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Radiographic assessment of secondary autogenous alveolar bone grafting in cleft lip and palate patients
J D Kindelan1, R R Nashed, M R Bromige
1Leeds Dental Institute, United Kingdom.
Objective:
To assess if a 4-point, radiographically based scale could be used between operators to reliably assess the success of secondary alveolar bone grafting.
Design:
The study was retrospective with the clinicians blind to patient identity. Radiographs were examined twice by two clinicians with 1 week between assessments.
Setting:
The research was carried out in a hospital-based orthodontic/oral and maxillofacial unit.
Patients:
All patients who had secondary alveolar bone grafting in this unit between February 1992 and March 1995 were included in this study. There were 38 patients with a total of 48 grafted sites.
Interventions:
The bone graft site was radiographed following orthodontic expansion prior to grafting. The radiograph was repeated postoperatively at a mean of 4 months after surgery.
Main Outcome Measure:
The degree of bony fill in the cleft area was assessed using a 4-point scale: Grade 1 > 75% bony fill; Grade 2 50-75% bony fill; Grade 3 < 50% bony fill; Grade 4 no complete bony bridge.
Results:
Overall, 50% of grafts achieved grade 1, 23% were grade 2, 22% grade 3, and 5% grade 4. Levels of intra- and inter-observer agreement were highly variable (.33 to .72 kappa statistic).
Conclusions:
The 4-point scale described could be used to assess the success of autogenous secondary alveolar bone grafting. It showed moderate to substantial intra-observer agreement, and fair-to-moderate inter-observer agreement.