Secondary bone grafting of alveolar clefts: A densitometric comparison of iliac crest and tibial bone grafts

Objective: To evaluate changes in the optical density of secondary alveolar cleft bone grafts obtained from two different donor sites over time and to determine whether one donor site gives a higher recipient bone density tha n the other. Methods: A prospective study was performed evaluating 40 healthy patients w ith congenital cleft lip and palate undergoing secondary alveolar bone graf ting, 20 (14 boys and 6 girls) having iliac crest and 20 (12 boys and 8 gir ls) receiving tibial bone grafts. Bone harvest and grafting was carried out by one operator (G.P.). Optical density of iliac and tibial grafts measure d using a computerized densitometer, was compared at 6 days, 6 weeks, and 3 months. Due to interference from orthodontic appliances, optical density m easurements for 16 subjects were not possible, and these patients were excl uded from the study. The length of hospital stay postoperatively for both g rafting procedures were recorded. Results: A significant decrease in relative bone density was demonstrated d uring the 3-month postoperative period in both iliac and tibial bone graft groups (p < .05). The difference in densities between iliac crest and tibia l groups were not significantly different at any of the time points (paired t test, p > .05). Subjects undergoing iliac crest grafts stayed an average of 5 days in the hospital postoperatively, compared with subjects with tib ial grafts who stayed an average of 3 days postoperatively. Conclusion: Optical density measurements of bone grafted into alveolar clef ts, reported here for the first time, provide a valuable objective assessme nt of graft progress. Tibial and iliac crest grafts gave similar optical de nsities at recipient sites over the first 3 months. Iliac crest grafts requ ired significantly longer postoperative stay; an important consideration in selecting donor sites for secondary bone grafting.