Failure Rates Based on Alveolar Cleft Volume: Analysis of the Critical-Size Defect for Alveolar Bone Grafting
Idean Roohani1,2, Simon Youn3,4,1,2, Sarah Alfeerawi1
1Keck School of Medicine, University of Southern California.
Background:
Alveolar bone grafting (ABG) using iliac crest bone graft (ICBG) is the best practice for children with complete cleft lip and palate. With the advent of recombinant human bone morphogenetic protein (rhBMP-2) and demineralized bone matrix (DBM), excellent results can be achieved while avoiding donor-site morbidity. This study aimed to determine critical-size defects by analyzing graft failure rates for ICBG and rhBMP-2/DBM to guide surgeons performing ABG.
Methods:
A retrospective review was conducted evaluating patients who underwent ABG from 2016 through 2022. Patients with preoperative and postoperative cone beam computed tomography (CBCT) imaging were included. Volumetric defect sizes were calculated using preoperative imaging. Graft success criteria were based on both clinical and radiographic outcomes. Logistic regressions analyzed graft failure rates to identify an optimal cutoff, which defined the critical-size defect.
Results:
A total of 93 patients were included. Bone graft cohorts included ICBG ( n = 30) and rhBMP-2/DBM ( n = 63). The critical-size defects were calculated to be 810 mm 3 and 885 mm 3 for ICBG and rhBMP-2/DBM, respectively. There were significantly higher graft failure rates beyond the critical size compared with below for both ICBG (71.4% versus 0.0%; P < 0.001) and rhBMP-2/DBM (65.0% versus 14.0%; P < 0.001).
Conclusions:
This study identified critical-size defects based on alveolar cleft volume for ICBG or rhBMP-2/DBM with higher graft failure rates beyond the predicted thresholds. Distinct ranges in cleft volume were identified where patients might benefit from each select graft option.
Clinical Question/Level Of Evidence:
Therapeutic, III.
