Block iliac bone grafting enhances osseous healing of alveolar reconstruction in older cleft patients: A radiological and histological evaluation

Background: Older alveolar cleft patients (>12 years old) often have wide bone defect as well as teeth loss, resulting in poor osseous healing with conventional alveolar bone grafting (ABG). In this study, we investigated a surgical technique of block iliac bone grafting for the alveolar cleft reconstruction and evaluated the clinical and radiological outcomes of these cleft patients. Material and Methods: Fifteen patients were included in this study. All cases received preoperative cone bean computed tomography (CBCT) scans for the alveolar cleft evaluation. Osseous outcomes of block iliac bone grafting were assessed at 1 week, 3- and 6-month postoperatively. Volume changes and bone resorption rates were calculated using the measurement modules of Simplant software. Bone samples from one patient undergoing dental implantation were assessed by micro-CT and histological examination. The morbidities of donor-site were analyzed by clinical examination and questionnaire survey. Results: The average age of the case series was 18.53 +/- 2.50 years. The intraoral incision of thirteen cases healed well. However, two cases had oronasal fistula and graft exposure at 1-week postoperatively. The results of follow-up CBCT scans showed significant resistance to radiation on both sides of the bone graft, suggesting a good osseous healing and new bone formation. The mean residual bone volume was 1.68 +/- 0.26 cm(3), 1.29 +/- 0.23 cm(3) and 1.15 +/- 0.23 cm(3) at 1-week, 3- and 6-month postoperatively. Correspondingly, the mean bone resorption rates in 3- and 6-month postoperative were 21.78 +/- 6.88% and 30.66 +/- 8.97%, respectively. From micro-CT and HE examinations, the block bone samples exhibited a cancellous structure in which mature bone trabecula and functional blood vessels appeared. The average scores of donor-site morbidities were drastically decreased at 3- and 6-month postoperatively compared with those at 1-week postoperatively. Conclusions: Our results demonstrated that block iliac bone grafting could achieve satisfying osseous outcomes in older alveolar cleft patients, and this technique provided favorable bony condition for further treatments, especially dental implantation.