Effect of Platelet Rich Plasma (PRP) on Bone Graft in Alveolar Cleft Repair

Osman, Omar; Kamel, Ibrahim H; Elshereif, Ahmed; Mohamed, Ahmed M; Magdy, Amr

doi:10.21608/ejprs.2020.68177

Effect of Platelet Rich Plasma (PRP) on Bone Graft in Alveolar Cleft Repair

Document Type : Original Article

Authors

¹ The Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Minia* University

² The Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Ain Shams University

³ The Department of Plastic, Burn and Maxillofacial Surgery, Faculty of Medicine, Minia University

10.21608/ejprs.2020.68177

Abstract

Background: Ultimate repair of alveolar defects is a great
challenge in practical field, many bone graft materials have
been evolved in the literatures for alveolar defect reconstruction
as autogenous, allogenic, xenogenic, and alloplastic grafts
[1], autogenous iliac crest bone graft is the gold standard
among other graft materials evaluated. However, the procedure
associated with a potential risk of early complications such
as graft resorption, graft leakage, infection, or graft failure,
failure rate is about 30% [2].
Objectives: To assess the efficacy of using Platelet Rich
Plasma (PRP) in alveolar cleft reconstruction; in combination
with Iliac Crest Bone Graft (ICBG) in comparison to the
conventional Iliac Crest Bone Grafting (ICBG).
Patients and Methods: 20 patients underwent alveolar
cleft reconstruction at the age of mixed dentition over a 3-
year's period; their mean age was 8.8±2.3 years years and
their mean post-operative follow-up was 13.4 months. Of
these, 10 patients treated with ICBG combined with PRP
(Group I), and 10 patients repaired by ICBG alone Group II
(control group) results were assessed by rating the radiographs
obtained 3, 6, and 12 months post-operatively according to
cone beam CT (CBCT) volume and density assessment.
Results: Alveolar cleft repairs using PRP combined cancellous
bone (Group I) were 90 percent successful, alveolar
cleft repairs using cancellous bone (Group I) were 70 percent
successful as regard; bone resorption reduction, bone volume
gaining and improved bone density in CBCT at 3, 6, and 12
months post-operative with decreased post-operative complication
rates.
Conclusion: Application of 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 post-operative complications.

Keywords

Main Subjects

References

1- Abyholm F.E., Bergland O. and Semb G.: Secondary bone
grafting of alveolar clefts. A surgical/orthodontic treatment
enabling a non-prosthodontic rehabilitation in cleft lip
and palate patients. Scand J. Plast. Reconstr. Surg., 15:
127-40, 1981.
2- Long R.E. Jr., Spangler B.E. and Yow M.: Cleft width
and secondary alveolar bone graft success. Cleft. Palate
Craniofac. J., 32: 420-7, 1995.
3- Enemark H., Krantz-Simonsen E. and Schramm J.E.:
Secondary bone grafting in unilateral cleft lip and palate
patients: Indications and treatment procedure. Int. J. Oral
Surg., 14: 2-10, 1985.
4- Boyne P.J.: Bone grafting in the osseous reconstruction
of alveolar and palatal clefts. Oral Maxillofac. Surg. Clin.
North. Am., 3 (3): 589-97, 1991.
5- Johanson B. and Ohlsson A.: Bone grafting and dental
orthopaedics in primary and secondary cases of cleft lip
and palate. Acta. Chir. Scand., 122: 112-24, 1961.
6- Semb G.: Effect of alveolar bone grafting on maxillary
growth in unilateral cleft lip and palate patients. The Cleft
palate Journal, 1988.
7- Skoog T.: The use of periosteum and Surgicel for bone
restoration in congenital clefts of the maxilla. A clinical
report and experimental investigation. Scand J. Plast.
Reconstr. Surg., 1: 113-30, 1967.
8- Ritsila V.: Bone formation with free periosteal grafts in
reconstruction of congenital maxillary clefts. Annales
chirurgiae et gynaecologiae, 65 (5): 342-4. February 1972.
9- Rosenstein S., Dado D.V., Kernahan D., et al.: The case
for early bone grafting in cleft lip and palate: A second
report. Plast. Reconstr. Surg., 87: 644, 1991.
10- Bergland O., Semb G., Abyholm F., et al.: Secondary
bone grafting and orthodontic treatment in patients with
bilateral complete clefts of the lip. Annals of Plastic
Surgery J., 17 (6): 460-74, 1986.
11- Enemark H., Krantz-Simonsen E. and Schramm J.E.:
Secondary bone grafting in unilateral cleft lip and palate
patients: Indications and treatment procedure. Int. J. Oral
Surg., 14: 2-10, 1985. Sommerlad B.C.: A technique for
cleft palate and alveolus repair. Plast. Reconstr. Surg.,
112: 154, 2004.
12- Nagashima H., Sakamoto Y., Ogata H., et al.: Evaluation
of bone volume after secondary bone grafting in unilateral
alveolar cleft using computeraided engineering. Cleft
Palate Craniofac. Surg., 51: 665-8, 2014.
13- Rosenstein S.W., Long R.E. Jr., Dado D.V., et al.: Comparison
of 2-D calculations from periapical and occlusal
radiographs versus 3-D calculations from CAT scans in
determining bone support for cleft adjacent teeth following
early alveolar bone grafts. Cleft Palate Craniofac. J., 34:
199-205, 1997.
14- Everts P.A., Brown Mahoney C., Hoffmann J.J., et al.:
Platelet-rich plasma preparation using three devices:
Implications for platelet activation and platelet growth
factor release. Growth Factors, 24: 165-71, 2006.
15- Berkowitz S., Mejia M. and Bystrik A.: A comparison of
the effects of the Latham-Millard procedure with those
of a conservative treatment approach for dental occlusion
and facial aesthetics in unilateral and bilateral complete
424 Vol. 43, No. 3 / Effect of Platelet Rich Plasma (PRP) on Bone Graft in Alveolar Cleft Repair
cleft lip and palate: Part I. Dental occlusion. Plast. Reconstr.
Surg., 113: 1-18, 2004.
16- Eppley B.L., Woodell J.E. and Higgins J.: Platelet quantification
and growth factor analysis from platelet-rich
plasma: Implications for wound healing. Plast. Reconstr.
Surg., 114: 1502-8, 2004.
17- Hagberg C., Larson O. and Milerad J.: Incidence of cleft
lip and palate and risks of additional malformations. Cleft
Palate Craniofac. J., 35: 40, 1998.
18- Van Hout W.M., Mink Van Der Molen A.B., Breugem
C.C., Koole R. and Van Cann E.M.: Reconstruction of
the alveolar cleft: Can growth factor-aided tissue engineering
replace autologous bone grafting? A literature
review and systematic review of results obtained with
bone morphogenetic protein-2. Clin. Oral Investig., 15
(3): 297-303, 2011.
19- Sarkar M.R., Augat P., Shefelbine S.J., Schorlemmer S.,
Huber-Lang M., et al.: Bone formation in a long bone
defect model using a platelet-rich plasma-loaded collagen
scaffold. Biomaterials, 27: 1817-23, 2006.
20- Feichtinger M., Zemann W., Mossböck R., et al.: Threedimensional
evaluation of secondary alveolar bone grafting
using a 3D-navigation system based on computed tomography:
A two-year follow-up. Br. J. Oral Maxillofac. Surg.,
46: 278-82, 2008.
21- Boyne P.J. and Sands N.R.: Combined orthodontic-surgical
management of residual palato-alveolar cleft defects. Am.
J. Orthod., 70 (1): 20-37, 1976.
22- Feichtinger M., Zemann W., Mossböck R., et al.: Threedimensional
evaluation of secondary alveolar bone grafting
using a 3D-navigation system based on computed tomography:
A two-year follow-up. Br. J. Oral Maxillofac. Surg.,
46: 278-82, 2008.
23- Shirota T., Kurabayashi H., Ogura H., et al.: Analysis of
bone volume using computer simulation system for secondary
bone graft in alveolar cleft. Int. J. Oral Maxillofac.
Surg., 39: 904-8, 2010.
24- Zhang W., Shen G., Wang X., Yu H. and Fan L.: Evaluation
of alveolar bone grafting using limited cone beam computed
tomography. Oral Surg. Oral Med. Oral Pathol.
Oral Radiol., 113: 542-8, 2012.
25- Lee C., Nishihara K., Okawachi T., Iwashita Y., Majima
H.J. and Nakamura N.: A quantitative radiological assessment
of outcomes of autogenous bone graft combined
with platelet-rich plasma in the alveolar cleft. Int. J. Oral
Maxillofac. Surg., 38 (2): 117-25, 2009.
26- Macisaac Z.M., Rottgers S.A., Davit A.J., 3rd, Ford M.,
Losee J.E. and Kumar A.R.: Alveolar reconstruction in
cleft patients: Decreased morbidity and improved outcomes
with supplemental demineralized bone matrix and cancellous
allograft. Plast. Reconstr. Surg., 130 (3): 625-32,
2012.