Background: Although different bone graft materials have
been suggested in the literatures for alveolar cleft reconstruction
including autogenous, allogenic, xenogenic, and alloplastic
grafts, Autogenous bone graft either from the iliac crest or
the tibial plateau remains the gold standard against which
other graft materials are evaluated. However, the procedure
is invasive and associated with a potential risk of early
complications such as bleeding, pain, infection, fracture and/or
late complications such as chronic pain, scarring, paresthesia
and gait abnormalities. Moreover, its failure rate is about
15%.
Objectives: To assess the efficacy of using adipose derived
stem cells (ASCs) in alveolar cleft reconstruction; whether
added to the cancellous bone or used with demineralized bone
matrix scaffold; in comparison to the conventional iliac crest
bone grafting (ICBG).
Patients and Methods: 24 patients underwent alveolar
cleft reconstruction at the age of mixed dentition over a 3-
years period; three of them had two grafted sites (bilateral
cleft cases) giving an overall total of 27 grafted sites assessed
during this study. Their mean age was 11.9 years and their
mean postoperative follow-up was 11.7 months. Of these, 9
constituted the ICBG group (standard group), 10 constituted
the ACSs with ICBG scaffold (ASCs/ICBG) group, whereas
the remaining 8 made up ACSs with DBM (ASCs/DBM)
group. Results were assessed by rating the radiographs obtained
6 months postoperatively according to Bergland scale.
Results: Alveolar cleft repairs using cancellous bone only
(ICBG group) were 77.8 percent successful, alveolar cleft
repairs using cancellous bone enhanced with ASCs (ASCs/
ICBG group) were 90 percent successful, and alveolar cleft
repairs using DBM enhanced with ASCs (ASCs/DBM group)
were 50 percent successful, but there were no significant
statistical difference between the groups. ASCs/DBM group < br />shows significantly shorter operative time, and higher cleft
site infection rates.
Conclusion: Using ASCs whether with DBM or ICBG is
not significantly better than the conventional method, while
using DBM significantly reduced operative time, but associated
with higher risk of infection.