Clinical Outcomes of Dental Implant Therapy in Alveolar Cleft Patients: A Systematic Review

Purpose: The purpose of this report was to evaluate data from published articles to determine the success and effectiveness of advanced bone grafting and dental implant therapy in alveolar cleft patients. Materials and Methods: A MEDLINE (PubMed) search was conducted of articles published in English without limits regarding year of publication. Bone grafting, implant survival and success rates, marginal bone resorption, esthetic outcomes, and patient satisfaction were evaluated. Screening of eligible studies, quality assessment, and data interpretation were conducted by two reviewers independently. Results: Seven retrospective and four prospective clinical studies were selected and analyzed. In all, 484 dental implants in 377 participants were investigated. The mean survival rate was 91.5% ± 4.77% with a mean follow-up of 54.3 ± 24.7 months. One hundred eleven of the 257 patients (43.1% ± 31.6%) with inadequate bone volume following initial bone grafting received secondary and/or tertiary bone grafting. The donor sites included the tibia, iliac crest, mandibular symphysis, and mandibular ramus. After dental implant placement, studies showed a difference in marginal bone loss around implants ranging from a mean of 0.28 mm with a 40-month follow-up to a mean of 3.5 mm with a 76-month follow-up. There were few data reporting the esthetic outcomes of implants; these focused on the loss of papillae and longer definitive restorations. Conclusion: Differing levels of evidence were available for clinical outcomes of dental implants in alveolar cleft patients. Treatment with dental implant therapy and bone grafting for patients with a history of alveolar clefts seems to be a predictable treatment option in the short term ( 5 years). However, more long-term (> 5 years) data for implant success rates and peri-implant clinical parameters are needed. Keywords: alveolar bone grafting, alveolar cleft, cleft lip and palate, dental implants, secondary alveolar bone grafting