303 - Effect of Secondary Alveolar Bone Grafting Timing on Cleft Outcomes

Abstract:

Purpose:

This retrospective cohort study evaluated the impact of secondary alveolar bone grafting (SABG) timing relative to permanent canine eruption on postoperative outcomes in patients with alveolar clefts.

Methods:

Records of patients ages 6–18 years who underwent SABG at a single tertiary care center were reviewed. Patients were stratified into pre-eruption and post-eruption groups based on canine eruption status at grafting. Autogenous bone grafts from iliac crest and other donor sites were included. The primary outcome was graft success, defined as bone continuity, without oronasal fistula. Secondary outcomes included spontaneous canine eruption, root development, postoperative complications, need for additional surgical intervention, and orthodontic treatment requirements.

Results:

Eighty eight patients met inclusion criteria (pre-eruption = 67; post-eruption = 21). Baseline characteristics were similar, although the post-
eruption group had more bilateral clefts. There were no significant differences between these 2 groups in terms of graft success and
complication rates. In the pre-eruption group, although early canine eruption within the first 2 years was limited, over 90 percent of them eventually erupted. Pre-eruption SABG was significantly associated with a higher likelihood of additional surgical procedures, which were largely planned and non-complication related interventions. Besides pre-canine eruption SABG, postoperative orthodontic intervention was significantly associated with increased likelihood of additional surgeries. Specifically for non-complication- related procedures, graft success was associated with increased likelihood of them. Pre-eruption SABG remained a significant factor in this model as well.

Conclusions:

In this preliminary cohort, Clinically, graft success and complications were influenced more by surgical technique and orthodontic planning than timing alone, and both early and delayed grafting can achieve reliable results. Early grafting facilitated canine eruption, which supported performing SABG before eruption. The higher number of additional procedures in this group likely reflects treatment sequencing and orthodontic management, rather than graft-related complications. Overall, both pre- and post-eruption SABG showed comparable graft success and low complication rates.

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