TY - JOUR
T1 - Factors contributing to delay or absence of alveolar bone grafting
AU - Pfeifauf, Kristin D.
AU - Cooper, Danielle C.
AU - Gibson, Ella
AU - Skolnick, Gary B.
AU - Naidoo, Sybill D.
AU - Snyder-Warwick, Alison K.
AU - Patel, Kamlesh B.
N1 - Funding Information:
Research reported in this publication was supported in part by the National Institutes of Health National Institutes of Health National Institute of Neurological Disorders and Stroke Grant Number K08NS096232 .
Funding Information:
Research reported in this publication was supported in part by the National Institutes of HealthNational Institutes of Health National Institute of Neurological Disorders and Stroke Grant Number K08NS096232.
Publisher Copyright:
© 2022 American Association of Orthodontists
PY - 2022/6
Y1 - 2022/6
N2 - Introduction: Alveolar bone grafting (ABG) delay can lead to suboptimal outcomes. This study seeks to categorize reasons patients with cleft lip and palate have no record of ABG or who underwent later than typical ABG (≥13 years). Methods: At a single tertiary care center, a retrospective review was performed of all patients with unilateral, complete cleft lip and palate, born 1998-2005. Database query identified which patients had timely, late, or no record of ABG. The retrospective cohort study was performed to categorize ABG delay or absence of recorded ABG. Results: Of 135 participants, 82 (61%) had timely, 8 (6%) had late, and 45 (33%) had no record of ABG. The primary factor for late ABG was noncompliance or refusal (n = 5 of 8, 63%), comorbidity or medical complexity (n = 1 of 8, 13%), orthodontic unpreparedness (n = 1 of 8, 13%), or inaccurate prior assessment of alveolar sufficiency (n = 1 of 8, 13%). The primary factor for ABG record absence was loss to follow-up (n = 40 of 45, 89%), noncompliance or refusal (n = 3 of 45, 7%), comorbidity or medical complexity (n = 1 of 45, 2%), or orthodontic unpreparedness (n = 1 of 45, 2%). Racial majority (White, Asian) patients received preferred care (timely ABG or medically appropriate absence or delay) at a significantly higher rate (67%) than underrepresented minorities (African American, Hispanic, Native American, other) (35%, P = 0.016). Families with private insurance and those who were self-pay received preferred care at a significantly higher rate (77%) than families with Medicaid (42%) (P <0.001). Conclusions: The high number of patients lost to follow-up highlights the impact of poor retention on ABG completion. Possible health disparities based on race and insurance status warrant clinical focus.
AB - Introduction: Alveolar bone grafting (ABG) delay can lead to suboptimal outcomes. This study seeks to categorize reasons patients with cleft lip and palate have no record of ABG or who underwent later than typical ABG (≥13 years). Methods: At a single tertiary care center, a retrospective review was performed of all patients with unilateral, complete cleft lip and palate, born 1998-2005. Database query identified which patients had timely, late, or no record of ABG. The retrospective cohort study was performed to categorize ABG delay or absence of recorded ABG. Results: Of 135 participants, 82 (61%) had timely, 8 (6%) had late, and 45 (33%) had no record of ABG. The primary factor for late ABG was noncompliance or refusal (n = 5 of 8, 63%), comorbidity or medical complexity (n = 1 of 8, 13%), orthodontic unpreparedness (n = 1 of 8, 13%), or inaccurate prior assessment of alveolar sufficiency (n = 1 of 8, 13%). The primary factor for ABG record absence was loss to follow-up (n = 40 of 45, 89%), noncompliance or refusal (n = 3 of 45, 7%), comorbidity or medical complexity (n = 1 of 45, 2%), or orthodontic unpreparedness (n = 1 of 45, 2%). Racial majority (White, Asian) patients received preferred care (timely ABG or medically appropriate absence or delay) at a significantly higher rate (67%) than underrepresented minorities (African American, Hispanic, Native American, other) (35%, P = 0.016). Families with private insurance and those who were self-pay received preferred care at a significantly higher rate (77%) than families with Medicaid (42%) (P <0.001). Conclusions: The high number of patients lost to follow-up highlights the impact of poor retention on ABG completion. Possible health disparities based on race and insurance status warrant clinical focus.
UR - http://www.scopus.com/inward/record.url?scp=85125500875&partnerID=8YFLogxK
U2 - 10.1016/j.ajodo.2021.01.033
DO - 10.1016/j.ajodo.2021.01.033
M3 - Article
C2 - 35219554
AN - SCOPUS:85125500875
VL - 161
SP - 820-828.e1
JO - American Journal of Orthodontics and Dentofacial Orthopedics
JF - American Journal of Orthodontics and Dentofacial Orthopedics
SN - 0889-5406
IS - 6
ER -