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Clefting of the alveolar process is present in the majority of patients (75%) with cleft lip and palate. A peri-alveolar, oronasal fistula, commonly associated with the bony cleft, communicates between the alveolus, anterior hard palate, and floor of the nose
Repair of bony defects continues to be a challenging part of the many reconstructive procedures. Although autogenously bone graft remains the standard in the reconstruction of bony defects, there are disadvantages, including the limited amount of available bone and donor site morbidity. Regenerative medicine approaches can potentially obviate these problems by using platelet rich plasma or isolation of undifferentiated mesenchymal cells from the bone marrow that can differentiate into osteoblasts.
The use of Platelet-rich plasma (platelet gel--PRP--) was introduced in the oral and maxilofacial surgery 10 years ago. Its good results are due to the quickly generation of new bone and the acceleration of the period of surgical scar formation. Its employment in the alveolar reconstruction of the cleft patient is not still consistent and the works published in the literature are infrequent.
In our study on twenty patients in age group from 6 to 13 years patients divided into 2 main groups group I ten patients with alveolar cleft treated by iliac bone graft only and group II treated by iliac bone graft combined with PRP we found good results with group II according to wound healing, fewer post-operative complications, good bone quality, density and bone regeneration.
We found evidence for PRP application to facilitate bone formation in secondary alveoloplasty although its consistency makes easier handling and packing the graft. Though use of Platelet-rich plasma (PRP) is beneficial in reconstruction in patients with congenital alveolar clefts, if used with bone graft, it decrease bone graft resorption and enhances bone regeneration, its low price and morbidity do it recommendable for its employment in cleft patients.
Thus use of autogenous iliac graft combined with PRP for secondary alveolar bone grafting achieves all these several objectives: (1) to obtain maxillary arch continuity, (2) to maximize bone support for the dentition, (3) to stabilize the maxillary segments after orthodontic treatment, (4) to eliminate oronasal fistulae, (5) to provide nasal alar cartilage support, (6) to establish ideal alveolar morphology, and (7) to provide available bone with attached soft tissue for future endosteal implant placement in cases where there is a residual dental space. We advocate for the use of PRP with iliac crest bone graft for alveolar reconstruction.
On preliminary trials, PRP enhances bone formation in alveolar clefts when admixed with autologous bone graft harvested from the iliac crest as it leads to early bone formation, increased bone density, decreases bone resorption, low infection rate and least postoperative complications.
The present series is too small to obtain conclusive results. More prospective randomized controlled studies are needed to achieve definitive data against or in favour of PRP use on alveoloplasty of cleft patients. There are still two important points with no agreement. The first one is to establish a standard method of obtaining PRP so that its properties were comparable in different studies. The second point is to accord an accepted way to quantify bone increase after alveoloplasty.