PLACEMENT OF ENDOSSEOUS IMPLANTS IN GRAFTED ALVEOLAR CLEFTS

Objective: The purpose of this study was to determine the optimal timi ng for placement and to evaluate short-and long-term outcomes of endos seous implants in bone-grafted alveolar clefts. Design: Fourteen patie nts who underwent alveolar cleft bone grafting (ACBG) and closure of a n oronasal fistula followed by restoration of the missing lateral inci sor tooth using endosseous implants (EI) were studied. The oronasal fi stulae were closed using local flaps, and the alveolus was grafted wit h fresh autogenous iliac marrow. Endosseous implants were placed a min imum of 4 months following ACBG. The average age at ACBG was 20.35 yea rs (range, 12-65 yr), and at implant placement 22.2 years (range, 15-6 6 yr). It was necessary to regraft the alveolar cleft region in six pa tients to provide adequate bone volume for implant placement. Those wh o required alveolar regrafting had an increased mean interval between the initial ACBG and planned implant placement compared to the patient s with adequate bone available for implant placement 26.4 months (rang e, 4-46 mo) versus 15.75 months (range, 4-36 mo). Results: Twenty-nine implants were placed in 14 patients, 9 outside of the cleft region an d 20 in grafted alveolar clefts. Eighteen of 20 (90%) implants in the bone-grafted alveolar clefts have been successfully restored. The mean followup after implant placement was 39.1 months (range, 1-54 mo), an d after restoration 28.5 months (range, 1-47 mo). Conclusions: Endosse ous implants can be placed in bone-grafted alveolar clefts. Considerat ion should be given to the adequacy of graft volume and ridge morpholo gy at the time of ACBG. The interval between ACBG and implant placemen t is important. The greater the interval beyond 4 months, the more lik ely there will be inadequate bone volume to accept an implant.