Evaluating the success of gingivoperiosteoplasty versus secondary bone grafting in patients with unilateral clefts.

BACKGROUND: The role of gingivoperiosteoplasty in closure of the cleft alveolus remains controversial. Few studies have documented long-term results of gingivoperiosteoplasty and how it compares to secondary bone grafting. The purpose of this study was to compare gingivoperiosteoplasty with secondary bone grafting by evaluating the amount of bone produced at the alveolar cleft site in patients with unilateral clefts. This comparison should help delineate the role of gingivoperiosteoplasty in the management of patients with clefts.

METHODS: Eighty-six unilateral patients past the age of permanent canine tooth eruption with repaired alveolar clefts were identified. Clinical evaluations of the alveolar cleft site were performed. Grading for 73 periapical and occlusal films was recorded using the scales of Bergland, Long et al., and Witherow et al. and grouped according to gingivoperiosteoplasty (n = 64) or secondary bone grafting (n = 9).

RESULTS: The average patient age was 17 years. The clinical success rate of gingivoperiosteoplasty was lower than that of secondary bone grafting, 41 percent versus 88 percent, respectively. Radiologic evaluations showed that the gingivoperiosteoplasty group had a greater than 90 percent failure rate. In addition, patients in the gingivoperiosteoplasty group that had salvage bone grafting after failed gingivoperiosteoplasty (n = 19) still had less bone at the alveolar cleft compared with patients in the secondary bone grafting group.

CONCLUSIONS: Gingivoperiosteoplasty resulted in bone of less quantity and poorer location within the alveolar cleft. Most unilateral clefts repaired with a gingivoperiosteoplasty will require additional bone grafting. Secondary bone grafting should continue to be considered the standard treatment.