الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Secondary alveolar bone grafting (SABG) is a standard treatment protocol for patients with cleft lip and palate (CLP) and cleft of alveolus (CLA), The surgical procedure primarily aims to unify the maxillary segments for tooth eruption, close the oronasal fistula, and stabilize the maxillary arch. Flap techniques and various graft materials have been extensively studied to optimize benefits for patients. (205,206)
Iliac cancellous bone graft remains the gold standard in alveolar cleft grafting , no study showed the superiority of any other bone origin over iliac cancellous bone. (207)
In ACG Surgeries, Wound dehiscence is one of the first soft tissue complications, which might result in graft exposure, infection, or both which leads to severe graft resorption or failure. Its cause is linked to decreased tissues viability, previous scarring, grafting excessively bone into the cleft, soft tissue tension after wound closure, postoperative local trauma, or poor patient compliance with postoperative oral hygiene. (107,208)
Following a review of the current literature, we discovered that only a few studies have focused on the success and failure rates of ACG, with just a few papers discussing complication rates (said to be between 15% and 40%), such as flap dehiscence, ONF and decreased amount of formed bone. (204,209,210,211,212)
This study attempted to investigate the effect of Photobiomodulation therapy on the clinical outcomes of ACG regarding soft tissue healing, recurrence of ONF and preservation of the grafted bone. The LASER wavelength applied in this study was the semi-conductor diode laser (660nm).
Photobiomodulation Therapy acts on regeneration of tissue based on molecular and cells level. Laser light penetrates the tissue and is absorbed by certain chromophores, acting on cell metabolism amplification by increasing the ATP synthesis performed by mitochondria. (213,214)
The application of LLLT refers to the use of red-beam or near infrared lasers with a wavelength of 600–1,100 nm and an output power of 1-500 mW. This type of radiation is a continuous wave that consists of a constant beam of relatively low energy density (0.04–50 J/cm2), and the laser is directed at the target tissue using powers measured in milliwatts (mw). (134)
Low-level lasers have been used to heal hard and soft tissues as it modulates the tissue repair process, promotes anti-inflammatory and analgesic effects, stimulates the immune system, allows cell regeneration and favors the processes of angiogenesis, collagen synthesis and osteogenesis (215,216) LLLT can promote new bone formation by inducing proliferation and differentiation of osteoblasts and stimulate angiogenesis, a key component of bone regeneration.(217,218)
The study included 30 patients with Alveolar Clefts, grouped into 2 groups: study group and control group. The study group included 15 cases and the control group included 15 cases done starting from January 2019 till December 2021 at Cleft Care Clinic with the routinely performed procedure using an iliac crest graft, where ACG was performed using standard procedures. Photobiomodulation therapy applied to the study group intraoperatively and continued postoperatively for 6 months.
The application of LLLT in ACG surgeries has a significant impact in soft tissue healing, regarding flap dehiscence and recurrence of oro nasal fistula; the study group was free from soft tissue complication compared to the control group which encountered 5 cases with flap dehiscence and recurrence of oro-nasal fistula.
Better results of bone regeneration with LLLT application was achieved in the study group compared to the control since majority of the cases in the study group had 9 class (II) (60.0%) while cases in the control group had 6 class (IV) (40.0%). Based on the results of this study the difference between the study and the control group in bone healing results not statistically significant and this relatively due to small sample size.
The results shown the application of LLLT in ACG has significant enhancement of soft tissue and bone healing and this demonstrate why LLLT highly useful in biomedicine and can have anti-inflammatory, analgesic, and bio stimulatory effects. Therefore, it can be used clinically for wound healing and tissue regeneration. (219,220 221,222)
Photobiomodulation therapy is an effective adjunctive modality can be incorporated in ACG surgeries as one of the local factors which significantly improve soft tissue healing and enhance success rate.
The applied protocol (660nm Diode Laser, 0.1W, 2J, 4 J/cm2, 20 sec) was successful in improving the outcome of wound healing and adequate bone formation postoperatively.