The Effects of Maxillary Expansion on Late Alveolar Bone Grafting in Patients With Unilateral Cleft Lip and Palate

The purpose of this study was to answer the research question of whether maxillary expansion provides enough postgraft stimulation to decrease the volume loss of alveolar bone grafts in patients with cleft lip and palate (CLP) who missed the appropriate treatment time.

This study was designed as a prospective controlled clinical trial. Thirty patients in the permanent-dentition stage with unilateral CLP were divided into 2 groups: In group I (mean age, 19.33 ± 5.16 years), slow maxillary expansion was performed before secondary alveolar bone grafting (SABG); in group II (mean age, 19.93 ± 3.99 years), slow maxillary expansion was performed 6 weeks after SABG. The iliac crest was preferred as a donor site for autogenous bone graft harvesting. Cone beam computed tomography images were taken 1 week, 6 months, and 12 months postoperatively. The volume and density of the alveolar bone graft were calculated using Mimics software (version 13.1; Materialise, Ann Arbor, MI), and SPSS software (version 19.0; IBM, Armonk, NY) was used for statistical analysis.

The bone graft volume loss was significantly higher in group I than in group II after 6 months of healing (P = .003). The increase in bone density was significantly higher in group II than in group I after 6 months of healing (P = .017). Although the mean loss of volume was lower and the mean density of the bone graft was higher in group II, there was no significant difference between the 2 groups in terms of mean graft volume and mean bone density 12 months after the operation. For groups I and II, the mean bone graft volume loss was 46.3% and 34.6%, respectively, and the mean increase in bone density was 16% and 49%, respectively, after 12 months of healing.

Maxillary expansion after late SABG may be taken into consideration as a treatment choice in selected unilateral CLP patients to provide bone graft stimulation.