Implant Rehabilitation in Grafted Alveolar Clefts: Clinical and Radiographic Outcomes

Objective: Implant rehabilitation in grafted alveolar clefts requires a complex staged reconstructive approach, and a clinically important yet underexplored question is which patients require additional pre-implant block regrafting after primary grafting has already been completed. This single-centre retrospective cohort study aimed to evaluate whether a history of maxillary advancement is associated with a reduced likelihood of requiring pre-implant block regrafting (defined here as Re-graft 1), and to describe medium-term implant survival outcomes in a cleft implant cohort. Methods: Forty-two patients with Veau class III or IV cleft palate who underwent implant rehabilitation in grafted alveolar cleft sites between 2011 and 2023 were included. A total of 80 dental implants were evaluated at the implant level; analyses of primary grafting outcomes and the need for Re-graft 1 were performed at the patient level. Mean age at implant placement was 21.07 years (range, 17-38 years); mean follow-up was 83 months. Patients were categorised by maxillary advancement history: distraction osteogenesis (n = 11), orthognathic Le Fort I advancement (n = 9), or no advancement (n = 22). Bergland grades were assigned independently by two attending surgeons from postoperative radiographs. Implant outcomes were classified using the ICOI/Misch four-level scale (success, satisfactory survival, compromised survival, failure). Group comparisons used chi-square and Fisher's exact tests. Results: Patients with any maxillary advancement history were significantly less likely to require Re-graft 1: 65.0% of patients with advancement did not require Re-graft 1, compared with 27.3% in the no-advancement group (Fisher's exact p = 0.029; OR = 4.95). Overall implant survival was 93.75%; 58.75% of implants were classified as complete success, and 30.00% as satisfactory survival. Conclusions: In this observational, hypothesis-generating cohort, maxillary advancement history was associated with a lower likelihood of requiring pre-implant block regrafting. Implant rehabilitation showed favorable medium-term survival. These findings are limited by the retrospective single-center design, modest sample size, and absence of multivariable adjustment, and require confirmation in larger prospective studies with standardized regrafting criteria.