Alveolar clefts bone grafting: on the issue of modern treatment paradigm

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Abstract

Relevance. One of the most common birth defects is congenital cleft lip, palate and alveolar ridge. Modern aspects of surgical correction of alveolar clefts are discussed in this literature review. Approaches to performing this operation have changed significantly over time. A unified concept does not exist to this day due to the fact that the intervention can affect the growth of the upper jaw, and the fact that approaches used in pediatric surgery may not be effective in adult patients. The choice of osteoplastic materials also remains a very pressing issue, since the results of using these materials for other pathologies vary. The aim of the study is to systematize data on osteoplastic surgeries for alveolar clefts in patients of different ages and analyze of published scientific works. Materials and Methods. The authors analyzed scientific data in the search engines PubMed, Google Scholar and eLibrary. Scientific literature published from 1901 to 2024 was analyzed. Results and Discussion. At the moment, most authors are inclined to perform the operation during the period of early mixed dentition in the presence of a lateral incisor rudiment, or late mixed dentition (before the eruption of the canine) in its absence. Performing surgery in adult patients is associated with a greater degree of graft resorption and additional difficulties. Among osteoplastic materials, preference is given to autologous bone. The most popular remains an avascular autograft from the iliac crest region. Attempts are being made to avoid the use of autologous materials and to reduce its quantity in order to reduce donor morbidity. In complex cases, it may be necessary to use techniques using revascularized autografts or prosthetics. Great importance is attached to the orthodontic preparedness of patients. Conclusion. The approach to patients with alveolar cleft should be differentiated. It is important to take into account the patient’s age, somatic and dental status to select the most correct management tactics.

About the authors

Alexey M. Kuznetsov

Sechenov University

Email: hannaimanova@yandex.ru
ORCID iD: 0000-0002-7254-4205
Moscow, Russian Federation

Khanna Z. Imanova

Sechenov University

Author for correspondence.
Email: hannaimanova@yandex.ru
ORCID iD: 0000-0001-8335-8283
SPIN-code: 9492-9905
Moscow, Russian Federation

Artem M. Gusarov

Sechenov University

Email: hannaimanova@yandex.ru
ORCID iD: 0000-0002-6583-4685
SPIN-code: 4604-5103
Moscow, Russian Federation

Oleg S. Yackevich

Belarusian State Medical University

Email: hannaimanova@yandex.ru
ORCID iD: 0009-0009-8599-115X
SPIN-code: 7120-8088
Minsk, Republic of Belarus

Maryanna E. Zorych

Clinic ʺEcomedserviseʺ

Email: hannaimanova@yandex.ru
ORCID iD: 0009-0007-0074-6389
SPIN-code: 4171-2542
Minsk, Republic of Belarus

Nadezhda L. Korotkova

Sechenov University; Privolzhsky Research Medical University

Email: hannaimanova@yandex.ru
ORCID iD: 0000-0001-7812-1433
SPIN-code: 8709-8397
Moscow, Russian Federation; Nizhny Novgorod, Russian Federation

Ulyana O. Kopylova

Sechenov University

Email: hannaimanova@yandex.ru
ORCID iD: 0009-0007-3203-8985
Moscow, Russian Federation

Artem M. Nagajchenko

Sechenov University

Email: hannaimanova@yandex.ru
ORCID iD: 0000-0002-3014-4924
Moscow, Russian Federation

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Supplementary files

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1. Figure 1. Alveolar cleft grafting by de Barros Dias B.S. et al. [155], progress of the operation. А — Cuts are made along the planned lines (the lines are marked with a dotted line); Б — the appearance of surgical wound during the dissection process after making the incisions; В — the mucous membranes of the nose and palate are sutured; Г — osteoplastic material is placed in the area of the defect, for example, as in the picture, where 1 — cortical plate, 2 — membrane lining, 3 — cancellous autograft; Д — the appearance of wound after surgery

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