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Purpose: Patients needing revision alveolar bonegraft (ABG) pose a challenge due to lack of autograft donor sites. Previous experience at our institution has shown allograft combined with autograft is equivalent to autograft alone. This study aims to demonstrate the safety and efficacy of allograft alone in patients requiring revision ABG.
Methods: Retrospective review of our institution's ABG experience with open iliac crest bonegraft (ICBG), minimal-access ICBG plus allograft, or allograft alone was performed. All patients (n=47) were treated with alveolar fistula repair with primary closure.
Results: Group 1, ICBG alone, 22 patients (12 male/10 female, average age 10) were treated between October 2004 and December 2006; 17 clefts were unilateral and 5 bilateral (n=27). Group 2, ICBG plus allograft, 14 patients (8 male/6 female patients, average age 9) were treated between August 2009 and August 2011; 6 clefts were unilateral and 8 bilateral (n=22). Group 3, allograft alone, 11 patients (6 male/5 female, average age 13) were treated between February 2011 and January 2012; 7 clefts were unilateral and 4 bilateral (n=15). Average follow-up was 47.5, 12, and 3.5 months, respectively. Average operative time/alveolus was 78 mins for Group 3, shorter than 147 and 111 mins for Groups 1 and 2, respectively (p<0.0005). Average engraftment Enemark score was 1.2 in Group 3, better than 2.0 in Group 1 (p0.05). Revision ABG with allograft alone improved Enemark scores from 3.7 pre-op to 1.2 post-op (p<0.0001). Average hospital stay was 0.9 days for Group 3, shorter than 2.4 and 2.7 days for Groups 1 and 2, respectively (p<0.0001). Bone graft extrusion occurred in 6 patients (27.3%) in Group 1, no complications occurred in Group 2, and a single necrotic central incisor was lost at the time of revision bone grafting in Group 3 (9.1%). No wound infections, bleeding requiring transfusion/reoperation, or mortalities occurred.
 
Conclusions: The use of allograft alone in reconstruction of failed ABG is effective and provides a safe alternative to traditional ICBG in short-term follow up. Allograft alone is associated with low morbidity, short operative times, fewer complications, shorter hospital stay, and comparable rates of bone graft survival in patients that have previously failed traditional ABG.