Research Article| Volume 50, ISSUE 7, P617-620, October 2012

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Reliability of the Kindelan scoring system for alveolar bone grafting with and without a pre-graft occlusal radiograph in patients with cleft lip and palate

Published:November 24, 2011DOI:


      We aimed to compare the reliability of the Kindelan system using one postoperative radiograph to assess the success of alveolar bone grafts with the use of two occlusal radiographs (before and after operation). This retrospective reliability study took place at Glasgow Dental Hospital cleft unit, and two examiners scored 84 radiographs two weeks apart. The sample was taken from a database of patients having alveolar bone grafts between 2007 and 2010. They had an upper anterior occlusal radiograph taken before the graft and another at a mean of 6 months (range 3–12 months) postoperatively. Kappa scores were used to measure intraobserver and interobserver agreement. Intraexaminer agreement ranged from good to very good using one or two radiographs, and interexaminer agreement ranged from moderate to good for both systems. Reliability when scoring with either one or two radiographs was similar, and ranged from good to very good.


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        • Hammond M.
        Alveolar bone grafting for cleft lip and palate patients.
        Dent Update. 1993; 20: 62-64
        • Boyne P.J.
        • Sands N.R.
        Secondary bone grafting of residual alveolar and palatal clefts.
        J Oral Surg. 1972; 30: 87-92
        • Brattström V.
        • McWilliam J.
        The influence of bone grafting age on dental abnormalities and alveolar bone height in patients with unilateral cleft lip and palate.
        Eur J Orthod. 1989; 11: 351-358
        • Long Jr., R.E.
        • Spangler B.E.
        • Yow M.
        Cleft width and secondary alveolar bone graft success.
        Cleft Palate Craniofac J. 1995; 32: 420-427
        • Bergland O.
        • Semb G.
        • Abyholm F.E.
        Elimination of the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment.
        Cleft Palate J. 1986; 23: 175-205
        • Kindelan J.D.
        • Nashed R.R.
        • Bromige M.R.
        Radiographic assessment of secondary autogenous alveolar bone grafting in cleft lip and palate patients.
        Cleft Palate Craniofac J. 1997; 34: 195-198
        • Witherow H.
        • Cox S.
        • Jones E.
        • Carr R.
        • Waterhouse N.
        A new scale to assess radiographic success of secondary alveolar bone grafts.
        Cleft Palate Craniofac J. 2002; 39: 255-260
        • Wörtche R.
        • Hassfield S.
        • Lux C.J.
        • Müssig E.
        • Hensley F.W.
        • Kremplen R.
        • et al.
        Clinical application of cone beam digital volume tomography in children with cleft lip and palate.
        Dentomaxillfacial Radiol. 2006; 35: 88-94
        • Feichtinger M.
        • Mossböck R.
        • Kärcher H.
        Evaluation of bone volume following bone grafting in patients with unilateral clefts of lip, alveolus and palate using a CT-guided three-dimensional navigation system.
        J Craniomaxillofac Surg. 2006; 34: 144-149
        • Feichtinger M.
        • Mossböck R.
        • Kärcher H.
        Assessment of bone resorption after secondary alveolar bone grafting using three-dimensional computed tomography: a three-year study.
        Cleft Palate Craniofac J. 2007; 44: 142-148
        • Altman D.G.
        Practical statistics for medical research.
        Chapman and Hall CRC, London1991
        • McIntyre G.T.
        • Devlin M.F.
        Secondary alveolar bone grafting (CleftSiS) 2000–2004.
        Cleft Palate Craniofac J. 2010; 47: 66-72
        • Arai Y.
        • Tammisalo E.
        • Iwai K.
        • Hashimoto K.
        • Shinoda K.
        Development of a compact computed tomographic apparatus for dental use.
        Dentomaxillofac Radiol. 1999; 28: 245-248
        • Waitzman A.A.
        • Posnick J.C.
        • Armstrong D.C.
        • Pron G.E.
        Craniofacial skeletal measurements based on computed tomography: Part I. Accuracy and reproducibility.
        Cleft Palate Craniofac J. 1992; 29: 112-117