Cortical Block Grafting Successfully Augments Alveolar Cleft Sites for Dental Implant Placement

Mark A Green; Sarah Flanagan; Michael C Britt

doi:10.1016/j.joms.2024.03.034

Cortical Block Grafting Successfully Augments Alveolar Cleft Sites for Dental Implant Placement

J Oral Maxillofac Surg. 2024 Apr 3:S0278-2391(24)00216-7. doi: 10.1016/j.joms.2024.03.034. Online ahead of print.

Authors

Mark A Green¹, Sarah Flanagan², Michael C Britt²

Affiliations

¹ Instructor, Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, MA; Oral and Maxillofacial Surgeon, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA. Electronic address: mark.green@childrens.harvard.edu.
² Clinical Research Assistant, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.

PMID: 38643967
DOI: 10.1016/j.joms.2024.03.034

Abstract

Background: Supplemental bone grafting is regularly required before dental implant placement in patients with cleft lip and palate (CLP).

Purpose: The study purpose was to measure and compare implant osseointegration and changes in graft dimensions following lateral incisor onlay cortical bone grafting in CLP and non-CLP patients.

Study design, setting, sample: Retrospective cohort study composed of patients who presented to Boston Children's Hospital and underwent autogenous onlay cortical block bone grafting at lateral incisor sites from 2015 through 2023. Patients were excluded if the cone beam computed tomography (CBCT) quality was insufficient for accurate measurements.

Predictor variable: The predictor variable was CLP status coded as CLP or non-CLP.

Main outcome variable: The primary outcome variable was successful implant osseointegration confirmed by a torque of 35 N/cm or more after 3 months of implant healing. Secondary outcomes were change in bone width between preoperative and postoperative CBCT scans at lateral incisor sites and the need for additional bone augmentation prior to or during implant placement.

Covariates: Covariates were age, sex, cleft location, and time from bone graft to postoperative CBCT and implant placement.

Analyses: Data analyses were performed using t-tests, Fisher's exact tests, Mann-Whitney U tests, and Pearson's correlation. P < .05 was considered statistically significant.

Results: A total of 22 subjects (16 with CLP) were evaluated. The mean age at the time of graft was 19.3 ± 2.4 years with 52.6% males. Implants were osseointegrated at 20 of 22 lateral incisor sites (1 CLP failure, 1 non-CLP failure). There was significant change in bone width after grafting for patients with CLP (P < .001). Patients with CLP experienced a 3.32 (± 1.80) mm and 2.99 (± 1.61) mm increase in bone width at 2 different levels. Patients with CLP achieved greater boney changes near the alveolar crest than noncleft patients (P = .008) but the change was not significantly different more apically (P = .86). One subject with CLP required additional grafting during implant placement.

Conclusion and relevance: Cortical block onlay bone grafting is a predictable technique to augment lateral incisor sites in patients with CLP for placement of a dental implant.