SYSTEMATIC REVIEW article
Front. Oral Health
Sec. Oral Health Promotion
Volume 6 - 2025 | doi: 10.3389/froh.2025.1640933
Risk Factors Associated with the Failure of Secondary Alveolar Bone Grafting with Autologous Iliac Crest Bone in Patients with Alveolar Cleft Defects: A Systematic Review
Provisionally accepted
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Purpose: The purpose of this study was to perform a systematic review on the risk factors associated with secondary alveolar bone grafting (SABG) failure in patients with cleft alveolus. Methods: A comprehensive search was conducted across PubMed, Scopus, Embase, and Web of Science databases from their inception through to February 24, 2025, to identify relevant studies. The search keywords included "alveolar cleft" combined with either "survival" or "failure." Studies that investigated risk factors for the failure of SABG using autologous iliac crest bone were included in this review. Relevant data, including odds ratios (OR), hazard ratios (HR), or comparisons of variables between patients with and without SABG failure, were recorded and analyzed. Results: A total of nine studies, encompassing 1,855 grafts, were included. The most commonly used definition of SABG failure was a Bergland grade of 3 or 4. Reported failure rates varied significantly across studies, ranging from 1.0% to 45.1%. The primary risk factors for SABG failure included increased age at SABG (reported in 4 studies), poor oral hygiene (2 studies), and the presence of an erupted lateral or canine tooth (3 studies). Additionally, non-Caucasian ethnicity, international adoptee, large cleft size, a history of cleft lip/palate revision or oronasal fistula (ONF), nasoalveolar molding (NAM), and premaxillary osteotomy were also associated with a higher risk of SABG failure. No significant association was found between SABG failure and sex, alveolar cleft type (bilateral or unilateral), preoperative expansion, or preoperative orthodontics. Conclusions: The definition of SABG failure varied across studies, with Bergland grade 3 or 4 being the most commonly used criteria. The primary risk factors for SABG failure included increased age, poor oral hygiene, and the presence of an erupted lateral or canine tooth. Surgeons should be aware of these risk factors to optimize surgical strategies and guide patients effectively.
Keywords: Secondary alveolar bone grafting, Alveolar cleft, failure, Risk factors, bone grafting
Received: 05 Jun 2025; Accepted: 06 Oct 2025.
Copyright: © 2025 Wu, Zhuang, Ma, Yin and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yongqian Wang, surgeon_wyq@163.com
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