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Microstructured beta-tricalcium phosphate for alveolar cleft repair: a two-centre study.

N G Janssen1, R Schreurs2, A P de Ruiter1

  • 1Department of Oral and Maxillofacial Surgery, Utrecht University Medical Centre, Utrecht, The Netherlands.

International Journal of Oral and Maxillofacial Surgery
|December 31, 2018
PubMed
Summary

Microporous beta-tricalcium phosphate (β-TCP) shows promising results for alveolar cleft repair, offering a safe alternative to autologous bone grafts. This synthetic material facilitates successful bone regeneration and tooth eruption in patients with cleft lip and palate.

Keywords:
3D imagingalveolar cleftbeta-tricalcium phosphatebone substitutescleft lipcleft palatecone beam computed tomography

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Regenerative Medicine
  • Biomaterials Science

Background:

  • Alveolar cleft repair traditionally uses autologous bone grafts during the mixed dentition stage.
  • Donor site morbidity and extended operation times are associated with autologous bone grafting.
  • Synthetic bone substitutes offer potential advantages in reducing surgical complications and procedure duration.

Purpose of the Study:

  • To investigate the efficacy and safety of using microporous beta-tricalcium phosphate (β-TCP) for secondary alveolar bone grafting in patients with unilateral cleft lip and palate.
  • To evaluate bone regeneration, oronasal fistula recurrence, and canine eruption following β-TCP grafting.
  • To compare outcomes with established autologous bone graft procedures.

Main Methods:

  • Prospective study involving 20 patients with unilateral cleft lip and palate across two centers.
  • Alveolar cleft repair performed using microporous β-TCP.
  • Postoperative evaluation at 1 year included assessment of alveolar process continuity, oronasal fistula recurrence, and adjacent tooth eruption.
  • Cone beam computed tomography (CBCT) scans analyzed using volume-based semi-automatic segmentation.

Main Results:

  • No adverse events were reported during the study period.
  • Mean residual bone volume in the repaired cleft was 65% at 1 year postoperative.
  • No recurrence of oronasal fistulas was observed.
  • 90% of teeth adjacent to the cleft erupted spontaneously, and all patients achieved a continuous alveolar process.

Conclusions:

  • Secondary alveolar grafting with microporous β-TCP is a safe and effective clinical option.
  • Outcomes regarding bone volume, canine eruption, and complication rates are comparable to those achieved with autologous bone grafts.
  • β-TCP represents a viable alternative to autologous bone for alveolar cleft repair, potentially reducing donor site morbidity.