Early secondary closure of alveolar clefts with mandibular symphyseal bone grafts and β-tri calcium phosphate (β-TCP)

Donor site procedure. (a) A complete thickness hole was created with a drill. (b) Using an oscillating saw a rectangular bone transplant was harvested. (c) The bicortical mandibular symphyseal bone graft was elevated, leaving (d) the lower border intact.

Symphyseal bone graft (a) with β-TCP granules (black arrow). Space discrepancies were filled with the β-TCP granules. At the buccal side of the bone transplant the granules function as barrier (a).

β-TCP granules were positioned at the buccal side of the graft and remaining minor spaces, in such a way that the central part of the cleft region was always filled by autogenous bone forming a bony bridge between the adjacent parts of the maxilla.

(a) Direct postoperative occlusal radiograph. (b) 1 year postoperative occlusal radiograph. Root length of the incisor adjacent to the former cleft (A). Alveolar height (B). Comparing A with B gives the ratio of the alveolar height to the length of the incisor. Percentage loss of alveolar height after 1 year can be determined by comparing A with B.