Secondary Alveolar Bone Grafting for a large Cleft alveolar defect
1. Before bone grafting | 2. Surgical exposure of cleft alveolus | 3. Secondary alveolar bone graft done | 4. Closure done.
What is Cleft alveolar?
Cleft alveolar Almost 90 percent of the individuals with cleft lip have an associated Cleft Clveolus too. this defect is not that visible to the naked eyes as it lies beneath the gums and the side or the alar part of the nose.
What is SABG or Secondary Alveolar Bone Grafting?
SABG is a procedure wherein bone is harvested from some other place in the body and the alveolar defect is grafted. It is called secondary as this procedure is usually done just before the eruption of the secondary teeth or the permanent teeth in the region. Earlier, decades before, even primary bone grafting used to be done in some countries but after much research, it has been found out that SABG is better for the patients. To augment the success of this procedure, we also add platelet-rich fibrin as an over and /or an underlayer. The preferred site for bone harvest is the iliac crest or the hip bone. Since we at Richardsons Dental and Craniofacial Hospital use the keyhole technique to harvest this bone, it barely leaves any scar.
What is exactly done in the surgery?
In the surgery, bone is harvested from the donor site and cut into small pieces. This then is tightly packed in the cleft alveolar defect in a three-dimensional fashion eliminating any fistulae or openings.
What is the downtime?
The patient usually needs to stay in the hospital for around 3 to 4 days. A further 10 days of rest is needed as well.
What are the advantages?
if done correctly and perfectly, the main advantage is that the permanent teeth erupt in its normal position ( without the bone it would be unable to erupt or come into the oral cavity ). At the same time, the nasal base symmetry is also achieved in most cases as the alveolar defect well extends up to the nasal base. Thirdly, any small fistulas or communications can also be concomitantly addressed or closed.
What is the ideal time?
The ideal time for this procedure is decided after taking some radio-graphs or cone beam CT scans. It is usually between 7 and 9 years of age.
What happens for individuals who haven’t got SABG surgery?
Well, the teeth in that region don’t come down into the mouth and so they are gaps. Sometimes, they might erupt in crooked fashions too. Plus the fistulas in the region could adversely affect speech. But there is still hope for individuals who haven’t got this done at the most appropriate age. Dr. Sunil Richardson and his team are able to perform some variation of the surgery and improve the smile and the nasal symmetry of these patients as well… hence all is not lost if not done at the right time.
With the vast experience of the Craniofacial team headed by Dr. Richardson, and with the able support of efficient team members, quality surgical results have been consistently delivered for a decade and a half now. More than 1000 patients have undergone this procedure thus far with excellent long-term results. Our vision and goal to make these individuals with clefts just like others without clefts would not be true without these kinds of many secondary procedures that enable us to iron out each and every defect systematically.
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