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Cleft alveolar bone grafting /certified fixed orthodontic courses by Indian dental academy
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Cleft alveolar bone grafting /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call

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  • 1. CLEFT ALVEOLAR BONE GRAFTING www.indiandentalacademy.com
  • 2. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.co m www.indiandentalacademy.com
  • 3. Cleft Alveolar Grafting Latin Terminology - A small trough that contains the tooth buds Anatomy - Anatomically a complete Cleft of the alveolus passes superiorly in to the Nasal Cavity & Posteriorly in to the anterior palate, with Continuation of the alveolar, Nasal and Palatal Mucoperiostium www.indiandentalacademy.com
  • 4. Common Sites * Between Lateral Incisor & Canine (No-4 Tessier Classification) * Between Central and Lateral Incisor (No -3 Tessier Classification) * Rare - Between Central Incisors (No-0 Tessier Classification) * More Distally www.indiandentalacademy.com (No -5 & 6 Tessier Classification)
  • 5. History * Drachter (1914) first attempt of Bone graft of alveolar Cleft *Veau (1931) classification and attempted tibial graft to cleft palate * Nordin et al. (1955) early repair cleft alveolus and palate with autogenous bone * Jolley et al. (1968) described the detrimental effects of early bone graft on Maxillary growth. * Boyne & Sands ( 1972) protocols for secondary bone grafting *Wolf et al.(1983) showed favorable results using calvarian bone * Nique et al.(1987) performed alveolar grafting with allogenic bone www.indiandentalacademy.com
  • 6. _______ Problems Patients _________ •Food / Fluids coming out of their nose •An Inability to blow balloons or to suck a straw •A persistent smell from the Nose •Poor speech •An Inability to clean •Deformed / missing teeth •Mobility and overgrowth of the pre maxilla •Lack of alar base & columella www.indiandentalacademy.com
  • 7. Surgical goals of Alveolar Bone Grafting and Reconstruction * Stabilization of the Dental osteal segments & Mobile Premaxilla in bilateral cases * Oronasal fistula closure * Improvement in the Alveolar ridge form so that an Implant or Prosthesis can be placed. * Prevention of tooth loss due to lack of Periodontal bone support * Provision of the Nasal alar support www.indiandentalacademy.com
  • 8. Benefits * Stabilization of the dental arch and closure of the Oronasal fistula are the major benefits of alveolar grafting. * The greater segment has tendency to collapse due to lack of alveolar continuity and palatal scarring. * Transverse deficiency with posterior lateral crossbite. * Lack of vertical growth in the cuspid region resulting in a vertical maxillary deficiency. * Anterior maxillary crossbite. www.indiandentalacademy.com
  • 9. Classification of Alveolar Grafting * Primary Bone grafting : Less than 2 Years of age. * Early secondary Bone grafting : 2-6 Years of age. * Secondary Bone grafting : 7-12 Years of age. * Late secondary Bone grafting : Adult. * Grafting at the time of Le forte I Osteotomy. * Revision grafting. www.indiandentalacademy.com
  • 10. Timing of Bone Grafting Primary ☻Primary bone grafting before the age of two was routinely done during the 1950-1960’s. ☻Jolley et al (1968) demonstrated significant limitation of anterior- posterior growth in these patients with and increased incidence of cross bites. www.indiandentalacademy.com
  • 11. Timing of Bone Grafting Early Secondary * Early secondary bone grafting, between the age of 2 & 6 is done primarily to provide Alveolar Bone support for the eruption of the lateral incisor. * Radiographic evaluation of the lateral incisor & canine associated with the Cleft defects will help to determine timing of the graft. * The most common time for Alveolar Cleft Grafting is between the age of 9 & 11 Years. www.indiandentalacademy.com
  • 12. *Before the eruption of the canine when the root is 1/2 to 2/3 formed * Grafting between the age of 9 and 11 does not have much effect on midface growth and will provide boney support for the erupting canine Timing of Bone Grafting Adults * Higher incidence of graft failure is noted. * Closure of Oronasal communication and providing a stable Maxillary arch are the primary objectives. www.indiandentalacademy.com
  • 13. Surgical Preparation Orthodontic management - Mixed Dentition Stage - Cross bite correction - Alignment of teeth - Expansion appliance - 3 months Surgical Preparation - Soft Tissue Evaluation - Flap Design - Periodontal Support - Oronasal Communication - Support of the Alar Base - Evaluate the Donor site. www.indiandentalacademy.com
  • 14. Fundamental Principles Nasal side closure first Adequate volume of Bone Water tight tension free closure of the mucosa www.indiandentalacademy.com
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  • 25. Postoperative Management ☻ Clear liquid diet for 3-5 days followed by a soft diet, oral hygiene ☻ Evaluate for dehiscence over Bone Graft ☻ Absolutely no trauma or loading to the area, including tongue. ☻ 8 weeks. Complications ☻ Infection ☻ wound dehiscence ☻ loss of graft ☻ Incomplete closure www.indiandentalacademy.com
  • 26. Success Rates Cohen et al 1996 (Teaching model) 1. Fistula closure (95%) 2. Canine eruption, Bone support to adjacent teeth (95%) 3. Bone Architecture - Bone strut (95%) Abyholum and Bergland - Radiological Grading Grade I : Normal interdental Alveolar height Grade II : > 75% Normal interdental Alveolar height Grade III : 50 to 75% Normal interdental Alveolar height Grade IV : < 50% Normal interdental Alveolar height Success varies from 0 to 100 % and is usually at 60 to 80% www.indiandentalacademy.com
  • 27. www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com