Professor, Harvard School of Dental Medicine, and Oral Surgeon in Chief, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
Medical Student, Erasmus University Medical Center, Rotterdam, the Netherlands.
J Oral Maxillofac Surg. 2022 Apr;80(4):633-640. doi: 10.1016/j.joms.2021.12.004. Epub 2021 Dec 16.
Success of alveolar bone grafting has been estimated using 2-dimensional periapical radiographs that are associated with image distortion. Cone beam computed tomography (CBCT) accurately displays 3-dimensional anatomy. This study sought to develop and apply a radiographic measure of alveolar bone grafting success using CBCT.
This was a retrospective case series composed of patients with cleft lip/palate who had iliac crest bone grafting by 1 surgeon from 2005 to 2020. CBCT scans were obtained ≥4 months after graft. The outcome variables included vertical bone height on cleft adjacent teeth, labiopalatal thickness, and nasal floor symmetry and were scored using a 1 to 4 ordinal scale. Vertical height was determined by the distance from the cementoenamel junction to the marginal bone level of cleft adjacent teeth (1: ≥75% root length, 2: ≥50 to <75%, 3: ≥25 to <50%, 4: <25%), labiopalatal thickness was scored by comparing graft thickness with root width of cleft adjacent teeth (1: <50%, 2: ≥50, 3: ≥75%, 4: ≥100%), and piriform symmetry was established by comparing the nasal floor height between sides (1: ≥6 mm, 2: ≥3 and < 6 mm, 3: ≥1 and < 3 mm, 4: a score of ≥3 < 1 mm). To be considered a successful graft, each dimension scored ≥3. Grafts were also successful if piriform symmetry scored 2, when all other measures indicated success.
The sample was composed of 618 patients with 783 alveolar cleft sites. Subjects' median age was 10.0 (interquartile range 1.6 years), and 59% were male. CBCT scans were obtained a median of 9.7 months (interquartile range 68.8 months) after grafting. There was good-to-excellent intrarater and inter-rater agreement for measurements. Alveolar bone grafting was radiographically successful in 94% of patients.
This is a valid and reliable assessment tool, and when applied to a large cohort, it demonstrated a 94% graft success rate. Future studies will identify predictor variables associated with bone graft outcomes.
牙槽骨移植的成功已通过与图像失真相关的二维根尖射线照相来评估。锥形束计算机断层扫描（CBCT）可准确显示三维解剖结构。本研究旨在开发并应用一种基于 CBCT 的牙槽骨移植成功的放射学测量方法。
这是一项回顾性病例系列研究，纳入了 2005 年至 2020 年间由同一位外科医生进行髂嵴骨移植的唇腭裂患者。在移植后至少 4 个月获得 CBCT 扫描。结局变量包括裂侧邻牙的垂直骨高度、唇腭厚度和鼻底对称性，并使用 1 到 4 的有序量表进行评分。垂直高度通过从牙釉质牙骨质界到裂侧邻牙的边缘骨水平的距离来确定（1：≥75%根长，2：≥50%至<75%，3：≥25%至<50%，4：<25%），唇腭厚度通过比较移植厚度与裂侧邻牙的根宽（1：<50%，2：≥50%，3：≥75%，4：≥100%）来评分，梨状孔对称性通过比较两侧的鼻底高度（1：≥6mm，2：≥3mm 且<6mm，3：≥1mm 且<3mm，4：≥3mm<1mm）来建立。如果每个维度的评分≥3，则认为移植成功。如果梨状孔对称性评分为 2，且所有其他指标均表明成功，则移植也被认为是成功的。
该样本由 618 名患者的 783 个牙槽裂部位组成。受试者的中位年龄为 10.0 岁（四分位距 1.6 岁），其中 59%为男性。CBCT 扫描在移植后中位 9.7 个月（四分位距 68.8 个月）获得。测量的观察者内和观察者间一致性良好至优秀。94%的患者的牙槽骨移植在影像学上是成功的。
这是一种有效且可靠的评估工具，在应用于大样本时，显示出 94%的移植成功率。未来的研究将确定与骨移植结果相关的预测变量。
