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Orthodontics

40 - Analysis of failed sABG cases from the perspective of dentists: a case- series study

Friday, May 22, 2026
11:00 AM - 11:15 AM PST
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    Presenting Author(s)

  • JL

    Jeff Lee, DDS

    2nd year dental resident
    Cincinnati Children’s Medical Center Hospital, Cincinnati, OH
    Cincinnati Children's Hospital Medical Center
    Cincinnati, Ohio, United States

    • Co-Author(s)

  • JW

    Jue Wang, DDS

    Orthodontist/Assistant Professor
    Cincinnati Children's Hospital Medical Center
    Cincinnati, Ohio, United States

    • Research Mentor(s)

  • JW

    Jue Wang, DDS

    Orthodontist/Assistant Professor
    Cincinnati Children's Hospital Medical Center
    Cincinnati, Ohio, United States

    • Program Director(s)

  • Scott Schwartz, DDS, MPH

    Associate Professor
    Cincinnati Children’s Medical Center Hospital, Cincinnati, OH
    Cincinnati Children's Hospital Medical Center
    Cincinnati, Ohio, United States

Abstract:



Purpose: Secondary alveolar bone grafting (sABG) is standard for alveolar clefts, yet failure remains common. While pre-ABG orthodontics is commonly used for maxillary expansion, targeted orthodontic preparation to optimize tooth position, bone healing, and soft tissue closure is not routine. Existing literature emphasizes surgical and bone-related factors, with limited evidence on dental influences. This study analyzes tooth characteristics in failed sABG cases to identify dental features contributing to failure.



Methods: Records from 13 failed sABG cases were reviewed. Longitudinal data included orthodontic and surgical histories, clinical photographs, intraoral scans, and radiographs (CBCT, panoramic, and periapical). Parameters analyzed included alveolar cleft size, tooth development stage at sABG, tooth eruption through the graft site, presence and position of teeth at or within the cleft, root angulation, overlapping teeth at the suture site, and vertical or sagittal alveolar segment discrepancies.



Results: The cohort included 7 females and 6 males (4 bilateral, 9 unilateral clefts), totaling 17 cleft sites. Mean age at sABG was 8.38 ± 1.8 years. Most cases (12/13) involved tooth eruption through the graft site. Teeth were present at the cleft margin in 9 cases and within the defect in 6 cases. Tooth overlap at the gingival suture site was observed in 6 cases. Vertical and sagittal alveolar segment misalignment occurred in 9 and 4 cases, respectively.



Conclusion: Failed sABG cases frequently exhibited malpositioned teeth within the cleft, overlapping teeth interfering with soft tissue closure, and alveolar segment misalignment. Targeted pre-ABG orthodontic preparation addressing these factors may improve sABG outcomes.



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