Rivers Clare M, Grant Jaime, McIntyre Grant, Devlin Mark F D, Russell Craig J H, Gillgrass Toby
The Cleft Surgical Service for Scotland, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, United Kingdom.
The Craniofacial service, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
Eur J Orthod. 2024 Dec 4;47(1). doi: 10.1093/ejo/cjae065.
To develop a reproducible, reliable clinical index of alveolar bone grafting (ABG) outcome based on the eruption position of the cleft canine tooth and determine the association between eruption position and radiographic outcome at 6 months post-grafting.
Children with complete, non-syndromic, unilateral/bilateral cleft lip and palate in the West of Scotland were identified. Post-ABG radiographic outcome (Kindelan index) and canine eruption position in children with a cleft of the alveolus who had undergone ABG were documented. A Kindelan score was assigned to the 6-month post-bone-graft radiograph. Following canine tooth eruption, four-point clinical index scale (CIS) scores were assigned to maxillary occlusal images taken prior to commencement of definitive orthodontics; 1-canine eruption in alveolar crest, 2-canine eruption buccal to alveolar crest, 3-canine eruption palatal to alveolar crest, and 4-canine impaction. Intra and inter-rater reliability was assessed using Cohen and Fleiss kappa's, respectively. Duration of orthodontics treatment, number of orthodontic clinic visits, and clinical management of the cleft site space were noted.
Eighty-three patients representing 98 bone graft sites were identified. CIS scoring intra- and inter-rater reliability was 0.69-0.99 and 0.63-0.75, respectively. CIS score was associated with reduced visits (P = .015), months in orthodontics (P = .009), and likelihood of space closure (P = .006).
This is a retrospective study with small numbers but is comparative to other similar studies in the literature.
The CIS presented appears to be a reliable index of ABG outcome. It also demonstrates an association with the burden of orthodontic care post-cleft alveolar bone graft.
基于唇腭裂犬齿的萌出位置，制定一个可重复、可靠的牙槽骨移植（ABG）结果临床指标，并确定移植后6个月时萌出位置与影像学结果之间的关联。
确定苏格兰西部患有完全性、非综合征性、单侧/双侧唇腭裂的儿童。记录接受ABG治疗的牙槽裂儿童的ABG术后影像学结果（Kindelan指数）和犬齿萌出位置。为移植后6个月的骨移植X光片指定一个Kindelan评分。犬齿萌出后，为确定正畸治疗开始前拍摄的上颌咬合图像指定四分临床指标量表（CIS）评分；1-犬齿萌出于牙槽嵴顶，2-犬齿萌出于牙槽嵴颊侧，3-犬齿萌出于牙槽嵴腭侧，4-犬齿阻生。分别使用Cohen和Fleiss卡方评估评分者内和评分者间的可靠性。记录正畸治疗的持续时间、正畸门诊就诊次数以及腭裂部位间隙的临床处理情况。
确定了83例患者，代表98个骨移植部位。CIS评分的评分者内和评分者间可靠性分别为0.69 - 0.99和0.63 - 0.75。CIS评分与就诊次数减少（P = 0.015）、正畸治疗月数（P = 0.009）以及间隙关闭的可能性（P = 0.006）相关。
这是一项小样本的回顾性研究，但与文献中的其他类似研究具有可比性。
所呈现的CIS似乎是ABG结果的可靠指标。它还表明与牙槽骨移植后正畸治疗负担有关。
