Assessment of secondary alveolar bone grafting using a modification of the Bergland grading system  P.J Hynes, M.J Earley  British Journal of Plastic Surgery  Volume 56, Issue 7, Pages 630-636 (October 2003) DOI: 10.1016/S0007-1226(03)00361-8

Fig. 1 (A) The Bergland grading system records only the occlusal level of the bone graft. Its four-point scale compares this level to that of normal interdental bone. This corresponds to the level of the amelocemental junctions of the cleft teeth. Native alveolar bone surrounds the root of the cleft central incisor and much of that of the cleft canine. (B) In this study the basal level of the graft is also recorded and compared with that of normal interdental bone. The latter corresponds to the level of the root apices and anterior nasal spine. (C) Once the occlusal and basal levels of the graft are evaluated total bone graft height at the mid-region of the cleft is measured. British Journal of Plastic Surgery 2003 56, 630-636DOI: (10.1016/S0007-1226(03)00361-8)

Fig. 2 (A) The distribution of the various types of bone grafts using the Bergland grading system in which occlusal levels alone are recorded (N=71). (B) The distribution of bone graft types when their basal levels alone are evaluated. (C) The distribution of total bone graft heights measured after both the basal and occlusal levels have been recorded. Both bone graft basal levels (B) and heights (C) are categorised with respect to their expected normal values using the same scale described in the Bergland grading system (Table 1). British Journal of Plastic Surgery 2003 56, 630-636DOI: (10.1016/S0007-1226(03)00361-8)

Fig. 3 The occlusal level of the alveolar bone graft reaches the level of the amelocemental junction (ACJ) and hence it is categorised as a Bergland type I bone graft. Since its basal level extends to the desired normal level it is considered a type I graft using the Bergland scale. Its total height is that of normal interdental bone and it is therefore also considered a type I bone graft. (1) Central incisor; (2) lateral incisor when present; (3) canine; (4) first premolar. An asterisk marks the ACJ of the adjacent cleft teeth and therefore one lies on either side of the grafted cleft. The broken line represents the desired basal level of bone grafts and therefore passes from the apex of the canine root to that of the central incisor. This approximates the expected level of the pyriform margin laterally and the ANS medially. British Journal of Plastic Surgery 2003 56, 630-636DOI: (10.1016/S0007-1226(03)00361-8)

Fig. 4 The occlusal level of the bone graft extends to the level of the ACJ (Bergland type I) but its basal level does not quite reach the desired normal level and is therefore categorised as a type II graft. Its total height is at least three quarters of normal and therefore by height analysis it is also considered a type II graft. Some slight absence of bone graft around the apex of the canine root (type II) is unlikely to influence the final position of its crown. (1) Central incisor; (2) lateral incisor when present; (3) canine; (4) first premolar. An asterisk marks the ACJ of the adjacent cleft teeth and therefore one lies on either side of the grafted cleft. The broken line represents the desired basal level of bone grafts and therefore passes from the apex of the canine root to that of the central incisor. This approximates the expected level of the pyriform margin laterally and the ANS medially. British Journal of Plastic Surgery 2003 56, 630-636DOI: (10.1016/S0007-1226(03)00361-8)

Fig. 5 The occlusal level of the bone graft extends to the level of the ACJ (Bergland type I) but less than three quarters of normal inter-dental alveolar bone height has been achieved. By both basal and height analysis it is categorised as a type III graft. Significant absence of bone graft around the root apex of the mesially tilted canine prevents its bodily movement to a desired upright and a more functional position. (1) Central incisor; (2) lateral incisor when present; (3) canine; (4) first premolar. An asterisk marks the ACJ of the adjacent cleft teeth and therefore one lies on either side of the grafted cleft. The broken line represents the desired basal level of bone grafts and therefore passes from the apex of the canine root to that of the central incisor. This approximates the expected level of the pyriform margin laterally and the ANS medially. British Journal of Plastic Surgery 2003 56, 630-636DOI: (10.1016/S0007-1226(03)00361-8)

Fig. 6 The occlusal level of the bone graft just fails to reach the level of the ACJ (Bergland type II). Its base fails noticeably to extend to the desired level. Less than three quarters of normal height has been achieved. By both basal and height analysis it is categorised as a type III graft. When apical root resorption affects a cleft incisor the contralateral central incisor or ANS is used to indicate the desired basal level of the bone graft medially. (1) Central incisor; (2) lateral incisor when present; (3) canine; (4) first premolar. An asterisk marks the ACJ of the adjacent cleft teeth and therefore one lies on either side of the grafted cleft. The broken line represents the desired basal level of bone grafts and therefore passes from the apex of the canine root to that of the central incisor. This approximates the expected level of the pyriform margin laterally and the ANS medially. British Journal of Plastic Surgery 2003 56, 630-636DOI: (10.1016/S0007-1226(03)00361-8)

Fig. 7 Complete failure of bone graft. Thus by occlusal (Bergland), basal and height analysis it is considered a type IV graft. At regrafting the vestigial lateral incisor was extracted to remove a possible source of infection. (1) Central incisor; (2) lateral incisor when present; (3) canine; (4) first premolar. An asterisk marks the ACJ of the adjacent cleft teeth and therefore one lies on either side of the grafted cleft. The broken line represents the desired basal level of bone grafts and therefore passes from the apex of the canine root to that of the central incisor. This approximates the expected level of the pyriform margin laterally and the ANS medially. British Journal of Plastic Surgery 2003 56, 630-636DOI: (10.1016/S0007-1226(03)00361-8)