The current gold standard treatment for oral clefts is autologous bone grafting. This treatment, however, presents another wound site for the patient, greater discomfort, and pediatric patients have less bone mass for bone grafting. A potential alternative treatment is the use of tissue engineered scaffolds. Hydrogels are well characterized nanoporous scaffolds and cryogels are mechanically durable, macroporous, sponge-like scaffolds. However, there has been limited research on these scaffolds for cleft craniofacial defects. 3D-printed molds can be combined with cryogel/hydrogel fabrication to create patient-specific tissue engineered scaffolds. By combining 3D-printing technology and scaffold fabrication, we were able to create scaffolds with the geometry of three cleft craniofacial defects. The scaffolds were then characterized to assess the effect of the mold on their physical properties. While the scaffolds were able to completely fill the mold, creating the desired geometry, the overall volumes were smaller than expected. The cryogels possessed porosities ranging from 79.7% to 87.2% and high interconnectivity. Additionally, the cryogels swelled from 400% to almost 1500% of their original dry weight while the hydrogel swelling did not reach 500%, demonstrating the ability to fill a defect site. Overall, despite the complex geometry, the cryogel scaffolds displayed ideal properties for bone reconstruction.

https://www.mdpi.com/2079-4983/9/3/46/pdf

Tissue Engineering Scaffolds Fabricated in Dissolvable 3D-Printed Molds for Patient-Specific Craniofacial Bone Regeneration.

Dental implants are one of the best valid tooth replacement options, though these are not always appropriate in growing young patients. Tooth autotransplantation can be indicated then. However, this is not the only scenario where dental transplantation can be indicated. This comprehensive literature review discusses a wide range of unusual indications of dental transplantation as reported throughout the medical literature. Surprisingly, these indications include management of some developmental dental anomalies, hypodontia, oroantral communications, alveolar clefts, deficient alveolar ridges, ectopic teeth, and maxillofacial injuries. Limited high-quality evidence in this field regarding most of these unusual indications warrants further research of high-quality design.

/pdf/unusual-indications-of-teeth-transplantation-a-literature-2q5527f0.pdf

Unusual Indications of Teeth Transplantation: A Literature Review

This study investigated the levels of bone morphogenetic protein 2 (BMP-2), osteocalcin, and 3D CT Hounsfield units following hyperbaric oxygen therapy (HBOT) in patients with cleft lip and palate (CLP) undergoing alveolar bone grafts to provide a pilot evaluation of the role of HBOT in osteogenesis.This prospective, quasi-experimental, pre-post-intervention study evaluated seven patients with CLP receiving HBOT after single-stage reconstructions with alveolar bone grafts. The outcomes included the serum levels of BMP-2 and osteocalcin and the 3D CT Hounsfield units obtained before and after the surgery, and after the five HBOT sessions, to a total of 12 measurements. The data were analyzed with linear mixed-effects models using the intervention stage (pre-surgery, pre-HBOT, first to fifth HBOT sessions) as covariates and adjusting for several baseline factors.A significant difference was found in outcome measures across time (ANOVA p < 0.001 for BMP-2 and osteocalcin, p = 0.01 for Hounsfield units), with mean values appearing to steadily increase once HBOT began. Regression analyses indicated that the effect of HBOT was evident in serum osteocalcin after the 1st HBOT session (adjusted b = 1.32; 95% CI 0.39, 2.25) and in serum BMP-2 after the third session (adjusted b = 6.61; 95% CI 1.93, 11.28). After the fifth session, the HBOT effect was fairly pronounced on the two outcomes: the adjusted increase compared to the baseline was 28.06 ng/mL for BMP-2 and 6.27 ng/mL for osteocalcin. Our mixed-effect models also showed a post-HBOT increase in Hounsfield units.We found an increase of BMP-2, osteocalcin, and Hounsfield units following the HBOT intervention. These may suggest an effect of HBOT on osteogenesis. 

Serum BMP-2 and osteocalcin levels, and CT Hounsfield unit post hyperbaric oxygen therapy in patients with cleft lip and palate post alveolar bone graft: A case study

Presurgical evaluation of the alveolar cleft defect is an essential and crucial step for procedural success. This study proposes a method for rapid and precise volumetric assessment of alveolar cleft defects using computed tomography data and computer-aided engineering (CAE) software. For comparison, 3-dimensional-printed models of the alveolar bone were also made. A simulated graft was used on the models and the graft volume was measured using the water displacement technique. We then compared the CAE software-derived volumes with the actual volumes of the simulated grafts. The intraclass correlation coefficient ranged from 0.95 to 0.97 (intraobserver) and 0.94 to 0.98 (interobserver), indicating a high level of reliability and reproducibility of the CAE measurements. The mean time spent to calculate an alveolar cleft defect volume was 8.4 minutes. The average volume of the simulated bone grafts of 3-dimensional-printed models was 1.39 mL, which was lower than the mean volume of 1.42 mL calculated using the CAE software. The paired Student t-test showed no statistically significant difference between the volumes derived from the 2 methods. This study demonstrates that this quick assessment method is a useful adjunct to busy clinical practice.

Quick Method for Presurgical Volumetric Analysis of Alveolar Cleft Defects.

/pdf/sustained-release-of-catechin-from-gelatin-and-its-effect-on-pjrxkl4cg4.pdf

Sustained Release of Catechin from Gelatin and Its Effect on Bone Formation in Critical Sized Defects in Rat Calvaria

/pdf/presadivanje-kosti-u-alveolarni-greben-pacijenta-s-rascjepom-3j5odslacz.pdf

Presađivanje kosti u alveolarni greben pacijenta s rascjepom: od koštanog defekta do zubnih implantata

Cleft lip and palate is the most common congenital deformity affecting craniofacial structures. Orofacial clefts have great impact on the quality of life which includes aesthetics, function, psychological impact, dental development and facial growth. Incomplete fusion of facial prominences during the fourth to tenth week of gestation is the main cause. Cleft gaps are closed with alveolar bone grafts in surgical procedure called osteoplasty. Autogenic bone is taken from the iliac crest as the gold standard. The time of grafting can be divided into two stages: primary and secondary. The alveolar defect is usually reconstructured between 7 and 11 years and is often related to the development of the maxillary canine root. After successful osteoplasty, cleft defect is closed but there is still a lack of tooth. The space closure with orthodontic treatment has 50-75% success. If the orthodontic treatment is not possible, in order to replace the missing tooth there are three possibilities: adhesive bridgework, tooth transplantation and implants. Dental implant has the role of holding dental prosthesis, prevents pronounced bone atrophy and loads the augmentation material in the cleft area. Despite the fact that autologous bone from iliac crest is the gold standard, it is not a perfect source for reconstruction of the alveolar cleft. Bone morphogenic protein (BMP) is appropriate as an alternative graft material. The purpose of this review is to explain morphology of cleft defects, historical perspective, surgical techniques and possibilities of implant and prosthodontic rehabilitation.

/pdf/alveolar-bone-grafting-in-cleft-patients-from-bone-defect-to-g8hos9rixl.pdf

Alveolar Bone Grafting in Cleft Patients from Bone Defect to Dental Implants.

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Presađivanje kosti u alveolarni greben pacijenta s rascjepom: od koštanog defekta do zubnih implantata

Alveolar Bone Grafting in Cleft Patients from Bone Defect to Dental Implants.