthesis

Data Analysis

Results

Selection of Studies

Study Characteristics

Non-radiographic Assessments

Radiographic Assessments

Discussion

Limitations

Future Research

Interpretations

Conclusions

Supplemental Material

sj-docx-1-fac-10.1177_27325016251338530 – Supplemental material for A Scoping Review on Long-Term Assessment Methods After Secondary Alveolar Bone Grafting of Patients with Cleft, Lip and/or Palate

Footnotes

Acknowledgements

Data Availability Statement

Declaration of Conflicting Interests

Funding

Ethical Approval

Informed Consent

ORCID iD

Supplemental Material

References

Supplementary Material