Clinical outcomes of modified tension-free bone grafting for unilateral alveolar cleft repair: a 7-year retrospective study.

Abstract

Our study aimed to evaluate the clinical efficacy of a modified tension-free bone grafting technique for unilateral alveolar cleft repair. A retrospective analysis was performed on 30 patients with unilateral complete alveolar clefts treated between January 2019 and December 2025, including a modified group that received tension-free Z-plasty closure with dual-layer (labial and palatal) collagen membrane placement (n = 15) and a conventional group that received linear closure with a labial membrane only (n = 15). Postoperative outcomes, graft success, and CBCT-based measurements of bone bridge height (H) and buccolingual thickness (T) were assessed at baseline, 3 months, and 6 months. Longitudinal changes were analyzed using linear mixed-effects models. The modified group consisted of 15 patients (8 males, 7 females) with a mean age of 13.4 ± 3.1 years, while the conventional group included 15 patients (8 males, 7 females) with a mean age of 12.7 ± 2.8 years. All patients achieved primary wound healing except for two infections in the conventional group. A higher graft success rate was observed in the modified group (100% vs. 86.7%). Mean bone resorption was lower in the modified group (32.4% vs. 44.4%). Longitudinal analysis demonstrated a significantly slower reduction in bone thickness in the modified group (Group × Time: P = 0.013). In conclusion, the modified tension-free technique was associated with reduced bone resorption and improved preservation of buccolingual bone thickness. This approach may provide a stable foundation for subsequent orthodontic and implant treatment.