Gingivoperiosteoplasty following alveolar molding with a Latham appliance versus secondary bone grafting: the effects on bone production and midfacial growth in patients with bilateral clefts.
BACKGROUND
The role of gingivoperiosteoplasty in closure of bilateral alveolar clefts remains unclear. The purpose of this study was to evaluate bone production and midfacial growth in patients with bilateral clefts treated with gingivoperiosteoplasty following alveolar molding with a pin-retained Latham appliance versus secondary bone grafting.


METHODS
Patients with complete bilateral clefts past permanent canine eruption were included. Ethics approval and informed consent were obtained. Periapical films and lateral cephalograms were analyzed by one blinded rater based on three radiographic grading scales--Bergland, Witherow et al., and Long et al.--and standard cephalometric landmarks, respectively. Repeated measurements were recorded to assess intrarater reliability. Measurements were grouped according to gingivoperiosteoplasty versus secondary bone grafting and compared using parametric and nonparametric tests.


RESULTS
Fifty-three patients (gingivoperiosteoplasty, n = 43; secondary bone grafting, 10) met inclusion criteria. Average age was 15 years and 66 percent were male patients. Thirty-five patients had adequate radiographs for evaluation (gingivoperiosteoplasty, n = 25; secondary bone grafting, n = 10). Gingivoperiosteoplasty was clinically less successful than secondary bone grafting, 58 percent versus 90 percent, respectively. The quantitative radiographic success rate of gingivoperiosteoplasty, however, was 28 percent. Secondary bone grafting demonstrated higher Bergland, eight-point, and location grading (p < 0.002), and less alveolar notching (p = 0.008). Anteroposterior maxillary and mandibular dimensions were significantly decreased for the gingivoperiosteoplasty group versus the secondary bone grafting group.


CONCLUSIONS
Bone quantity and location were inferior following bilateral gingivoperiosteoplasty versus secondary bone grafting, and the majority of patients required subsequent bone grafting. The gingivoperiosteoplasty group had decreased maxillary growth with mandibular compensation. Secondary bone grafting therefore remains our first choice for repair of bilateral alveolar clefts.
Power
Stephanie M
SM
London, Ontario, Canada From the Division of Plastic and Reconstructive Surgery, the Division of Paediatric Surgery, and the Department of Paediatrics, University of Western Ontario.
Matic
Damir B
DB
D000293:Adolescent; D000539:Alveolar Process / Q000601:surgery*; D016025:Bone Transplantation; D002508:Cephalometry; D002972:Cleft Palate / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005893:Gingivoplasty; D006801:Humans; D008297:Male; D008445:Maxillofacial Development; D009967:Orthodontic Appliances; D009971:Orthodontics, Corrective; D010521:Periosteum / Q000601:surgery*; D011184:Postoperative Period; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome