Alveolar Ridge Notching as a Predictor for Secondary Bone Grafting in Incomplete Alveolar Clefts

Objectives: To clarify the need for secondary alveolar bone grafting (ABG) in incomplete alveolar clefts identified clinically from its appearance and test the usefulness of alveolar ridge notching in the edentulous stage as a predictor for ABG. Design: A prospective, cross-sectional study comparing three groups of patients at two stages. Patients: Twenty-four patients with unilateral incomplete cleft of primary palate who underwent either no surgery or cheiloplasty only. Methods: Cleft severity was assessed at two stages. Initially, the appearance of untreated clefts was assessed before cheiloplasty or at 3 months of age in the patient without cheiloplasty and graded by severity into three groups. Later alveolar bone defects were assessed with computed tomography in the primary or mixed dentition period. A decision regarding the requirement for ABG was then made. Finally, the relationship between untreated clefts and the need for ABG was determined. Main Outcome Measures: Nine (75%) of 12 patients with alveolar ridge notching in the edentulous stage were diagnosed as fulfilling the criteria for ABG. Results: The alveolar bone defects correlated with the severity of untreated cleft conditions (Spearman r = 0.65, p = .002). The need for ABG was greater in patients with alveolar ridge notching, compared with those without notching (9/12 versus 0/12, p = .00034). Conclusions: Most patients with incomplete alveolar clefts clinically identified in the edentulous stage required ABG, and alveolar ridge notching in the edentulous stage could therefore serve as a predictor for ABG.