Sains Malaysiana 49(2)(2020): 349-356

http://dx.doi.org/10.17576/jsm-2020-4902-13

 

Orthodontic Considerations in Bone Graft Selection for Alveolar Cleft Repair

(Pertimbangan Ortodontik dalam Pemilihan Graf Tulang untuk Pembaikan Klef Alveolus)

 

ROHAYA MEGAT ABDUL WAHAB1*, WAN CHING NG1, FARINAWATI YAZID2, NUR ATMALIYA LUCHMAN1 & SHAHRUL HISHAM ZAINAL ARIFFIN3

 

1Discipline of Orthodontics, Department of Family Oral Health, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Jalan Raja Muda Aziz, 50300 Kuala Lumpur, Federal Territory, Malaysia

 

2Discipline of Paediatric Dentistry, Department of Family Oral Health, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Jalan Raja Muda Aziz, 50300 Kuala Lumpur, Federal Territory, Malaysia

 

3Department of Biotechnology and Functional Food, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor Darul Ehsan, Malaysia

 

Received: 12 February 2019/Accepted: 6 November 2019

 

ABSTRACT

The enthusiastic development of non-autogenous bone graft materials to correct oral cleft defects in dentistry is founded on arguments of post-operative morbidity and quantity limitation when using conventional iliac crest bone grafts. While success in tooth movement is usually reported for the grafted extraction socket, the results cannot be extrapolated to congenital alveolar clefts as there are differences in terms of vasculature and soft tissue support. This paper provides an overview of the dental and skeletal anomalies in cleft patients, followed by the orthodontic implications of cleft correction and, lastly, a review of the available evidence in bone grafts used for alveolar clefts alone. The non-autogenous grafts used are derived from another human (allografts), animal (xenografts), synthetic bones (alloplasts) or the latest tissue-engineered graft material. The main advantage of using these grafts is a reduction in the number of operative sites. The drawbacks are cost, reduced tooth movement, possibility of root resorption and host reaction. Tissue-engineered grafts seem promising but there is still a lack of clinical trials in human subjects. Important properties related to orthodontics are the graft resorption rate, along with the effect on root resorption and tooth movement rate. To date, autogenous bone grafts remain the first choice for cleft repair.

 

Keywords: Alveolar bone graft; autogenous bone; cleft palate; orthodontic tooth movement; tissue engineering

 

Abstrak

Kadar morbiditi yang tinggi setelah pembedahan graf tulang alveolar serta keterbatasan kuantiti tulang penderma daripada kresta iliak mencetuskan perkembangan pesat dalam teknologi penghasilan graf tulang bukan autogenus. Graf tulang bukan autogenus telah dilaporkan mampu menyokong pergerakan gigi secara ortodontik merentasi soket cabutan. Namun begitu, pergerakan gigi mungkin terhalang sekiranya graf tersebut digunakan pada defek yang lebih besar seperti klef alveolus kongenital. Ini disebabkan perbezaan daripada segi vaskularisasi dan sokongan tisu lembut antara kedua-dua jenis defek tersebut. Artikel ini membincangkan tentang anomali pergigian dan rahang pesakit klef bibir dan/atau lelangit, implikasi ortodontik terhadap pembetulan klef dan rumusan perkembangan semasa graf tulang yang digunakan dalam defek tulang alveolar. Sumber graf tulang bukan autogenus boleh diperoleh daripada manusia lain (alograf), haiwan (xenograf), bahan sintetik (aloplas) atau disediakan secara kejuruteraan tisu. Kelebihan utama penggunaan graf bukan autogenus adalah pengurangan bilangan kawasan pembedahan manakala kelemahannya termasuk kos yang tinggi, pergerakan gigi yang terhad dan kemungkinan berlakunya penyerapan akar gigi serta tindak balas tubuh badan perumah yang negatif. Penggunaan graf daripada teknologi kejuruteraan tisu mempunyai potensi yang memberangsangkan tetapi masih memerlukan lebih banyak bukti daripada kajian klinikal. Ciri-ciri penting sesuatu graf yang perlu dipertimbangkan dalam bidang ortodontik adalah kadar penyerapan graf, selain kesan terhadap penyerapan akar dan kadar pergerakan gigi. Sehingga kini, graf tulang autogenus masih menjadi pilihan dan merupakan kaedah piawai dalam rawatan pembetulan klef tulang alveolar.

 

Kata kunci: Graf tulang alveolar; klef lelangit; kejuruteraan tisu; pergerakan gigi secara ortodontik; tulang autogenus

 

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*Corresponding author; email: rohaya_megat@ukm.edu.my

 

 

 

 

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