Three-dimensional evaluation and alveolar bone graft planning in cleft patients: can we improve?

Objectives: Alveolar bone grafting is a common procedure in the treatment of maxillary defects in cleft patients. The defect has a complex 3D form and can be difficult to visualize. Recently, CBCT, MSCT reconstructions and volumetric analyses have been introduced for surgical planning. Our purpose was to evaluate the feasibility and reliability of a 3D planning method based on CBCT and virtual planning software.

Methods: In 10 consecutive unilateral cleft lip and palate patients from the joined database of the Bruges Cleft and Craniofacial Centre and the Cleft Service of the Semmelweis University Budapest, the alveolar clefts were virtually evaluated using the iPlan ENT 3.0 software. An individually planned, anatomically correct virtual template was fit into the alveolar defect on the 3D CBCT model. The same investigator repeated this procedure after one month for the intraexaminer reliability and a second investigator was involved for the interexaminer reliability. 2 cleft patients were operated on with this new technique. The virtual templates were printed out and consecutively sterilized. An iliac bone graft was taken according to the size and form of the 3D template and was adjusted meticulously to the 3D virtual template prior to transfer and positioning it into the alveolar defect.

Results: The results of this study showed a high reliability (ICC 0.977 p 0.05 for intraexaminer reliability; ICC 0.787 p 0.05 for interexaminer reliability) in the 3D definition of the virtual template of the alveolar cleft defect. Preliminary clinical assessment on two cleft patients showed an excellent feasibility.

Conclusion: 3D virtual CBCT planning with individual customized templates for alveolar bone grafting, can improve the treatment of cleft patients.

Key words : alveolar graft; 3D simulation

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Jan 20, 2018 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Three-dimensional evaluation and alveolar bone graft planning in cleft patients: can we improve?
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