Tai Yamaguchi

Surgical Repositioning of the Premaxilla in Combination with Two-Stage Alveolar Bone Grafting in Bilateral Cleft Lip and Palate

OBJECTIVE This paper introduces a surgical technique for premaxillary repositioning in combination with two-stage alveolar bone grafting for the correction of the premaxillary deformity of patients with bilateral cleft lip and palate (BCLP). The paper also reports on two patients with BCLP who underwent this surgical management. SURGICAL PROCEDURE The operation is usually performed when the patient is 8 to 14 years of age. In the first stage of surgery, the side more accessible to the septo-premaxillary junction is selected, and an osteotomy of the premaxilla and unilateral alveolar bone grafting are performed. Approximately 4 to 12 months after the first stage of surgery, contralateral alveolar bone grafting is carried out. CONCLUSION We have found that this surgical procedure is highly effective, because it ensures the blood supply to the premaxilla and minimizes the potential for surgical failure. Moreover, it affords wide exposure of the premaxillary bone surface, facilitating sufficient boney bridging and allowing for orthodontic tooth movement.

Placement of endosteal implants combined with chin bone onlay graft for dental reconstruction in patients with grafted alveolar clefts

Endosteal implants were inserted into grafted alveoli after particulate cancellous bone and marrow grafting in seven patients with cleft lip or palate in conjunction with simultaneous chin bone onlay grafting. In these patients, the alveolar bone height of the bony bridge was insufficient when evaluated by both computed tomographic and periapical radiographic images. The age at first implant surgery ranged from 14 to 28 years. Although four of the seven patients had an uneventful course, three had wound dehiscence, and in all but one of them the exposed chin bone underwent partial or total necrosis. Ultimately all seven implants integrated into the bone, and the alveolar bone height was increased in all but one patient. The results indicate that chin bone onlay grafting with simultaneous implant insertion is useful in patients with cleft lip or palate with insufficient alveolar bone height.

Use of an Osseointegrated Implant for Dental Rehabilitation after Cleft Repair by Periosteoplasty: A Case Report

OBJECTIVE We report here on a patient with unilateral cleft lip and alveolus who underwent dental rehabilitation of cleft alveolus using an osseointegrated implant after cleft repair by periosteoplasty. The patient, whose lateral incisor was congenitally missing, had periosteoplasty, followed by excellent bone formation at the cleft alveolus within 2 years. After the completion of orthodontic alignment of the maxillary dental arch, a Brånemark single-tooth implant was placed into the bone-formed alveolus. CONCLUSION This treatment procedure offers an option of dental rehabilitation for the alveolar clefts of patients with cleft lip and/or palate.

Long-term follow-up of dental implants placed in a grafted alveolar cleft: evaluation of alveolar bone height

OBJECTIVE The purpose of this study was to evaluate the long-term follow-up of dental implants placed in the grafted alveoli of patients with cleft lip or palate clinically. PATIENTS AND METHODS Sixteen patients (8 males and 8 females) who had dental implants placed in alveoli grafted using particulate cancellous bone and marrow (PCBM) from the iliac crest were evaluated. The marginal bone level around the implant was evaluated radiologically at 1 (stage I), 3 (stage II), and 6 years (stage III) after connecting the abutment. The interdental alveolar bone height (IABH) was also evaluated radiologically for up to 6 years. RESULTS During the follow-up period of an average of 8.6 +/- 0.6 years (range: 7.2 to 9.4 years), only 2 implants were lost in 1 patient, the cumulative survival rate was 90.9%, and the clinical outcome was uneventful in all implants. The marginal bone levels around the implants were 0.29 +/- 0.18, 0.29 +/- 0.19, and 0.28 +/- 0.15 mm at stages I to III, respectively. Moreover, IABH was reduced only in 2 of 16 (12.5%) of the implant-placed grafted alveoli, and was maintained after implant placement for up to 6 years. CONCLUSIONS These findings indicate that the use of dental implants placed in grafted alveoli is beneficial for maintenance of the grafted bone in patients undergoing secondary bone grafting for cleft repair.

Characteristics of nonverbal behavior in patients with cleft lip and palate during interpersonal communication

OBJECTIVE This study examined characteristics of nonverbal behavior that patients with cleft lip and palate (CLP) presented during interpersonal communication. DESIGN This was a case-control design comparing nonverbal behavior of adult women with CLP with females without CLP. PARTICIPANTS Subjects were 20 adult women with CLP and 20 noncleft control women matched for age and educational experience. MAIN OUTCOME MEASURES Subject gestures and facial expressions were videotaped during interviews and analyzed with a computer-based kinematic measurement system. RESULTS The clinical group displayed significantly fewer head movements and a lower smile frequency than the control group. Furthermore, head and hand movements and smiles were less coordinated or congruent for the subjects with CLP than for the comparison group. CONCLUSIONS Even slight facial disfigurement could have a harmful effect on communication behavior in female patients with CLP.

Rigid external distraction using skeletal anchorage to cleft maxilla united with alveolar bone grafting.

Objective Documentation of the application of maxillary distraction osteogenesis using rigid external distraction (RED) with skeletal anchorage combined with predistraction alveolar bone grafting (ABG) in cleft maxilla. Design Case report. Patient A patient with numerous congenital missing teeth and severe maxillary deficiency related to complete bilateral cleft lip and palate with large alveolar bone defect. Intervention The patient received preoperative orthodontic treatment, predistraction ABG, and maxillary distraction osteogenesis using RED with skeletal anchorage. Results Predistraction ABG completely united the cleft maxilla. The united maxilla was successfully advanced by the RED system with skeletal anchorage, despite unsound dentition with numerous congenital missing teeth. Conclusion The present study demonstrates that the combination of predistraction ABG and RED system with skeletal anchorage is effective for the treatment of severe maxillary deficiency related to complete bilateral cleft lip and palate with large bone defect and numerous congenital missing teeth.

Preliminary report of two-stage secondary alveolar bone grafting for patients with bilateral cleft lip and palate.

OBJECTIVE To overcome the difficulties of one-stage secondary alveolar bone grafting for patients with bilateral cleft lip and palate (BCLP) who have a broad alveolar cleft, the value of two-stage alveolar bone grafting was examined. PATIENTS Three patients (2 girls and 1 boy) with BCLP were treated by two-stage alveolar bone grafting. The procedure consisted of a first-stage surgery (mean age 8 year 6 months +/- 7.8 months), which consisted of alveolar bone grafting for one side of the BCLP, and second-stage surgery for the contralateral side several months later. For the postoperative assessment, radiographs of the operated site were examined. RESULTS The average amount of implanted bone per operation and per patient was 6.8 +/- 1.1 g and 13.7 +/- 1.0 g, respectively. Postoperative clinical and radiographic examinations revealed that an appreciable alveolar bone ridge had formed, and there were no major complications. CONCLUSIONS Two-stage alveolar bone grafting, which makes it possible to reduce the amount of implanted bone, could be an optional surgical procedure for patients with BCLP and a broad alveolar cleft.