Comparative evaluation of bone microstructure in alveolar cleft repair by cone beam CT: influence of different autologous donor sites and additional application of β-tricalcium phosphate



This study used cone beam computed tomography (CBCT) images to comparatively evaluate the three-dimensional microstructural features of reconstructed bone bridge based on the bone harvesting site and the presence/absence of artificial bone material, as well as the features of regenerated bone tissue after bone harvesting from mandibular symphysis in secondary alveolar bone grafting (SABG) for patients with cleft lip, with or without cleft palate.

Materials and methods

Thirty-one patients were divided into three groups in which SABG was performed by autologous bone harvesting from iliac crest (IC), mandibular symphysis (MS), or MS combined with β-TCP granules (MS+TCP). The microstructural trabecular bone parameters (TBPs) and bone structure indexes (SIs) were analyzed using datasets of CBCT images taken before and after SABG.


TBPs showed differences between IC and MS groups (P < 0.05), resulting in greater values of bone volume density (P < 0.05) and inferior value of TBPf (P = 0.070) in IC group compared with MS group. Using MS+TCP or filling β-TCP granules into donor site significantly improved reconstructed or regenerated BV/TV and Tb.Th (P < 0.05) compared with group without β-TCP.


Microstructural characteristics of reconstructed bone bridge were dependent on the donor site of bone harvesting; using an absorbable bone conductive material improved bone quality and increased bone volume density.

Clinical relevance

Application of β-TCP granules as a partial alternative with autologous bone from mandibular symphysis could obtain comparable outcomes in the microstructure of bone bridge to SABG with autologous iliac crest.

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Corresponding author

Correspondence to Susumu Tanaka.

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The authors declare that they have no conflict of interest.

Ethical approval

Approval from the Institutional Review Board of the Osaka University Dental Hospital, Osaka University Graduate School of Dentistry, was obtained for this study (H26-E47). All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from parents of all individual participants included in the study.

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Miyagawa, K., Tanaka, S., Hiroishi, S. et al. Comparative evaluation of bone microstructure in alveolar cleft repair by cone beam CT: influence of different autologous donor sites and additional application of β-tricalcium phosphate. Clin Oral Invest 24, 2789–2797 (2020).

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  • Alveolar bone grafting
  • Bone microstructure
  • β-TCP
  • Bone regeneration
  • Cleft lip and palate
  • Cone beam computed tomography