Anterior tooth replacement with implants in grafted alveolar cleft sites: a case series

When a residual edentulous space in the anterior region remains after surgical and orthodontic treatment of alveolar cleft patients, implant placement with or without additional grafting is a treatment option. We placed a total of 10 implants in nine consecutive alveolar cleft patients (five females, four males) with residual anterior edentulous spaces and non-restored neighbouring teeth. Patient age generally varied from 18 to 22 years. Additional (tertiary) bone grafting, implant placement after 3 months of graft consolidation and implant uncover after no less than 6 months was the favoured surgical protocol in the five most recent cases. Ample time was allowed to evaluate and guide the development of soft tissues, following second-stage surgery. For this purpose, temporary crowns were fabricated, adjusted and left in place for over 3-4 months in seven out of nine cases. No implants were lost after a mean observation period of 3.4 years and all implants function without objective (radiographic) or subjective problems. Aesthetics were considered acceptable in seven out of nine cases. Unsatisfactory aesthetic results originated from poor implant positioning or alignment in two patients who did not undergo tertiary bone grafting. We conclude that implant placement in alveolar cleft sites is a comprehensive but viable treatment option. Tertiary grafting of the site is recommended to achieve better ridge contour and bone height. This allows optimal implant placement and alignment.