A Novel 3D Approach for Assessing Bone Mineral Density After Alveolar Cleft Grafting: Comparison of Autografts and Synthetic Grafts

Introduction: Alveolar bone grafting (ABG) is crucial for treating alveolar clefts in cleft lip and palate patients. While bone mineral density (BMD) is a key indicator of bone quality, traditional 2D measurement methods lack accuracy. This study introduces a novel 3D BMD assessment technique to compare autografts and synthetic grafts. Methods: A retrospective analysis included 54 patients (36 autografts, 18 synthetic grafts) aged 8 to 12 years with unilateral alveolar clefts. Preoperative and postoperative CT scans (6 m) were processed using MIMICS software for 3D reconstruction. Newly formed bone regions were segmented, and mean HU were calculated. Intraobserver and interobserver reliability were assessed through the intraclass correlation coefficient (ICC), and BMD differences were analyzed using the Mann-Whitney U test. Results: The synthetic graft group exhibited significantly higher median BMD (636.38 HU) compared with autografts (483.88 HU, P <0.0001). The 3D method demonstrated excellent reliability, with ICCs >0.9 for both intraobserver and interobserver consistency. Conclusions: The novel 3D BMD measurement method provides a reliable and comprehensive assessment of bone quality post-ABG. Synthetic grafts resulted in higher BMD, potentially offering superior bone regeneration outcomes in clinical practice. This technique enhances clinical evaluation and graft material selection for alveolar cleft repair.