Late secondary alveolar bone grafting using autologous versus alloplastic material for treating patients with cleft lip and palate with one year follow-up-A retrospective comparative study.

Abstract

Cleft lip and palate (CLP) frequently require secondary alveolar bone grafting (SABG) to restore maxillary continuity and support orthodontic tooth movement. The choice of graft material influences the long-term outcomes, especially in late SABG cases. This retrospective study compared autogenous iliac crest bone grafts to a composite of demineralized freeze-dried bone allograft (DFDBA) and platelet-rich fibrin (PRF) in patients with unilateral CLP (UCLP) with residual alveolar clefts. Twenty-six patients (≥15 years) were divided equally into two groups: Group A (iliac crest autograft) and Group B (DFDBA + PRF). All patients underwent pre- and 12-month post-operative cone beam computed tomography (CBCT). Volumetric analysis were used to quantify the regenerated bone volume, and statistical comparisons were made using independent t-tests with p < 0.05 considered significant. Baseline cleft volumes were similar between the groups (4.53 ± 0.61 cm³ vs. 4.53 ± 0.68 cm³, p = 0.962). After 12 months, the mean residual cleft volumes were 2.92 ± 0.58 cm³ (autograft) and 2.95 ± 0.54 cm³ (DFDBA + PRF), with no significant intergroup difference (p = 0.668). Mean graft fill was 35.1% ± 10.8 (autograft) and 38.3% ± 8.7 (DFDBA + PRF), both achieving up to 57% regeneration of the initial defect. Inter- and intra-observer reliability for CBCT measurements was excellent (ICC = 0.89-0.93). Findings indicated that DFDBA + PRF achieved bone regeneration comparable to iliac crest autografts in late SABG for UCLP, while avoiding donor site morbidity and hospitalization. Therefore, DFDBA + PRF is a clinically viable, less invasive alternative for selected patients, though longer-term prospective studies are warranted to confirm its stability.