Secondary alveolar bone grafting (CLEFTSiS) 2000-2004

Objective: To determine whether alveolar bone graft outcomes improved with reorganization of Scottish cleft services following the Clinical Services Advisory Group United Kingdom finding of 58% success and to determine the accuracy of results from CLEFTSiS (national managed clinical network for Scottish cleft services) annual audits.

Design: Retrospective random analysis of electronic radiographs by two observers.

Setting: Surgical-orthodontic care provided through National Health Service.

Patients, Participants: Sixty-three of 261 patients eligible for alveolar bone grafting by cleft type did not undergo surgery. Nine surgeons operated on 198 patients (2 regrafts). Radiographs were available for 115 subjects (one was excluded).

Interventions: A standard protocol involved presurgical maxillary expansion (where necessary) and bone harvesting from the iliac crest.

Main Outcome Measure(s): The Kindelan Bone-Fill Index evaluated radiographic success with weighted kappa statistics for intraobserver and interobserver reproducibility. Two-sample t-tests were used to determine whether outcomes for bilateral and unilateral cleft lip and palate patients differed and to examine the effects of operator volume, presurgical expansion, and age at the time of grafting.

Results: Intraobserver (0.93 to 0.97) and interobserver (0.83 to 0.85) reproducibility were almost perfect. Grafts were successful in 76% of patients, while 23% were partial failures and 1% of cases were total failures. Patients who underwent presurgical expansion (n = 64) had statistically significantly better results (p = .046). However, there was no statistically significant effect for unilateral versus bilateral patients (p = .77), patients treated by the highest volume operator (p = .78), and patients under 11 years of age (p = .29).

Conclusions: CLEFTSiS alveolar bone graft results between 2000 and 2004 were improved on the Clinical Services Advisory Group study and annual CLEFTSIS audits. Patients who underwent maxillary expansion prior to surgery were more successful.