Two case reports from Prof. Otto and Dr. Blume highlight maxgraft® bonebuilder as a viable treatment option for alveolar cleft repair.

New indication for maxgraft® bonebuilder: First report worldwide about custom-milled allogeneic bone grafts for alveolar cleft osteoplasty

Otto S, et al., Custom-milled individual allogeneic bone grafts for alveolar cleft osteoplasty – A technical note, Journal of Cranio-Maxillo-Facial Surgery (2017),Volume 45, Issue 12, December 2017, Pages 1955-1961
https://doi.org/10.1016/j.jcms.2017.09.011

Surgeons from the Ludwig-Maximilians-University in Munich, Germany, showcase in this technical note the successful repair of an alveolar cleft using maxgraft® bonebuilder, an individualized allogeneic bone graft, in a 36-year old female patient with a 6-month-follow up showing good bony integration.

Cleft lip and palate is among the most frequent congenital abnormalities around the world. Of all cases, 75% are associated with osseous defects of the alveolus. Bone grafting of the alveolar cleft is often indispensable to allow a descent of the canine adjacent to the cleft or an orthodontic closure of the tooth row. The patient with a cleft alveolus with a continuous bony gap reaching from the alveolar crest (in region 22) into the piriform rim and nasal floor chose an allogeneic bone graft over iliac crest grafting for her tertiary alveolar cleft osteoplasty (permanent dentition) to restore normal anatomy in preparation for further combined orthodontic-orthognathic surgical treatment.

Today, bone grafts from the iliac crest are most commonly used for osteoplasties of the cleft alveolus.
This report shows the advantages of customized allogeneic bone grafts in comparison to autogenous bone, including immediate fit accuracy, abandoning free-hand sculpting and subsequent time savings, in addition to freedom from donor site morbidity with less pain and discomfort for the patient.

Especially for alveolar cleft osteoplasty the use of customized allogeneic bone grafts offers the possibility to simultaneously reconstruct the palatal shelf and cranial parts of the premaxilla around the piriform aperture giving support to the alar base.

Sven Otto

Reconstruction of a Unilateral Alveolar Cleft Using a Customized Allogenic Bone Block and Subsequent Dental Implant Placement in an Adult Patient

Blume O, Back M, Born T, Donkiewicz P.  J. Oral Maxillofac. Surg., Article in press
https://doi.org/10.1016/j.joms.2019.05.021

This case report presents the use of a customized allogenic bone block in a guided bone Regeneration (GBR) procedure for the reconstruction of a unilateral alveolar cleft and the successful insertion of dental implants in an adult patient.

Abstract
Cleft lip and palate is the most common congenital deformity with severe impact on the quality of life of affected patients. The deformity often includes an alveolar cleft (AC). In most instances, osteoplasty is performed using autogenous bone transplants harvested from the iliac crest, whereby this treatment represents a highly invasive procedure. As freeze-dried bone allografts (FDBA) are an increasingly accepted alternative to autogenous bone grafting in several indications, their application might also be suitable for AC reconstruction. In this case report we present the use of a customized allogenic bone block in a guided bone regeneration (GBR) procedure for the reconstruction of a unilateral AC and the successful insertion of dental implants after a healing period of 6 months. The use of FDBA seems to represent a successful treatment option for AC reconstruction. The allogenic bone block demonstrated high volume stability with ideal integration and revascularization, resulting in functional bone tissue suitable for implantation and aesthetic rehabilitation. Nevertheless, further investigations, especially concerning long-term stability of the augmented bone and dental implants, are needed to draw a definite conclusion on the performance of allogenic bone blocks in orofacial cleft osteoplasty.

Oliver Blume, Michael Back