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Alveolar Bone Grafting - a Summary of History and Current Literature on the Technique Jemds.com Review Article Alveolar Bone Grafting - A Summary of History and Current Literature on the Technique Karthika Manoj Nambiar1, Ranjit Kamble2, Kritika P. Suroliya3, Monika M. Ahuja4, Pallavi S. Daigavane5, Savi M. Vora6 1Department of Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India. 2Department of Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India. 3Department of Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India. 4Department of Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India. 5Department of Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India. 6Department of Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India. ABSTRACT BACKGROUND Cleft lip and palate is a common condition affecting thousands of children in India and Corresponding Author: Karthika Manoj Nambiar, overseas. With an incidence of 1 in 800 live births, these cleft lip and cleft palate T-24, Shalinta PG Girls Hostel, patients face numerous aesthetic as well as functional challenges. The condition goes DMIMSU, Sawangi Meghe, untreated in many scenarios, or patients do not receive adequate treatment due to Wardha-442001, Maharashtra, India. various reasons like lack of awareness, lack of specialist dentists etc. leading to E-mail: [email protected] permanent facial deformity with significant deterioration of quality of life. There have been many changes in the management of alveolar cleft in the past 100 years. DOI: 10.14260/jemds/2020/576 Documentation of the first cleft lip repairs dates back to 400 BC, and was performed by Hippocrates, while the first cleft velum repair was done for the first time by a How to Cite This Article: French dentist, Monnier, in 1764. The treatment protocol for the same has been Nambiar KM, Kamble R, Suroliya KP, et al. Alveolar bone grafting- a summary of upgraded with time, with better understanding of the anatomy and pathophysiology history and current literature on the of the condition, and for better results to the patients. Alveolar bone grafting (ABG) technique. J Evolution Med Dent Sci is now becoming an integral part of managing cleft patients. There still isn’t a fixed 2020;9(36):2652-2657, DOI: and widely accepted protocol for ABG in the management of cleft patients, but there 10.14260/jemds/2020/576 are various opinions of researchers around the world regarding the indications of bone grafting, the type of grafting (primary or secondary) to be employed, timing of Submission 11-05-2020, grafting, the source of bone graft and use of various bone graft substitutes in the Peer Review 11-07-2020, Acceptance 17-07-2020, procedure. An increasing value of multidisciplinary approach, including maxillofacial Published 07-09-2020. surgeons and orthodontists, towards managing such patients, is helping improve the outcome of such patients, and hence easing the overall treatment duration for the Copyright © 2020 JEMDS. This is an open patient and relatives. Hence, through this article, we aim to shed some light over the access article distributed under Creative evolvement and current place of alveolar bone grafting in treating cleft lip and palate Commons Attribution License [Attribution patients. The anatomy of involved parts, types and indications of ABG, clinical 4.0 International (CC BY 4.0)] evidences on the timing of the surgery, future evaluation, results and complications, and orthodontic treatment have been mentioned in this article. KEY WORDS Alveolar Bone Graft, ABG, Cleft Lip, Cleft Palate, Maxillofacial Surgery, Orthodontics J Evolution Med Dent Sci / eISSN - 2278-4802, pISSN - 2278-4748 / Vol. 9 / Issue 36 / Sept. 07, 2020 Page 2652 Jemds.com Review Article Cleft lip and Palate are one of the most common congenital the alveolar bone are joined by periodontal ligaments. In lack craniofacial deformities seen in children.1 Patients with cleft of the necessary bone stock in the alveolar cleft, needed for lip and palate (CLP) suffer from several aesthetic and eruption, the permanent teeth seize to be unsustainable. The functional challenges.2 Approximately every 1/800 live births typical eruption into the AC space is seen by the maxillary are born with a Cleft lip (CL). This may or may not be canine, while the lateral incisor eruption occurs, either next to accompanied by a cleft palate (CP).3 or even in the cleft. The eruption of these teeth occur mostly in Alveolus with a bony defect, which may also be termed as the age range of seven to twelve years. The most suitable time Alveolar cleft (AC), is a common congenital defect. This forms for ABG is before the involved tooth erupts. Hence to avoid up to 75% of CL or CL and CP patients. As poor as it may be, losing a tooth by its eruption into cleft alveolus, taking dental but the current literature related to cleft, points its cause to be x-rays early in life is advicable.5 having multiple factors, including genetic and environmental causes. The development of dentition may be affected by AC, leading to alveolar segment collapse.4 Historical Background The first reconstruction of cleft lip dates back to Hippocrates (400 BC) and Galen (150 AD). Breakthroughs in the procedure and results have been occurring over the years. Cleft velum’s first repair was done in 1764 by a dentist from France, Le Monnier. The cleft alveolus is a less prominent part of the cleft perpetuity. Also, the importance of ABG, which is a relatively new procedure, is responsible for the lack of many historical references to AC repair. In 1901, Von Eiselsberg performed the first ABG, using an osteocutaneous flap with a pedicle, Drachter in 1914, did the first successful ABG, using a graft from the tibia, including periosteum. In the two decades of the 1950s and 1960s, primary ABG, within the first few months of life, started becoming popular. Most of the dental professionals and surgeons during the Figure 1. Inability in Reconstruction of AC Leads to the Following Issues:4 1950s and 1960s began employing primary bone grafting of the alveolus in the early months of life. Initially, it was often Oronasal fistula having symptoms in a patient, of alveolar conducted while the patient had deciduous teeth, to avoid 5 process with an osseous defect and/or bone insufficiency maxillary collapse. Pickrell et al. in the year 1968, presented hindering tooth eruption or orthodontic treatment or that primary grafts did not grow proportionately with the prosthodontic rehabilitation in this area, can be contemplated skull. They also found out that the teeth didn’t persistently for Alveolar bone grafting (ABG).4 erupt in the primary ABG grafts. And hence, secondary This is now widely accepted that ABG is an integral to cleft grafting, in the time of mixed dentition, became famous. To treatment. This refers to the bony approximation of the defect date, there are various beliefs amongst dentists around the in alveolar bone that is needed to form normal upper dental world regarding the following points- arch. After Boyne and Sands’ study describing secondary ABG, 1. Timing of grafting during the second period this technique has become the popular method of choice and 2. Using orthodontic appliances before the surgery. holds a unique place in the entire system of cleft and palate 3. Surgical procedure and graft source, 3 treatment. 4 4. Outcome analysis of ABG. Given the comparatively high prevalence of lip and palate clefts, there are only a few studies on these patients’ treatment. In the present review, the literature on alveolar bone grafting ABG Goals is examined concerning timing, technique, bone sources, 1. Vestibular & Oronasal fistula closure various methods to determine the effectiveness of the graft 2. Providing enough bone stock for the permanent teeth and the complications are discussed. (central incisor of maxilla, lateral incisor and canine) 3. To make a base for the nasal skeleton 4. To make a bony architecture that is required for Development and Anatomical Features of Alveolus nasolabial muscles reconstruction in symmetry. Alveolar bone is a part of the primary palate. It is developed 5. To build a floor for nasal airway which is functional around the 5th to 6th week of intrauterine life by fusion of 6. Providing enough bone stock for the use of dental maxillary prominences. The nose, lip, prolabium and implants (osseointegrated) premaxilla are the parts arising from the primary palate, all being in front of the incisive foramen. The Word alveolus originated in Latin. It defines a tiny cavity or space. Dental alveolus is a Primary Bone Graft cavity/socket for the tooth. The tooth sockets are located at the Many dental surgeons were performing primary and early maxillary alveolar process and this forms the main concern secondary ABG in the 1950s and 1960s. regarding the functionality in alveolar clefting. The teeth and J Evolution Med Dent Sci / eISSN - 2278-4802, pISSN - 2278-4748 / Vol. 9 / Issue 36 / Sept. 07, 2020 Page 2653 Jemds.com Review Article (iii)Orthodontic treatment before ABG, and its functional results (Long 1995; Kindelan 1999)12. Only a 58% success rate was described in children undergoing grafting, relating to optimal age or ethnicity.13,14 Substandard outcomes and controversies around SBG creates a need for future researches to enhance the results of this procedure. Timing of Grafting A notable study in primary bone grafting was by Boyne and Sands, which advocated doing ABG in mixed dentition.15 But the study faced opposition due to deranged facial growth pattern which was observed after primary ABG.
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