Designed guide plate assisted cortico-cancellous Iliac crest bone grafting for alveolar cleft repair.

Abstract

Background: Alveolar cleft is a common developmental malformation in the maxillofacial region, often occurring with cleft lip or palate. The traditional "gold standard" iliac bone grafting implants only cancellous bone in the alveolar cleft region. However, this approach provides insufficient initial mechanical support and is prone to structural collapse and accelerated bone resorption. This study used digital guide plate assisted cortico-cancellous iliac crest bone grafting to repair alveolar clefts, aiming to provide better structural support while reducing bone resorption.

Method: This study retrospectively reviewed 39 patients with unilateral alveolar clefts, including 21 cases in the autogenous iliac cancellous bone grafting group (cancellous bone group, mean age 15.33 ± 5.36 years) and 18 cases in the digitally guided autogenous iliac cortical-cancellous composite bone grafting group (composite bone group, mean age 14.17 ± 4.05 years). Preoperative and 6-month postoperative assessments were performed using CBCT for three-dimensional evaluation. The study compared the bone graft volume, new bone fill rate, alveolar width in the grafted area, and bone density between the two groups.

Result: Postoperatively, the composite bone group exhibited markedly greater bone graft volume (698.58 ± 197.43 mm³ versus 378.23 ± 176.65 mm³, P < 0.01) and significantly higher new bone fill rate for volume, area, and height relative to the cancellous bone group. The composite bone has a clear advantage in maintaining alveolar ridge width compared to cancellous bone.

Conclusion: Compared with the traditional "gold standard" grafting, digital guide plate assisted cortico-cancellous iliac crest bone grafting for alveolar cleft repair significantly increased the bone graft volume. The surgical method introduced in this study provides a new option for the precise repair and functional reconstruction of alveolar clefts and has a broad application prospect.