Division of Plastic Surgery, Department of Surgery, University of California, San Diego, La Jolla, CA, USA.
Fresh Start Center for Craniofacial Anomalies, 14444Rady Children's Hospital, San Diego, CA, USA.
Cleft Palate Craniofac J. 2022 Jan;59(1):86-97. doi: 10.1177/1055665621995047. Epub 2021 Feb 25.
Alveolar bone grafting is utilized to manage alveolar clefts in patients with cleft lip and palate. However, the timing of bone grafting is variable with conflicting evidence supporting the use of primary alveolar bone grafting (PABG) in clinical practice.
To provide a qualitative systematic review analysis of long-term outcomes after PABG.
A qualitative systematic review was performed following the Cochrane Handbook and reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Summative findings were evaluated using Confidence in the Evidence from Reviews of Qualitative research to assess the quality of evidence supporting the findings.
After removing duplication, 2182 publications were identified, and 2131 were excluded after screening through titles and abstracts. Inclusion criteria for this study included patients who underwent PABG at 24 months of age or younger and a minimum of 5 year follow-up. Thirty-two publications met the inclusion criteria and were included for qualitative analysis. Primary outcome measures included cephalometric analysis, bone graft survival, occlusal analysis, hypomineralization, tooth eruption, radiograph analysis, and arch relationships. Four assessment themes were characterized from the systematic review: (1) bone graft survival, (2) craniofacial skeletal relationships, (3) occlusion and arch forms, and (4) recommendations for utilizing PABG in practice.
The reported systematic review provides evidence that performing PABG leads to poor long-term outcomes related to bone graft survival and maxillary growth restriction despite some reported positive outcomes.
牙槽骨移植术用于治疗唇腭裂患者的牙槽裂。然而，骨移植的时机存在差异，临床实践中存在支持采用原发性牙槽骨移植术（PABG）的证据相互矛盾。
对 PABG 后的长期结果进行定性系统评价分析。
按照 Cochrane 手册进行定性系统评价，并按照系统评价和荟萃分析的首选报告项目进行报告。使用来自定性研究评价的证据信心评估总结性发现，以评估支持这些发现的证据质量。
去除重复项后，共确定了 2182 篇出版物，经过标题和摘要筛选后排除了 2131 篇。本研究的纳入标准包括在 24 个月或更小年龄接受 PABG 且随访时间至少 5 年的患者。符合纳入标准的 32 篇文献被纳入定性分析。主要观察指标包括头影测量分析、骨移植存活率、咬合分析、矿化不良、牙齿萌出、X 线片分析和弓关系。从系统评价中确定了四个评估主题：（1）骨移植存活率，（2）颅面骨骼关系，（3）咬合和弓形态，（4）在实践中使用 PABG 的建议。
尽管有一些报告的积极结果，但所报告的系统评价提供的证据表明，PABG 会导致骨移植存活率和上颌骨生长受限的长期结果不佳。
