Secondary Alveolar Bone Grafting Timing Comparison in Non-Syndromic Complete Cleft Lip and Palate: A Volumetric Cone Beam Computed Tomography Study.

Abstract

ObjectiveTo compare volumetric bone graft outcomes between early and intermediate secondary alveolar bone grafting (SABG) in patients with non-syndromic complete unilateral cleft lip and palate (CLP).DesignRetrospective comparative cohort study.SettingTertiary medical center.PatientsForty patients with non-syndromic complete unilateral CLP who underwent SABG were divided into early SABG (age <8 years, before lateral incisor eruption, n = 20, mean age 7.18 ± 0.49 years) and intermediate SABG (age 8-12 years, before canine eruption, n = 20, mean age 9.19 ± 1.01 years) groups.Main Outcome MeasuresThree-dimensional volumetric bone fill percentage measured using cone beam computed tomography at pre-surgery and 6-month postoperative time points. Semi-automated segmentation with landmark-based superimposition was performed using Mimics software. Clinical grading (excellent, adequate, inadequate) was assessed by two independent evaluators.ResultsEarly SABG demonstrated significantly higher bone fill percentage (59.8 ± 11.7%) compared to intermediate SABG (49.1 ± 14.6%, P-value=0.0146, Cohen's d = 0.81), representing approximately 10.7% greater bone formation. Clinical grading revealed high adequacy rates in both groups (85% early SABG, 80% intermediate SABG, P-value =0.798), with early SABG providing additional margin for long-term support. No correlation existed between initial defect volume and bone fill percentage (R2=0.0005, P-value =0.893).ConclusionsThree-dimensional volumetric analysis demonstrates superior bone grafting outcomes with early SABG, though both timing protocols achieve high rates of clinically adequate outcomes. Eruption of the permanent maxillary incisor may serve as an appropriate clinical criterion for early SABG timing.