Clinical and Radiographic Assessment of Secondary Bone Graft Outcomes in Cleft Lip and Palate Patients

Abstract

Purpose. To compare the results of secondary alveolar bone grafts in patients with complete cleft lip and cleft lip and palate using 2 radiographic scales and according to the rate of canine eruption through the newly formed bone. Materials and Methods. We analyzed pre- and postoperative radiographs of 36 patients for the amount of bone in the cleft site according to the Bergland and Chelsea scales. The associations between the variables and the correlation between the scales were measured. Results. A total of 54.2% and 20.8% of cases were classified as type I and type II, respectively, using the Bergland scale, whereas 50% and 22.5% were classified as types A and C, respectively, using the Chelsea scale. A positive correlation between the 2 scales was observed. In 33.3% of males, 58.3% of females, 54.5% of unilateral cleft cases, and 12.5% of bilateral cleft cases, the permanent canines had erupted. Bone grafts performed prior to canine eruption achieved more satisfactory results. Conclusions. Our results suggest that both radiographic scales are important tools for the evaluation of bone grafts. Additionally, longer time periods of evaluation were associated with improved results for patients with secondary alveolar bone grafts.

Figure 1

Periapical radiographic images of autogenous bone grafts according to the Bergland classification. (a) Type I: 0 to 25% of bone resorption. (b) Type II: 25 to 50% of bone resorption. (c) Type III: 50 to 75% of bone resorption. (d) Type IV: 75 to 100% of bone resorption with no continuous bony bridge through the cleft.

Figure 2

Periapical radiographic images of autogenous bone grafts according to the Chelsea classification. (a) 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. (b) 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. (c) Type C: the presence of bone tissue surrounding at least 75% of the roots in the cleft area with an apical direction. (d) Type D: the presence of bone tissue surrounding at least 50% of both roots in the cleft area, with an apical to coronal direction. (e) Type F: the presence of 25% or less of bone tissue in both roots in the apical direction.