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Objective: To compare osseous outcomes of block and cancellous iliac bone grafting in older unilateral alveolar cleft patients., Design: Retrospective and observational follow-up study., Setting: Cleft Lip and Palate Centre, Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, China., Patients: Forty-five nonsyndromic patients with unilateral complete alveolar cleft were enrolled in this study (25 patients in block bone graft group and 20 patients in cancellous bone graft group)., Interventions: In cancellous bone graft group, the alveolar cleft was filled with iliac cancellous bone particulate. In group of block bone graft, the harvested bone block was trimmed and fixed in alveolar defect., Main Outcome Measures: A novel method was proposed to investigate the volume and density of residual bone graft at 1-week, 3- and 6-month, 1- and 2-year postoperatively based on cone beam computed tomography scans., Results: No difference in bone graft volume was found between 2 groups at 1-week and 3-month postoperatively; however, the residual volume of block bone graft group was significantly larger than that of cancellous bone graft group at 6-month, 1- and 2-year postoperatively. The bone density of block bone graft group was lower at 1-week and 3-month postoperatively but was comparable at 6-month, 1- and 2-year postoperatively. Our method was reliable and accurate to identify the range of residual bone graft when the boundary of grafted bone could not be identified clearly., Conclusion: Block bone graft could achieve comparable bone density and retain a greater amount of residual bone comparing to cancellous bone graft.

Purpose: This study evaluated the biologic response to titanium mesh and autogenous particulate bone grafts for the reconstruction of segmental mandibular defects in a dog model., Materials and Methods: Unilateral 40-mm critical-sized continuity defects of the mandible were made in five beagle dogs. Titanium mesh was shaped and fixed with titanium screws in the defects. Autogenous bone was harvested from the ablated mandible and iliac crest (the ratio of cortical bone:cancellous bone was 3:1) and used to fill the mesh. Two implants were placed into each bone graft. The animals were sacrificed after 6 months. Radiographs, histologic sections, scanning electron microscopy, and energy dispersive spectroscopy were performed to evaluate bone formation and osseointegration of the implants in the reconstructed mandibles., Results: The outline of the reconstructed mandible was satisfactory, and no bone resorption was observed in the defect area. All implants showed excellent osseointegration of the grafted bone. Furthermore, the density of bone formed around the implants was higher than that seen in control samples (intact, ungrafted dog hemimandibles)., Conclusions: Shaped titanium mesh with autogenous particulate bone graft is a predictable method for restoring critical-sized continuity defects of the mandible. Simultaneous implant placement is feasible and the structure of bone formed near implants may be optimal.

Objective: To observe the healing and bone formation of the autogenous particulate bone graft and osseointegration of the implants in shaped titanium mesh with autogenous particulate bone graft and simultaneous implant for reconstructing segmental mandibular defect in dogs., Methods: Five Beagle dogs were prepared with unilateral 40 mm segmental mandibular defect. Titanium mesh was shaped according to the mandibular defect and was fixed with titanium screws. The ablated mandibular bone and iliac bone were crashed to approximately 2 mm particulates which then filled the titanium mesh tightly (cortical bone:cancellous bone, 3:1). Two implants were placed in the autogenous particulate bone graft. The dogs were sacrificed after six months. X-ray films, histological sections, Scanning electron microscopy(SEM) and Energy disperse analysis of the reconstructed mandibles were examined to evaluate the bone formation of the bone graft and osseointegration of the implants., Results: The outline of the reconstructed mandible was satisfactory and its function was excellent. The ossific fusion among the particulate bone grafts was fine and no resorption was found. All implants showed excellent osseointegration with the bone graft. The bone near the implant was more compact than the bone away from it. The structure of the bone near implant was optimized because of simultaneous implant in shaped titanium mesh., Conclusions: The shaped titanium mesh with autogenous particulate bone graft is a good method for reconstructing segmental mandibular defect, and simultaneous implant is feasible in the reconstructed mandible in dogs.