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Sains
Malaysiana 49(2)(2020): 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, 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
Diserahkan:
12 February 2019/Diterima: 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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*Pengarang
untuk surat-menyurat; email: rohaya_megat@ukm.edu.my
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