Osteogenesis rate and success of secondary alveolar bone grafting: A 3D volumetric prognostic value.

Background: Secondary alveolar bone grafting (SABG) is a critical intervention for restoring anatomical integrity and functional capacity in patients with alveolar clefts. Despite advancements in surgical techniques and imaging, the optimal indicator for postoperative outcome evaluation remains undefined.

Methods: In this retrospective study, 126 patients with unilateral alveolar clefts who underwent SABG between 2016 and 2023 were analyzed. Preoperative and six-month postoperative craniofacial CT data were used to calculate preoperative bone defect volume, residual postoperative bone defect volume, osteogenesis volume, and osteogenesis rate using three-dimensional volumetric analysis. Surgical success was defined by imaging-based criteria assessing vertical height, labiopalatal width, and nasal floor symmetry. Receiver operating characteristic (ROC) curve analysis was employed to evaluate the prognostic performance of each 3D metric.

Results: The mean osteogenesis rate was 0.48±0.16, with a threshold of 0.507 yielding the highest diagnostic accuracy (AUC = 0.921; sensitivity = 0.894, specificity = 0.785). Among all evaluated parameters, osteogenesis rate demonstrated the strongest predictive capability for SABG success. However, it lacked direct representation of bone continuity and buccopalatal thickness.

Conclusion: Osteogenesis rate is a reliable and efficient prognostic marker for assessing SABG outcomes. Nevertheless, it should be interpreted alongside structural and clinical indicators to ensure comprehensive evaluation. Incorporating volumetric and morphological assessments into a multimodal framework may enhance clinical decision-making and long-term treatment success.