Bone fill following secondary alveolar bone grafting for children with cleft of the alveolus in New Zealand.

ABSTRACT

OBJECTIVE: To investigate the amount of bone fill post-secondary alveolar bone grafting for children with cleft in New Zealand. SETTINGS AND SAMPLE POPULATION Retrospective analysis of post-operative intra-oral periapical and upper anterior occlusal radiographs of 45 grafted sites where all grafting was undertaken within the New Zealand public hospital service. MATERIALS AND METHODS: A modified Kindelan Index and a 100 mm visual analogue scale (VAS) were used to assess the amount of bone fill using intra-oral radiographs by 4 orthodontists experienced in cleft care and who were blind to the patient's identity. Fourteen duplicated radiographs were randomly selected and added to the sample for reliability assessment. RESULTS: The Kindelan Index rated 37.8% Grade 1 (Good), 31.1% rated Grade 2 (Satisfactory), 22.2% rated Grade 3 (Unsatisfactory) and 8.9% Grade 4 (Failure), a combined unsatisfactory/failure rate of 31.1%. The average VAS score was 50 mm ± 24 mm, and there was a strong relationship between Kindelan and VAS assessments. Those patients aged 10-11 years had significantly better outcomes using both assessments compared to those aged <10 and >11. The VAS assessment found that higher caseload surgeons had better outcomes, although the difference was of borderline statistical significance (mean VAS 56 mm vs 44 mm P = 0.07). CONCLUSIONS: Contemporary secondary alveolar bone grafting bone fill outcomes in New Zealand are poor when compared to contemporary international studies. These findings indicate a review of secondary bone grafting is required to improve outcomes for New Zealand children with cleft.