Cleft Size and Success of Secondary Alveolar Bone Grafting-A Systematic Review

Abstract

Objective: This study aimed to review all research evidence of presurgical cleft size and related factors to success of secondary alveolar bone grafting (SABG).

Design and setting: The systematic review searched the OVID-Medline®, PubMed®, Embase®, and Cochrane Central Register of Controlled Trials (CENTRAL) up to August 2020. Two reviewers independently selected potential abstracts for full review. Disagreeements were resolved by consensus. The first author extracted data and assessed the risk of bias using Risk of Bias in Non-randomized studies-of Interventions tool.

Patients and interventions: Patients with non-syndromic clefts who received SABG were selected. Presurgical cleft size/volume and treatment results must be available.

Main outcome measures: Level of the grafted bone, achievement of orthodontic tooth movement into the grafted area, need for re-operation.

Results: From 962 abstracts, 23 publications were included. Mean cleft width was 6.80 ± 1.98 mm, cleft area 20-240 mm², and mean volume 0.89 ± 0.33 cm³. No definite conclusion was achieved on whether a narrow or wide cleft showed better treatment outcomes, but other potentially related factors were good oral hygiene and eruptive force of the maxillary canines. Lack of a standard definition of cleft size, a small sample size, varying outcome parameters, and moderate-to-high risk of bias contributed to the summary. A meta-analysis could not be performed because of the heterogeneity.

Conclusion: Due to insufficient evidence, cleft width/volume could not be specified leading to more successful SABG. Care of patients could be improved in both research by following rigorous methodology, and practice by clear communication.

Keywords: cleft lip and palate; secondary alveolar bone grafting; systematic review.