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Randomized Controlled Trial
. 2016 Apr 4:6:23597.
doi: 10.1038/srep23597.

Difference in the Surgical Outcome of Unilateral Cleft Lip and Palate Patients with and without Pre-Alveolar Bone Graft Orthodontic Treatment

Chun-Shin Chang  1   2 , Christopher Glenn Wallace  2 , Yen-Chang Hsiao  2 , Yu-Ting Chiu  2 , Betty Chien-Jung Pai  2 , I-Ju Chen  2 , Yu-Fang Liao  2 , Eric Jen-Wein Liou  2 , Philip Kuo-Ting Chen  2 , Jyh-Ping Chen  1 , M Samuel Noordhoff  2
Affiliations
Randomized Controlled Trial

Difference in the Surgical Outcome of Unilateral Cleft Lip and Palate Patients with and without Pre-Alveolar Bone Graft Orthodontic Treatment

Chun-Shin Chang et al. Sci Rep. .

Abstract

Presurgical orthodontic treatment before secondary alveolar bone grafting (SABG) is widely performed for cleft lip/palate patients. However, no randomized controlled trial has been published comparing SABG outcomes in patients with, and without, presurgical orthodontic treatment. This randomized, prospective, single-blinded trial was conducted between January 2012 and April 2015 to compare ABG volumes 6 months postoperatively between patients with and without presurgical orthodontic treatment. Twenty-four patients were enrolled and randomized and 22 patients completed follow-up. Patients who had presurgical orthodontics before SABG had significantly improved inclination (p < 0.001) and rotation (p < 0.001) of the central incisor adjacent to the defect, significantly improved ABG fill volume (0.81 ± 0.26 cm(3) at 6 months compared to 0.59 ± 0.22 cm(3); p < 0.05) and less residual alveolar bone defect (0.31 ± 0.08 cm(3) at 6 months compared to s 0.55 ± 0.14 cm(3); p < 0.001) compared to patients who did not have presurgical orthodontic treatment. In conclusion, orthodontic treatment combined with SABG results in superior bone volume when compared with conventional SABG alone.

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Figures

Figure 1
Figure 1. Consort statement flow chart.
Figure 2
Figure 2. Left upper first and second: the alveolar bone defect was defined.
The anatomic defect requiring alveolar bone grafting was also confirmed with three dimensional facial CT scans. Left upper third: A superiorly based gingival mucoperiosteal flap was raised to explore the alveolar bone defect. Left upper fourth: the palatal mucoperiosteal flap was raised to a level beyond the deepest margin of the alveolar fistula. Left lower first: the nasal floor tissue was completely closed. The bone graft was packed into the defect area. Left lower second and third: complete closure of gingival and palatal wounds.
Figure 3
Figure 3. Purple: alveolar bone graft formation; Orange: Residual Alveolar Bone Defect.
Figure 4
Figure 4. Central incisor inclination: Inclination of the central incisor was measured in degrees with respect to the vertical line.
Figure 5
Figure 5. Central incisor rotation: Rotation of the central incisor was measured in degrees with respect to the horizontal line.
See this image and copyright information in PMC

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