PhD Scientific Days 2023

Budapest, 22-23 June 2023

Clinical Medicine IV.

Alveolar cleft hard- and soft tissue reconstruction with an autogenous tooth derived particulate graft and a novel split thickness papilla curtain flap

Tamás Würsching 1,2 ; Bálint Molnár 3 ; Eleonóra Sólyom 3; Laura Pálvölgyi 1; Dániel Palkovics 3; Zsombor Drajkó 3; Krisztián Nagy 1

1. Pediatric Center, Semmelweis University, Budapest
2. Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University, Budapest
3. Department of Periodontology, Semmelweis University, Budapest

Text of the abstract

Introduction
During secondary alveolar cleft grafting, the use of autogenous cancellous bone harvested from the iliac crest is still considered the gold standard. Because of the risk of donor site morbidity and excessive graft resorption, alternative sources of graft (eg.: intraoral bone, xenografts) are being tested but with uncertain results. In terms of local flap design for alveolar cleft closure, the most commonly utilized method is the 4-flap technique as described by Nordin and Abyholm. This classic flap design does not address the scarce width and thickness of keratinized gingiva at teeth adjacent to the alveolar cleft, whereas a result periodontal impairment may develop.

Aim
To overcome limitations of current methods utilizing advancements provided by novel treatment approaches, the aim of the present pilot case series was to evaluate the efficacy of a digitally planned ATB powder graft combined with a novel split-thickness papilla curtain flap in the treatment of unilateral alveolar cleft defects.

Method
Auto Tooth Bone (ATB) is a novel graft material derived from extracted teeth which is widely and successfully used in preprosthetic and periodontal surgery. In our pilot study seven patients with unilateral cleft lip and palate were treated with ATB using their own deciduous teeth for alveolar bone grafting. CBCT scans were taken preoperatively for planning and 3 months postoperative to assess the integration of the graft.

Results
Initial wound healing was uneventful in all seven cases with no signs of graft exposure over the postoperative period. The quality of keratinized tissues was favorable, fully eliminating any muscle pull and vestibular distortions over the cleft. Our preliminary results show that the graft shows excellent integration after 3 months of healing, with no adverse effects or excessive resorption of the graft.

Conclusion.
ATB graft may be a safe and predictable grafting material in alveolar cleft reconstruction. The applied split-thickness papilla curtain flap was effectively utilized to avoid postoperative graft exposure and to improve soft tissue conditions around teeth adjacent to the alveolar cleft.

Funding.
The current study received no funding.