Autologous bone grafting with platelet-rich plasma for alveolar cleft repair in patient with cleft and palate

Ann Ital Chir. 2016:87:5-12.

Abstract

Purpose: Bone grafting of the alveolus has become an essential part of the contemporary surgical management of the oral cleft. The aim of this retrospective study was to evaluate the results of bone grafting in association with PRP (plateletrich plasma) to enhance osteogenesis and osteointegration.

Patients and methods: The study included 16 patients, aged between 9 and 11, affected with unilateral residual alveolar clefts, who underwent bone grafting using secondary alveoplasty. The eight patients belonging to the control group were administered autologous bone graft alone while the study group, consisting of 8 patients, underwent autologous bone grafting in association with PRP. All patients had pre and post surgery orthodontic treatment. The statistical analyses included Student's t test, 2 test and Kaplan-Meir time to event analysis. The p-value was considered significant if p<0.05. All statistical analyses were performed using SAS Software release 9.3 (SAS Institute, Cary, Nc).

Results: The control group (M 50%, mean age 10.2±2.3) underwent simple autologous bone graft while the study group (M 62.5%, mean age 9.9±2.2) was treated with a combination of autologous bone and PRP. No statistically significant differences were found between the two groups as regards age, gender and labial-palatal cleft clinical characteristics. 6, 12, 24 month follow-ups were performed by means of clinical and radiographic investigations. None of the study group developed oronasal fistulas or experienced bone height, bone bridging and bone quality loss; only two patients developed mild periodontal problems. The study group was able to undergo a significantly (p<0.001) earlier and shorter orthodontic treatment.

Conclusions: In our experience, the use of PRP enhances the quality of osteoplasty, accelerates "creeping substitution" and bone healing and favours earlier orthodontic treatment.

Key words: Alveolar cleft, Bone grafting, Palate, Platelet-rich plasma.

L’innesto osseo è essenziale nella terapia chirurgica della labiopalatoschisi (LPS), ma i tempi di osteogenesi ed integrazione ossea nella sede ricevente possono procrastinare i successivi interventi di ortodonzia. Nel nostro studio è stata valutata la capacità della PRP (platelet-rich plasma) associata al trapianto osseo nel diminuire il tempo d’attesa e la durata del trattamento ortodontico in una coorte di 8 bambini, confrontandola con 8 controlli sottoposti a semplice innesto osseo. I risultati hanno mostrato come i soggetti sottoposti a trapianto osseo + PRP abbiano avuto la possibilità di essere sottoposti ad un trattamento ortodontico più precoce (155 giorni vs 298) e più breve (295 giorni vs 356) rispetto al gruppo di controllo. Inoltre nel gruppo di controllo si sono verificate con maggiore frequenza complicanze post-chirurgiche (quali fistole oro-nasali, disturbi periodontali, malattie dentali, perdita di spessore, massa o trabecolatura ossea) rispetto al gruppo sottoposto a PRP. Perciò l’associazione della PRP (platelet-rich plasma) al trapianto osseo è una metodica che sembra associarsi ad una diminuzione statisticamente significativa dei tempi di integrazione ossea nei pazienti affetti da LPS, con conseguente anticipazione della ortodonzia e miglioramento degli outcome chirurgici.

MeSH terms

  • Alveolar Bone Grafting / methods*
  • Alveolar Process / abnormalities*
  • Alveolar Process / surgery
  • Alveoloplasty / methods
  • Child
  • Cleft Palate / surgery*
  • Combined Modality Therapy
  • Female
  • Humans
  • Ilium
  • Male
  • Orthodontics, Corrective
  • Platelet-Rich Plasma
  • Retrospective Studies
  • Time Factors
  • Transplantation, Autologous
  • Treatment Outcome