Disparities in Timing of Alveolar Bone Grafting and Dental Reconstruction in Patients With Clefts

Objective This study sought to identify disparities in the timing of alveolar bone grafting (ABG) surgery and the replacement strategy for missing maxillary lateral incisors for patients with clefts. Design A retrospective record review identified patients who underwent ABG. Multivariable regression analyzed the independent contribution of each variable. Setting This institutional study was performed at the University of California, San Francisco. Participants Patients who presented under age 12 and underwent secondary ABG between 2012 and 2020 (n = 160). Main Outcome Measures The age at secondary ABG and the recommended dental replacement treatment for each patient, either dental implantation or canine substitution. Results The average age at ABG was 10.8 +/- 2.1 years, 106 (66.3%) patients were not White, and 80 (50.0%) had private insurance. Independent predictors of older age at ABG included an income below $ 50 000 as estimated from ZIP code (beta = 15.0 months, 95% CI, 5.7-24.3, P = .002) and identifying as a race other than White (beta = 10.1 months, 95% CI, 2.1-18.0, P = .01). After ABG, patients were more likely to undergo dental implantation over canine substitution if they were female (odds ratio [OR] = 4.3, 95% CI, 1.3-17.1, P = .02) or had private insurance (OR = 12.5, 95% CI, 2.2-143.2, P = .01). Conclusions Patients who were low-income or not White experienced delays in ABG, whereas dental implantation was more likely to be recommended for patients with private insurance. Understanding the sources of disparities in dental reconstruction of cleft deformities may reveal opportunities to improve equity.