REDUCED NEED FOR ALVEOLAR BONE-GRAFTING BY PRESURGICAL ORTHOPEDICS AND PRIMARY GINGIVOPERIOSTEOPLASTY

Objective: The purpose of this study was to evaluate if narrowing and approximation of the alveolar cleft through presurgical alveolar moldi ng followed by gingivoperiosteoplasty (GPP) at the time of lip repair reduces the need for a bone-grafting procedure. Design: This was a ret rospective blind study of patients with unilateral or bilateral alveol ar clefts who underwent presurgical infant alveolar molding and GPP by a single surgeon. Alveolar bone formation was assessed prior to the e ruption of the maxillary lateral incisor or canine by clinical examina tion, panoramic and periapical radiographs, and/or a dental CT scan. T he criterion for bone grafting was inadequate bone stock to permit the eruption and maintenance of the permanent dentition. Setting: This st udy was performed at the Institute of Reconstructive Plastic Surgery b y the members of the Cleft Palate Team. Patients: All patients with un ilateral (n = 16) or bilateral (n = 2) alveolar clefts who underwent p resurgical infant alveolar molding and GPP by a single surgeon from 19 85 to 1988 were studied. The control population consisted of all alveo lar cleft patients (n = 14) who did not undergo alveolar modeling or G PP during the same time period. Interventions: Presurgical alveolar mo deling was performed with an intraoral acrylic molding plate. This pla te was modified on a weekly basis to align the alveolar segments and c lose the alveolar gap. The surgical intervention consisted of a modifi ed Millard GPP Main Outcome Measures: The primary study outcome measur e was the elimination of the need for a secondary bone graft in patien ts who underwent presurgical alveolar molding and GPP. Results: Of the 20 sites in the 18 patients who underwent GPP, 12 sites did not requi re an alveolar bone graft. Of the 8 sites requiring a bone graft, 4 pr esented minimal bony defects. All 14 patients in the control group req uired bone grafts. Conclusions: In this series of 20 alveolar cleft si tes treated with presurgical orthopedics and GPP, 60% did not need a s econdary alveolar bone graft in the mixed dentition.