Qamar Fatima, Cray James J, Halsey Jordan, Rottgers S Alex
Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital; St. Petersburg, FL, USA.
Department of Biomedical Education and Anatomy, The Ohio State University College of Medicine, and Division of Biosciences, The Ohio State University College of Dentistry, Columbus, OH, USA.
Cleft Palate Craniofac J. 2023 Nov;60(11):1366-1375. doi: 10.1177/10556656221104937. Epub 2022 Oct 31.
Alveolar bone grafting aims to restore bony continuity of the alveolus and provide optimal periodontal support for teeth adjacent to the cleft. We created a survey of cleft surgeons to assess the current standard of care regarding this procedure.
A multiple choice survey was implemented using Qualtrics software and emailed to a list of 708 surgeons from the ACPA membership directory. Correlation between various provider factors and treatment practices was assessed with Fisher's exact test and likelihood ratio tests.
The response rate was 17.5%. Eighty-seven percent of providers preferred to perform grafts prior to secondary canine eruption while 10% favored before central incisor eruption. Eighty-one percent favored palatal expansion prior to bone grafting. Wide variability existed regarding the time to initiate postoperative orthodontics; 43% waited 4 to 6 months. Sixty-four percent of surgeons now utilize cone beam CT to assess graft take. The majority of respondents utilized cancellous bone autograft (92%) from the anterior iliac crest (97%) as graft material. Seventy percent used three or more modalities for post-operative pain control management. Early career surgeons (0-5 years) appeared more likely to use non-autologous materials ( < .01) for grafting.
Alveolar bone grafting prior to secondary canine eruption remains the most common strategy but other protocols are employed. Surgeons utilize multiple modalities for radiographic evaluation and most often use autologous cancellous bone as the primary grafting material. There is no true consensus on the perioperative timing and sequencing of orthodontic manipulation while principles of multimodal perioperative pain control appear widely accepted.
牙槽骨移植旨在恢复牙槽骨的连续性，并为腭裂邻近的牙齿提供最佳的牙周支持。我们对腭裂外科医生进行了一项调查，以评估该手术目前的护理标准。
使用Qualtrics软件进行了一项多项选择调查，并通过电子邮件发送给美国腭裂颅面协会（ACPA）会员名录中的708名外科医生。使用Fisher精确检验和似然比检验评估各种提供者因素与治疗方法之间的相关性。
回复率为17.5%。87%的提供者倾向于在尖牙继发萌出之前进行移植，而10%的人倾向于在中切牙萌出之前进行。81%的人倾向于在骨移植之前进行腭扩展。在开始术后正畸治疗的时间方面存在很大差异；43%的人等待4至6个月。64%的外科医生现在使用锥形束CT来评估移植的成功情况。大多数受访者使用来自髂前嵴的松质骨自体移植（92%）作为移植材料。70%的人使用三种或更多方式进行术后疼痛控制管理。早期职业外科医生（0至5年）似乎更有可能使用非自体材料（<0.01）进行移植。
在尖牙继发萌出之前进行牙槽骨移植仍然是最常见的策略，但也采用了其他方案。外科医生使用多种方式进行影像学评估，并且最常使用自体松质骨作为主要移植材料。在正畸操作的围手术期时机和顺序方面没有真正的共识，而多模式围手术期疼痛控制的原则似乎已被广泛接受。
