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Efficacy of bone marrow concentrate and demineralized bone matrix for secondary alveolar bone grafting
Gregory M. Beddell, MD, Ananth S. Murthy, MD, Niyant V. Patel, MD, Candace K. Knuth, PAC
Summa Health System and Children's Hospital Medical Center of Akron
2014-03-14
Presenter: Gregory M. Beddell
Affidavit:
The majority of this project is the original work of the resident
Director Name: Douglas S. Wagner
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: The cleft alveolus is traditionally closed with iliac crest bone graft; obtained via an open approach. We propose a minimally invasive technique that combines percutaneously harvested bone marrow concentrate (BMC) with demineralized bone matrix (DBM).
Methods: A review was performed of all patients undergoing alveolar cleft closure utilizing the minimally invasive technique. Patients with a minimum follow-up of three months and a focused dental CT were included. The Enemark scale was used to assess graft take.
Results: Nineteen consecutive patients were reviewed in a 15-month period from 2012-2013. Fifteen patients, with an average age of 11 years, had a unilateral cleft. Four patients, with an average age of 12.3 years, had bilateral clefts. The mean follow-up period was 8.7 months. In unilateral clefts, 60% were Enemark level 1, 26.7% were level 2, 6.7% were level 3, and 6.7% were level 4 on a focused dental CT. In bilateral clefts, 75% were level 1, 12.5% were level 2, 0% were level 3, and 12.5% were level 4. Two patients (8.7% of grafts) had bone exposure requiring a minor office procedure. One case (4.3%) required a second graft because of failure. There were no donor site complications. No differences were identified between unilateral and bilateral cases. The last 7 patients had an average length of stay of 5.4 hours, compared to our institutional experience of 24 hours (p<0.01).
Conclusions: The minimally invasive technique has comparable results to our historical data with a potentially reduced donor site morbidity and length of stay.
