Three-dimensional evaluation of secondary alveolar bone grafting using a 3D-navigation system based on computed tomography:: a two-year follow-up

Secondary bone grafting is widely used in the closure of oronasal fistulas and reconstruction of maxillary defects. It often fails from lack of physiological stress or inadequate covering of the transplanted bone with surrounding tissue. The aim of this study was to assess the exact bone volume after secondary alveolar bone grafting over a period of two years using a navigation system based on computed tomography (CT). We examined 20 patients with complete unilateral cleft lip and palate (UCLP) who had been treated by secondary bone grafting during late mixed dentition. CT scans of the upper jaw were taken immediately preoperatively, and 1 and 2 years postoperatively. The cleft defects and the bony bridges were marked on the monitor. The software of the navigation system created three-dimensional models showing the amount and site of bone resorption. The mean bone loss after one and two years was 51% and 52%, respectively. There was a significant correlation between the size of the cleft and the success of the alveolar bone grafting (p=0.01). When the teeth adjacent to the cleft were missing the amount of bone lost was 95% after the first year. There was also significant bone loss in the buccopalatine direction. Three-dimensional reconstruction of the bony bridges with a navigation system accurately shows the amount of bone within the cleft site. This method is definitely superior to conventional two-dimensional orthopantomography. (c) 2008 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.