Paediatric OMS

Question 1

What is the paper that much of the Alveolar Bone Graft technique based upon?

Answer 1

Ochs 1996

Ochs, MW., 1996, “Alveolar Cleft Bone Grafting (Part II): Secondary Bone Grafting”, J Oral Maxillofac Surg.; 54:83-8

Question 2

What was Ochs’ 1996 paper describing?

Answer 2

The best technique for Alveolar Bone Graft Repair.

Discussed Timing - usually when canine root tip is 1-2/3rds complete, but this may change if the lateral incisor is involved and also if there are other social reasons which may change things.

Ideal Graft - Autogenous bone is gold standard. For large or bilateral clefts - Iliac crest is ideal. For unilateral/small then calvarium and mandibular ramus could be considered.

Imaging - Maxillary oblique occlusal to assess the outcome “Kindelean score”

Question 3

What are the aims of alveolar bone grafting?

Answer 3

To:

1. Obtain Bony Continuity
2. Support erupting teeth
3. Closure of any Oronasal communication
4. Support the nasal ala
5. Improve the arch form
6. Improve the gingival contour
7. Support maxillary growth

Question 4

Generally speaking, what is the appropriate time to consider Alveolar bone grafting

Answer 4

When the associated permanent canine root’s are 1/3 to 2/3 formed. This is usually around the ages of 9-11.

Specifically though, this can change depending on the involvement of the permanent lateral incisor and also for other social or medical reasons, hence the importance of the MDT.

Question 5

What is the gold standard graft type for the ABG?

Answer 5

Autogenous bone harvest.

Ochs 1996 goes through the advantages and disadvantages of each harvest site.

There are new studies considering the use of recombinant human morphogenic protein 2 (rh-BMP2) however current literature doesn’t show any outcome differences with its use.

Question 6

Advantages and Disadvantages of Iliac Crest bone graft for ABG

Answer 6

Advantages:
1. Large quantity of cancellous bone
2. Decreased operative time with two-team approach
Disadvantages:
Second distant site morbidity
1. Mild transient gait disturbance
2. Risk of Loss of sensation of lateral thigh

Question 7

For large cleft or bilateral clefts, what would the most appropriate graft site be?

Answer 7

Iliac crest. Large quantitiy of cancellous bone can be harvested. Two team approach can be used.

Question 8

Advantages and Disadvantages of Mandibular symphysis bone graft for ABG

Answer 8

Advantages
1. Same operative field
2. Rapid procurement
3. Minimal pain
Disadvantages
1. Sparse diploic/cancellous bone
2. Increased operative time with single-team approach

Suitable - only for small, unilateral defects

Question 9

What are the different sites available to donate for ABGs?

Answer 9