Evaluation and volumetric analysis of various grafting materials for alveolar cleft repair

This study compared autologous mandibular symphyseal bone grafts and biphasic calcium phosphate bone substitutes for unilateral alveolar cleft repair. A retrospective cohort of 112 patients with unilateral cleft lip and palate was analysed. Four groups were studied: autologous mandibular symphyseal bone graft (n = 37), pure phase β-tricalcium phosphate (n = 33), biphasic calcium phosphate (n = 18) and a hybrid construct of both calcium phosphate scaffolds (n = 24). Cone-beam computed tomography, preoperatively and 1 year postoperatively, was assessed using a segmentation protocol. Primary objectives included residual calcified tissue volume, spontaneous eruption of adjacent teeth, alveolar process continuity, and presence of oronasal fistula. Median residual calcified tissue volumes were: mandibular symphyseal bone 52.1%, pure β-TCP 35.6%, biphasic calcium phosphate 87.8% and hybrid construct 76.0%. Overall group comparison revealed a statistically significant effect (P < 0.001). Biphasic calcium phosphate and hybrid constructs showed significantly higher residual calcified tissue volumes compared to mandibular symphyseal bone (P = 0.003, P = 0.024). However, no significant differences were found in spontaneous tooth eruption, alveolar continuity, or oronasal fistula presence. Biphasic calcium substitutes and hybrid calcium phosphate constructs showed significantly higher residual calcified tissue volumes and comparable clinical outcomes compared to autologous bone grafts.