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Sains Malaysiana
49(2)(2020): http://dx.doi.org/10.17576/jsm-2020-4902-13
Orthodontic
Considerations in Bone Graft Selection for Alveolar Cleft Repair
(Pertimbangan Ortodontik dalam Pemilihan Graf Tulang untuk Pembaikan Klef Alveolus)
ROHAYA
MEGAT ABDUL WAHAB1*, WAN CHING NG1, FARINAWATI YAZID2,
NUR ATMALIYA LUCHMAN1 & SHAHRUL HISHAM ZAINAL ARIFFIN3
1Discipline of Orthodontics, Department of Family Oral
Health, Faculty of Dentistry, Universiti
Kebangsaan Malaysia, Jalan
Raja Muda Aziz, 50300 Kuala Lumpur,
Federal Territory, Malaysia
2Discipline of Paediatric
Dentistry, Department of Family Oral Health, Faculty of Dentistry,
Universiti Kebangsaan Malaysia, Jalan Raja
Muda Aziz, 50300 Kuala Lumpur, Federal Territory, Malaysia
3Department of Biotechnology and Functional Food, Faculty
of Science and Technology, Universiti
Kebangsaan Malaysia, 43600 Bangi,
Selangor Darul Ehsan, Malaysia
Received:
12 February 2019/Accepted: 6 November 2019
ABSTRACT
The enthusiastic
development of non-autogenous bone graft materials to correct oral cleft
defects in dentistry is founded on arguments of post-operative morbidity and
quantity limitation when using conventional iliac crest bone grafts. While
success in tooth movement is usually reported for the grafted extraction
socket, the results cannot be extrapolated to congenital alveolar clefts as
there are differences in terms of vasculature and soft tissue support. This
paper provides an overview of the dental and skeletal
anomalies in cleft patients, followed by the orthodontic implications of cleft
correction and, lastly, a review of the available evidence in bone grafts used
for alveolar clefts alone. The non-autogenous grafts used are derived from
another human (allografts), animal (xenografts), synthetic bones (alloplasts) or the latest tissue-engineered graft material.
The main advantage of using these grafts is a reduction in the number of
operative sites. The drawbacks are cost, reduced tooth movement, possibility of
root resorption and host reaction. Tissue-engineered grafts seem promising but
there is still a lack of clinical trials in human subjects. Important
properties related to orthodontics are the graft resorption rate, along with
the effect on root resorption and tooth movement rate. To date, autogenous bone
grafts remain the first choice for cleft repair.
Keywords: Alveolar bone graft; autogenous bone; cleft
palate; orthodontic tooth movement; tissue engineering
Abstrak
Kadar morbiditi yang tinggi setelah pembedahan graf tulang alveolar serta keterbatasan kuantiti tulang penderma daripada kresta iliak mencetuskan
perkembangan pesat
dalam teknologi penghasilan graf tulang bukan autogenus.
Graf tulang bukan
autogenus telah dilaporkan mampu menyokong pergerakan gigi secara ortodontik
merentasi soket
cabutan. Namun begitu, pergerakan gigi mungkin terhalang
sekiranya graf
tersebut digunakan pada defek yang lebih besar seperti
klef alveolus kongenital.
Ini disebabkan perbezaan daripada segi vaskularisasi dan sokongan tisu
lembut antara
kedua-dua jenis defek tersebut. Artikel ini
membincangkan tentang
anomali pergigian dan rahang
pesakit klef
bibir dan/atau
lelangit, implikasi
ortodontik terhadap pembetulan klef dan rumusan perkembangan
semasa graf
tulang yang digunakan dalam defek tulang
alveolar. Sumber graf
tulang bukan autogenus boleh diperoleh daripada manusia lain (alograf), haiwan (xenograf), bahan sintetik (aloplas) atau disediakan
secara kejuruteraan
tisu. Kelebihan utama penggunaan graf bukan autogenus
adalah pengurangan
bilangan kawasan pembedahan manakala kelemahannya termasuk kos yang tinggi, pergerakan gigi yang terhad dan kemungkinan
berlakunya penyerapan
akar gigi serta
tindak balas
tubuh badan perumah
yang negatif. Penggunaan
graf daripada teknologi
kejuruteraan tisu
mempunyai potensi yang memberangsangkan tetapi masih memerlukan lebih banyak bukti
daripada kajian
klinikal. Ciri-ciri penting sesuatu graf yang perlu dipertimbangkan dalam bidang ortodontik adalah kadar penyerapan
graf, selain
kesan terhadap penyerapan akar dan kadar pergerakan
gigi. Sehingga
kini, graf tulang
autogenus masih
menjadi pilihan dan merupakan kaedah
piawai dalam
rawatan pembetulan klef tulang alveolar.
Kata kunci: Graf tulang alveolar; klef lelangit; kejuruteraan tisu; pergerakan gigi secara ortodontik; tulang autogenus
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*Corresponding author; email: rohaya_megat@ukm.edu.my
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