Impact of alveolar bone grafting on bone resorption in patients with cleft lip and palate: a 3D analysis

Abstract

A cleft lip and palate are congenital defects that occur when the tissues of the face and mouth do not fuse properly during fetal development. These defects often require the use of bone grafts to achieve successful correction of the maxillary region. This study aims to investigate bone resorption in cleft lip and palate defects, specifically in the coronal and axial planes. Seventy CT images (2 per patient with a six-month interval) were collected from 35 patients at the Hospital Sant Joan de Déu. These images were segmented and exported, allowing for the extraction of different measurements. The ideal bone volume to correct the cleft was also computed using the patient’s skull STL file. The bone grafts were segmented and exported. They were processed using an iterative closest point (ICP) algorithm, focusing on the stable upper cranial region to ensure proper alignment between the two grafts (0 months and 6 months). A novel algorithm called Volume Processing Algorithm(VPA) was then applied to observe graft resorption patterns. The study yielded significant findings, including patient-specific ideal volumes, oversampled bone graft amounts during placement, and directions of bone resorption. These results have important implications, offering a pioneering methodology for STL analysis and providing valuable insights for surgeons. The findings can guide future studies to improve graft oversampling control, enhance osseointegration and address the varying importance of resorption in different anatomical regions. Furthermore, this study supports the hypothesis that bone resorption occurs in both the coronal and axial planes in cleft lip and palate defects.