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Published on: September 19, 2015
Implant Survival Rate in Grafted Cleft Defects in Patients with Cleft Lip and Palate: A Systematic Review
Purpose:
The aim of this systematic review was to assess dental implant survival in grafted cleft defects in subjects with cleft lip, alveolus and/or palate (CLAP).
Materials And Methods:
An electronic search of PubMed, ScienceDirect, Cochrane, and Scopus databases was conducted. From the 1,606 studies initially identified, 30 (1.87%) met the inclusion criteria. Studies were included if they reported on dental implants placed in patients with CLAP (grafted or not), evaluated implant survival rate, and indicated the time interval in which implant failure occurred. Case reports, reviews, animal studies, and studies with fewer than 10 implants or lacking survival data were excluded.
Results:
30 studies were included, comprising six prospective and 24 retrospective designs. Overall, 742 subjects (mean age 27.9 years) received 1,411 implants with a mean follow-up of 52 months. The implant survival rate was 95% at 6 months and 90.3% at 5 years, which was lower than in the noncleft population. Based on the available data, we did not observe a clear difference in the average time to failure between subjects with CLAP and those from noncleft populations. An association between the type of cleft and the implant survival rate as well as specific potential failure factors could not be identified due to a lack of available data in the relevant studies.
Conclusions:
Although lower than in the noncleft population, implant survival rates in patients with CLAP sequelae are sufficiently reliable to consider this treatment option a viable part of their oral rehabilitation. Tertiary bone grafting appears crucial for the long-term implant survival and should be performed either 3-6 months before implant placement or simultaneously. These conclusions should, however, be interpreted cautiously given the substantial heterogeneity, incomplete reporting, and limited long‑term follow‑up in the existing literature. A well-designed prospective clinical study is necessary to achieve comparable long-term results and to investigate potential failure factors, which are currently difficult to determine.
