• SWAG method continues to provide reliable scores of bone grafting protocols
• Secondary ABG performed on younger patients, prior to orthodontic intervention, produced improved SWAG scores

CHAPEL HILL, N.C. Feb. 9, 2021–A recent study examined how the timing of bone grafting and the amount of pregrafting orthodontics affects bone graft outcomes in children with cleft lip/palate (CL/P). The results were published in the February 2021 issue of The Cleft Palate-Craniofacial Journal (CPCJ).

“The authors of this paper stress the value of ‘self-evaluation and internal audit processes’ to evaluate outcome measures. More specifically, the authors state that quality improvement using this process of auditing and peer benchmarking is essential to the ‘discovery of practice-based evidence’. I fully support this statement and hope we continue to see large scale studies that compare multiple centers and offer the highest degree of transparency in reporting outcomes. This is crucial to the advancement of cleft care,” said Jamie L. Perry, PhD, CCC-SLP, editor of The Cleft Palate-Craniofacial Journal.

Secondary alveolar bone grafting (ABG) for CL/P patients with complete clefts of the lip, alveolus, and palate is a well-established treatment in the mixed dentition. The graft surgery, combined with orthodontic treatment, has many reported benefits. However, clinical outcomes vary significantly between centers. The Standardized Way to Assess Grafts (SWAG) method was designed to provide a relatively easy and reliable way to assess grafts from routinely performed periapical and/or occlusal radiographs.

“Having a reliable method to evaluate bone graft outcomes allows us to compare differing protocols from multiple centers to determine which variables have positive or negative effects on outcomes,” according to Catherine H. Lowry, DDS, lead researcher. “In this study, we wanted to determine whether a change in bone grafting protocol, grafting at an earlier age, and prior to any orthodontic intervention would result in improved outcomes. We also assessed the early secondary ABG outcomes relative to another center with similar treatment protocol.”

The study included patients from two North American cleft/craniofacial centers. All participants had complete alveolar clefts which required bone grafting, including unilateral or bilateral complete CL/P, as well as one patient with complete cleft of lip and alveolus only.

The reliability of the SWAG method, which was already perceived positively by the researchers, was confirmed again in this study. Overall, although SWAG scores generally improved when center 1 changed its protocol following the audit of its outcomes, the improvement was not statistically significant. However, the new protocol, with grafting at a younger age and without any pregrafting orthodontic intervention, may have helped reduce the burden of care for the patient by lessening the number of orthodontic appointments needed prior to bone grafting. In addition, the results of this study showed that the sample of patients treated with the new protocol at center 1 had significantly better SWAG scores in the coronal third of the cleft site.

“Although performing secondary ABG at an earlier age and prior to any orthodontic intervention yielded an overall improvement in patients’ SWAG scores, this data did not offer statistical significance when compared to those patients grafted at a later age and after pregrafting orthodontics,” Lowry said. “More research is needed in the areas of nasal floor repair and surgical technique to determine if further improvements can be made to SWAG scores in the apical third.”

To learn more about the American Cleft Palate-Craniofacial Association and cleft and craniofacial conditions, please visit acpa-cpf.org.

About the American Cleft Palate-Craniofacial Association
The American Cleft Palate-Craniofacial Association (ACPA) is a nonprofit 501(c)(3) association of interested individuals and health care professionals who treat and/or perform research on oral cleft and craniofacial conditions. Since 1943, ACPA has worked to optimize outcomes for individuals with oral cleft and craniofacial conditions through education, support, research, advocacy and interdisciplinary team care. ACPA also provides information to affected individuals and families and seeks to educate the public about facial differences through its ACPA Family Services program. For more information, please visit acpa-cpf.org.