Treatment of osseous cleft palate defects: a preliminary evaluation of novel treatment modalities.
OBJECTIVE
To compare the use of autogenous iliac bone graft (ABG) alone with nonresorbable expanded polytetrafluoroethylene Gore-Tex TR membrane (GTM) and with ABG plus resorbable Resolut XT membrane barriers for the secondary closure of alveolar cleft defects.


METHODS
Fifteen patients aged 9 to 17 years with unilateral cleft palate were included in this study. All patients had primary closure of the soft tissues at infancy. Presurgical orthodontics and scaling preceded the surgery. The patients were randomized to one of three surgical treatment groups: (1) ABG, (2) GTM, or (3) autogenous bone plus resorbable membrane (ABM). Periapical radiographs were taken pretreatment and 2 to 6 years later and were used to measure changes in size (linear and area) of the osseous defect.


RESULTS
Significant decreases were observed in mean initial defect width (9.8 to 6.7 mm; p = .0263), mean initial defect height (20.7 to 15.1 mm), and overall mean defect size (223.6 to 143.9 mm2). Greater improvement in mean defect width was observed for the ABM group (6.42 mm) compared with the ABG (1.22 mm) and GTM (1.38 mm) groups. The reduction in overall mean defect size was significantly greater in the ABM group (177 mm2) compared with the GTM (20.51 mm2) and ABG (41.69 mm2) groups.


CONCLUSIONS
Guided bone regeneration was found potentially useful for the treatment of osseous cleft palate defects. The combined approach yielded significantly greater defect fill. If further substantiated in larger independent studies, the adjunctive use of barrier membranes could improve the management of secondary closure of cleft palate defects.
Department of Maxillofacial Surgery, Rambam Medical Center, Haifa, Israel.
Micha
M
Peled
Dror
D
Aizenbud
Jacob
J
Horwitz
Eli E
EE
Machtei
D020341:Absorbable Implants; D000293:Adolescent; D000543:Alveoloplasty / Q000379:methods; D001861:Bone Regeneration; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D002972:Cleft Palate / Q000601:surgery*; D016557:Guided Tissue Regeneration, Periodontal / Q000379:methods*; D006801:Humans; D019344:Lactic Acid; D008567:Membranes, Artificial; D019647:Oral Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D011091:Polyesters; D011108:Polymers; D011138:Polytetrafluoroethylene; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome
D008567:Membranes, Artificial; D011091:Polyesters; D011108:Polymers; D019344:Lactic Acid; C033616:poly(lactide); D011138:Polytetrafluoroethylene