The use of bone allograft and platelet-rich fibrin in cleft alveolar bone grafting : an alternative to iliac crest harvesting

INTRODUCTION: Cleft lip and palate (CLP) are congenital anomalies requiring complex multidisciplinary care, including alveolar bone grafting (ABG). ABG restores alveolar continuity, facilitates proper dental alignment and improves nasal function. Traditional autologous bone grafting, often using iliac crest bone, is associated with donor-site morbidity, prompting exploration of alternatives such as bone allografts and biomaterials. This study evaluated the efficacy of bone allograft combined with Platelet-Rich Fibrin (PRF) in pediatric ABG. MATERIALS AND METHODS: This prospective cohort study included all pediatric patients with unilateral or bilateral CLP undergoing ABG between January 2020 and January 2023. All patients underwent ABG using bone allograft combined with PRF. Pre and postoperative conebeam computed tomography (CBCT) scans were used to assess graft volume and consolidation by quantifying the residual bone allograft. Statistical analyses evaluated factors influencing graft success, including preoperative palatal expansion and cleft characteristics. RESULTS: A total of 47 patients (54 alveolar clefts) were included. The mean residual bone volume was 73.4 +/- 21%. Lateral incisor presence dit not significantly influence graft consolidation, with residual bone volumes of 76.44 +/- 21.01% versus 70.13 +/- 21/14 % (p=0.19). In contrast, preoperative palatal expansion was associated with significantly improved outcomes: patients treated with Quad Helix expansion demonstrated a markedly greater residual bone percentage (79.14 +/- 18.60 % versus 59.77 +/- 20.99 %; p = 0.002; Cohen's d = 1.00). Overall, bone allografts combined with PRF achieved substantial and consistent postoperative ossification with low complications rates with only one case of graft failure. CONCLUSION: Bone allografts combined with PRF demonstrate satisfactory outcomes in pediatric ABG, offering a viable alternative to autografts. Further studies are needed to evaluate the durability of the grafts, their impact on long-term oral and functional outcomes, and their impact on orthognathic surgery and prosthetic and implant rehabilitation.