treatment of the residual alveolar defect in patients with cleft lip and palate often requires bone grafting .
an important goal for this treatment , apart from restoring the missing alveolar bone in the cleft area , is to obtain favorable periodontal conditions for the teeth adjacent to the defect .
attempts to move the teeth into the edentulous spaces often result in significant periodontal problems .
the first report about the alveolar bone grafting aiming to obtain the continuity of the alveolar process was published by lexer in 1908 , who used free bone grafting or pedicled flap of bone and soft tissues of the fifth digit .
various sources of autogenous bone are used , but an anterior iliac crest is considered the gold standard for grafting . its resorption rate seems to be high within the 1 year after grafting . from since , multiple techniques and materials have been described to repair the alveolar bone cleft deformity .
we describe a transoral mucosal to repair cleft alveolar bone with bioglass and z - plasty .
a 10-year - old male , born with a unilateral left cleft lip and palate was presented to our clinic .
the history indicated that there was no known familial incidence of cleft lip or palate . at the time of the initial dental evaluation ,
the patient show complete alveolar bone cleft on the left side of the premaxilla with nasolalvelar fistula [ figure 1a ] .
the patient complained from the nasal regurgitation of both food and fluids into the nose and the disfigurement during a smile .
( b ) postoperative picture for patient with repaired cleft alveolar after 1-year first , a z - plasty was designed by donning a z - incision in the mucosal side of the upper lip forming two mucosal triangles ( 1 and 2 ) flap with small mucosal triangle ( 3 ) in between [ figure 2a ] , this small mucosal triangle ( 3 ) used to cover the floor of the nose [ figure 2b ] . in addition , the bioactive glass ( bioglass was mixed with blood [ figure 3 ] and then inserted into the pocket done after the closure of the nasal floor
. finally , the two triangles ( 1 and 2 ) are suture together using a 5 - 0 vicryl by crossing each other . wound healing of the recipient sites
wound complications such as bleeding , infection , dehiscence , and neurologic disturbance were recorded .
furthermore , the evaluation of bone graft quantities was performed according to the bergland scale ( oslo grading system ) . with this scale ,
the obtained bone level of the interdental septum is compared with the normal side , and it was type 1 in this case after 1-year [ figure 1b ] .
( a ) z - plasty mucosal triangle ( 1 and 2 ) flap with small mucosal triangle ( 3 ) in between ( b ) the small mucosal triangle ( 3 ) used to cover the floor of the nose ( a ) bioactive glass ( bioglass ) maples .
alloplastic grafts have been used successfully in the repair of artificial alveolar clefts in animals . according to the literature ,
autogenic grafts are mostly used ; however , alloplastic graft material started to take place in repair alveolar clefts in human beings .
four major categories of surface - active biomaterials have been developed ; dense hydroxylapatite ceramics , bioactive glasses , bioactive glass - ceramics , and bioactive composites .
bioactive glass is a commercially available family of bioactive glasses , composed of silicone dioxide ( sio2 ) , sodium dioxide ( na2o ) , calcium oxide ( cao ) and phosphorous pentoxide ( p2o5 ) in specific proportions .
bioglass or 45s5 are bioactive glass which is composed of 45% sio , 24.5% cao , 24.5% na2o and 6% p2o5 .
bioactive glass such as ( e.g. , 45s5 or bioglass ) bind to soft tissues and bone , while bioactive glass - ceramics ( e.g. , 5s4.3 or ceravital ) bind only to bone , both designed to engender surface reactions that lead to osseointegration , in this case i used the bioactive glass ( bioglass ) .
johnson et al . reported that the bioactive glass material in animals was surrounded with osteoid and new bone .
alloplastic graft materials that provide simply a scaffolding effect to give support to vascular ingrowth and later calcification are known as osteoconductive .
osteoinductive materials , on the other hand , are those that contain morphogens , substances that initiate the development of tissues and organ systems by stimulating undifferentiated cells to convert phenotypically .
suggest that one should graft as much bone as possible to obtain adequate facial appearance .
their study examined 18 patients with complete unilateral cleft lip and palate using computed tomography 20 years after secondary cancellous bone graft from the iliac crest .
they concluded that , even though all dental gaps were closed , and patients were functionally intact , the amount of alveolar bone in the cleft side was less than that of the noncleft side .
feichtinger et al . also showed that the absence of adjacent teeth to the cleft site leads to mean the bone volume loss of 95% .
hence , the augmentation of unilateral alveolar cleft could be archived perfect by using this technique and the bioactive glass material , which gave a result of bergland 's scale type 1 after 1-year of follow - up .
transoral mucosal repair of cleft alveolar bone by z - plasty using bioactive glass demonstrated an alternative easy and simple approach for augmentation of unilateral alveolar cleft patients .
hence , we recommend more patients to undergo this new technique and a longer time for follow - up .
 multiple literature addresses cleft alveolar bone , with little consensus on the preferred surgical technique . 
 hence , we described a transoral approach for repair of cleft alveolar bone with z - plasty and using bioactive glass . 
 study design : case presentation and surgical technique description . in conclusion , 
 transoral mucosal repair cleft alveolar bone z - plasty using bioactive glass demonstrated an alternative easy and simple approach for augmentation of unilateral alveolar cleft patients . 
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