O Bergland

Secondary bone grafting of alveolar clefts. A surgical/orthodontic treatment enabling a non-prosthodontic rehabilitation in cleft lip and palate patients

A procedure combining grafting of cancellous bone to the residual cleft of the primary palate with subsequent orthodontic movement of teeth into the former cleft area is described. The preliminary results from the first 80 patients (89 clefts) are presented. The age of the patients at the bone grafting ranged from 8 to 18 years, and the observation time from 17 to 44 months. The results have been assessed 1) on the basis of dental radiographs and 2) clinically, by the response of the grafted area to the orthodontic movement of adjacent teeth. In 69 clefts in which the cleft side canine had been brought into its final position at the time of evaluation, the height of the interal-veolar septum was assessed to be approximately normal in 38% and slightly less than normal in 44%. A septum of insufficient height (less than 3/4 of the normal) had formed in 5 clefts (7%). Even in these cases, the main objects of the operation were fulfilled: The maxillary segments were stabilized, the teeth adjacent to the cleft ...

Secondary bone grafting and orthodontic treatment in patients with bilateral complete clefts of the lip and palate

The results of secondary bone grafting and orthodontic treatment in 41 patients with bilateral complete clefts of the lip and palate are reported. Good bone formation was found in 98% of the cleft sites grafted before the eruption of the canines, and in 80% of the clefts grafted later. Closure of both cleft spaces by orthodontic means was achieved in 20 of the 21 patients in the first group, and in 14 of the 20 patients in the second group. The bone grafts failed in one cleft site in 4 patients, all of which were regrafted with satisfactory results. In 2 patients one of the canines was later affected by external root resorption, necessitating endodontic treatment. Both the failures and the root resorptions occurred in patients bone grafted at an older age than was considered optimal for bilateral clefts: 10 to 11 years. Seven patients needed a bridge prosthesis, 3 of these over one cleft space only. Even these patients benefited greatly from bone grafting.

Significance of secondary osteoplasty in orthodontic treatment of facial cleft patients

Eine Restsplate beeutet ein Probem sowohl fur Den Patienten als auch fur den Kieferorthopaden. Um einige Nachteile, die durch den Knochendefekt verursach waren, zu verbessern, wurde 1977 in Oslo sekundare Knochentransplantation nach den Prinzipien vonBayne undSands [3–5] angefangen. Das Splaten spongiose Knochenspane vom Beckenkamm transplantiert. Die Patienten sind bei der Operation zwischen acht und 18 Jahre alt gewesen; das Durchschnittsalter ist 11.5 Jahre. Wir sehen, das das optimale Alter fur Osteoplastik neum bis elf Jahre zu sein scheint.

The Role of the Nasal Septum in Midfacial Growth in man Elucidated by the Maxillary Development in Certain Types of Facial Clefts: A Preliminary Report

Four cases of a rare cleft variant, viz. bilateral clefts of the primary palate in combination with an apparently normal secondary palate, have been studied preliminarily. In two infant cases a complete disjunction between the nasal septum/vomer and the clinically normal secondary palate has been proved presurgically. In two adult cases in which no hard tissue junction between the nasal septum and the secondary palate could be ascertained by tomography, the occlusal development and facial growth appear to have attained a final morphology well within the normal ranges of variation. These four cases are taken as evidence that the nasal septum does not play any influential role in either pre- or in post-natal growth of the maxillary complex in man. The morphology of different variants of the described cleft deformity is discussed, as well as observations reported on in the literature which appear to concern cases similar to our series and support our conclusions.

EXPERIMENTAL TRANSPLANTATION OF TEETH TO SIMULATED MAXILLARY ALVEOLAR CLEFTS

A total of 14 teeth were transplanted to simulated alveolar clefts in 5 monkeys. Autogenous cancellous bone was grafted to the cleft together with the tooth in ten instances. Healing processes were observed 216 or 271 days postoperatively. Another group of four teeth were transplanted in the cleft areas 133 days after bone grafting. These teeth were observed for 138 days before sacrifice. Radiological and histological findings support previous reports on adverse effects to dental tissues when placed in direct contact with fresh transplanted bone. Root resorption and ankylosis occurred to a large extent. Establishment of a normal periodontal membrane could, however, be observed when the tooth was transplanted to an area grafted 4 months previously. An interval before tooth transplantation allowing the cancellous graft to organize and bone to remodel seems to be indicated.