title: Reduced need for alveolar bone grafting by presurgical orthopedics and primary gingivoperiosteoplasty.
abstract: OBJECTIVE
  The purpose of this study was to evaluate if narrowing and approximation of the alveolar cleft through presurgical alveolar molding followed by gingivoperiosteoplasty (GPP) at the time of lip repair reduces the need for a bone-grafting procedure.
  
  
  METHODS
  This was a retrospective blind study of patients with unilateral or bilateral alveolar clefts who underwent presurgical infant alveolar molding and GPP by a single surgeon. Alveolar bone formation was assessed prior to the eruption of the maxillary lateral incisor or canine by clinical examination, panoramic and periapical radiographs, and/or a dental CT scan. The criterion for bone grafting was inadequate bone stock to permit the eruption and maintenance of the permanent dentition.
  
  
  METHODS
  This study was performed at the Institute of Reconstructive Plastic Surgery by the members of the Cleft Palate Team.
  
  
  METHODS
  All patients with unilateral (n = 16) or bilateral (n = 2) alveolar clefts who underwent presurgical infant alveolar molding and GPP by a single surgeon from 1985 to 1988 were studied. The control population consisted of all alveolar cleft patients (n = 14) who did not undergo alveolar modeling or GPP during the same time period.
  
  
  METHODS
  Presurgical alveolar modeling was performed with an intraoral acrylic molding plate. This plate was modified on a weekly basis to align the alveolar segments and close the alveolar gap. The surgical intervention consisted of a modified Millard GPP.
  
  
  METHODS
  The primary study outcome measure was the elimination of the need for a secondary bone graft in patients who underwent presurgical alveolar molding and GPP.
  
  
  RESULTS
  Of the 20 sites in the 18 patients who underwent GPP, 12 sites did not require an alveolar bone graft. Of the 8 sites requiring a bone graft, 4 presented minimal bony defects. All 14 patients in the control group required bone grafts.
  
  
  CONCLUSIONS
  In this series of 20 alveolar cleft sites treated with presurgical orthopedics and GPP, 60% did not need a secondary alveolar bone graft in the mixed dentition.
authors.affiliation: Department of Orthodontics, University of Puerto Rico School of Dentistry, USA.
authors.forename: P E
authors.initials: PE
authors.lastname: Santiago
authors.forename: B H
authors.initials: BH
authors.lastname: Grayson
authors.forename: C B
authors.initials: CB
authors.lastname: Cutting
authors.forename: M P
authors.initials: MP
authors.lastname: Gianoutsos
authors.forename: L E
authors.initials: LE
authors.lastname: Brecht
authors.forename: S M
authors.initials: SM
authors.lastname: Kwon
mesh_terms: D000539:Alveolar Process / Q000000981:diagnostic imaging / Q000254:growth & development; D000543:Alveoloplasty; D016025:Bone Transplantation; D016009:Chi-Square Distribution; D002648:Child; D002971:Cleft Lip / Q000601:surgery; D002972:Cleft Palate / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D003481:Cuspid / Q000502:physiology; D003818:Dentition, Mixed; D005069:Evaluation Studies as Topic; D005500:Follow-Up Studies; D005893:Gingivoplasty; D006801:Humans; D007180:Incisor / Q000502:physiology; D007223:Infant; D008046:Lip / Q000601:surgery; D008437:Maxilla / Q000000981:diagnostic imaging / Q000254:growth & development; D010158:Palatal Obturators; D010486:Periapical Tissue / Q000000981:diagnostic imaging; D010521:Periosteum / Q000601:surgery*; D011862:Radiography, Panoramic; D012086:Reoperation; D012189:Retrospective Studies; D016037:Single-Blind Method; D014057:Tomography, X-Ray Computed; D014078:Tooth Eruption; D016896:Treatment Outcome