Long-Term Stability of Alveolar Bone Graft in Cleft Lip and Palate Patients: Systematic Review and Meta-Analysis

Abstract

Objective: Alveolar bone grafts are the golden standard in treating patients with oral cleft and hence, the long-term success of this treatment is the subject of many studies. The aim of this study was to systematically review literature that examined the long-term stability of alveolar bone grafting in patients with cleft lip and palate.

Methods: In this study, data was collected via a comprehensive search of random and nonrandom studies evaluating the success of bone grafts in patients with cleft lip and palate in ISI Web of Science, EMBASE, Scopus, Medline, and Cochrane Central Register of Controlled Trials from the beginning until July 3, 2020. Also, a search was conducted for ongoing studies in the trial registry and a hand search of related gray literature and references of the relevant studies. The relevant data of the included studies were extracted using predefined extraction forms. Meta-analysis was performed using inverse-variance for calculating the pooled outcome of outcome measures. The pooled mean success rate of alveolar bone graft and mean difference of cleft volume after 1 year was presented as the outcome of the analysis.

Results: Eight studies (1 randomized clinical trial study and 7 controlled prospective studies) were included in this meta-analysis. The results of the analyses showed that the total percentage of secondary alveolar success in the follow-up period of at least 1 year according to the Bergland index was 76.52% (pooled success = 76.52%, 44.92-98.10). Also, bone defect in the cleft area reduced significantly after bone grafting (MD = 0.62 cm3, 0.48-0.75, P < 0.00001). The total percentage of bone filling after 1 year and according to CBCT (cone beam computed tomography) was about 63.38%, and the rate of definite natural eruption of canine within the graft was 80.89%.

Conclusions: The total success rate of secondary alveolar bone grafting in the follow-up period of at least 1 year was clinically significant and alveolar bone grafting significantly reduced bone defect volume. Also, there was no difference in the amount of bone remaining after 1 year in patients whose canine had erupted through the grafted bone and in those whose canine had not erupted.