# Single-Stage Primary Palatal Closure and Bone Grafting: A Comparison Between Unilateral Cleft Lip and Alveolus and Unilateral Cleft Lip and Palate

## TL;DR

This study compares surgical outcomes of bone grafting in patients with different types of clefts, finding that a combined approach improves bone stability and reduces the need for multiple procedures.

## Contribution

The study introduces a modified surgical protocol combining alveolar bone grafting with anterior palate closure, demonstrating its effectiveness in reducing graft resorption.

## Key findings

- Both groups showed favorable bone graft outcomes with no significant age difference.
- Complete bone fill was observed in the apical third for all patients.
- Simultaneous anterior palate closure reduced graft resorption and enhanced bone stability.

## Abstract

Background

This study aimed to evaluate the outcomes of secondary alveolar bone grafting by assessing grafted bone resorption in the alveolar region and the anterior third of the hard palate in patients with unilateral cleft lip and palate (UCLP). A modified protocol involving simultaneous alveoloplasty and anterior palate closure was employed to optimize surgical outcomes and reduce the number of required procedures.

Materials and methods

A total of 55 patients were retrospectively evaluated: 16 with unilateral cleft lip and alveolus (UCLA) who underwent bone grafting limited to the alveolar cleft and 39 with UCLP who received simultaneous alveolar bone grafting and closure of the anterior one-third of the hard palate. All patients underwent surgery between 2012 and 2019. Surgical outcomes were assessed using the 6-point Standardized Way to Assess Grafts (SWAG) scale, based on postoperative dental radiographs. Bone fill was independently evaluated at the coronal, middle, and apical thirds of the cleft site.

Results

The median ages at surgery were 10.5 years (range: 8.75-12.6) for the UCLA group and 10.59 years (range: 8.33-15.3) for the UCLP group, with no significant age difference between groups. The mean total SWAG scores indicated favorable bone graft outcomes in both. Notably, complete bone fill (score 2) in the apical third was observed in all patients. No significant difference was found in bone resorption patterns between groups, and no resorption was noted on the apical side in either group. The difference in bone level at each third (coronal, middle, apical) between groups was not statistically significant. These findings highlight the efficacy of simultaneous anterior palate closure in reducing graft resorption and enhancing bone stability.

Conclusions

Simultaneous alveolar bone grafting and anterior hard palate closure in patients with UCLP is a clinically effective treatment protocol. It achieves stable bone regeneration with minimal resorption, reduces the need for multiple procedures, and enables reliable assessment through routine clinical radiographs. The SWAG scale proved to be a practical and reproducible tool for postoperative evaluation, and these findings provide valuable baseline data for clinical decision-making and informed consent.