Need For Alveolar Bone Grafting Research Articles

Gingivoperiosteoplasty in Children with Cleft Lip and Palate: The Need for Alveolar Bone Grafting.

This study aimed to determine the efficacy of gingivoperiosteoplasty (GPP) in preventing alveolar bone grafting (ABG) among children with cleft lip and palate (CLP). Retrospective university hospital single center study. Children with CLP treated with GPP from 2000-2015 were included. Those under eight years of age, without definitive conclusions regarding need for ABG or with incomplete data were excluded. Included patients were analyzed for demographics, cleft type, age at GPP, associated cleft surgery, use of nasoalveolar molding (NAM), indication for ABG, operating surgeon and presence of residual alveolar fistula. T-tests and Fisher's exact tests were utilized for statistical analysis. The need for ABG. Of the 1682 children identified with CLP, 64 underwent GPP and met inclusion criteria. 78% of patients with CLP who underwent GPP were recommended for ABG. Those who received GPP at a younger age (P = .004) and at the time of initial cleft lip repair (P = .022) were less likely to be recommended for ABG. Patients with complete CLP were more likely to be recommended for ABG than patients with cleft lip and alveolus only (P = .015). The operating surgeon impacted the likelihood of ABG (P = .004). Patient gender, race, ethnicity, laterality, and NAM were not significantly associated with recommendation for ABG. GPP does not preclude the need for ABG. Therefore, the success of ABG after GPP and maxillary growth restriction should be analyzed further to determine if GPP is a worthwhile adjunct to ABG in cleft care.

A novel technique for prevention of anterior fistula and facilitation of alveolar cleft repair: Gingivoperiosteoplasty with palatoplasty.

Background & Objectives:The Cleft palate is one of the most commonly encountered congenital deformity in plastic surgery clinics and can be associated with cleft lip and alveolus. Though palate repair can be associated with several complications, the most frequent and troublesome is anterior fistula formation. Various technical modifications are in practice to avoid this dreaded complication. We have started combining gingivoperiosteoplasty with palate repair to avoid postoperative anterior fistula formation and to close alveolar cleft at the same time.Methods:A prospective study was performed at the department of plastic and reconstructive surgery, Liaquat National Hospital, Karachi and selected patients were enrolled in the study after informed consent. A total of 15 patients were operated on from January 2017 to December 2020. All patients had cleft palate repair along with primary gingivoperiosteoplasty (GPP) at the age of standard palatal repair. Buccal/oral and nasal layers of the alveolus were dissected as per standard gingivoperiosteoplasty and repaired in continuation with nasal and oral layers of the palate. Postoperatively, the standard cleft palate repair protocol was followed. Follow-up was done at four weeks, 12 weeks, and six months and repair integrity was checked. Future follow-up at 4-5 years of age is planned to see the effect on alveolar collapse, bone growth, and the need for secondary bone grafting.Results:All patients were followed up regularly. None had a complication of fistula. The repairs of both palate and alveolus remained intact. Patients were kept on the follow-up to assess the need for alveolar bone grafting in the future.Conclusion:Gingivoperiosteoplasty combined with the palatal repair is a novel technique for the prevention of anterior palatal fistula.

Preoperative Alveolar Segment Position as a Predictor of Successful Gingivoperiosteoplasty in Patients with Unilateral Cleft Lip and Palate.

Gingivoperiosteoplasty can avoid secondary alveolar bone grafting in up to 60 percent of patients with a cleft. However, preoperative predictors of success have not been characterized. This study reports on the preoperative alveolar segment position most favorable for successful gingivoperiosteoplasty. The authors performed a single-institution, retrospective review of patients with a unilateral cleft who underwent nasoalveolar molding. Alveolar segment morphology was directly measured from maxillary dental models created before and after nasoalveolar molding. Statistical analysis was performed to identify parameters associated with the decision to perform gingivoperiosteoplasty and its success, defined as the absence of an eventual need for alveolar bone grafting. Fifty patients with a unilateral cleft who received nasoalveolar molding therapy were included in this study (40 underwent gingivoperiosteoplasty and 10 did not). Eighteen alveolar morphology and position characteristics were tested, including cleft gap width, horizontal and vertical positions of the alveolar segments, alveolar stepoff, and degree of alveolar segment apposition. Post-nasoalveolar molding vertical rotation of the greater segment and the percentage of segment alignment in the correct anatomical zone were statistically significant predictors of the decision to perform gingivoperiosteoplasty (86 percent predictive power). Cleft gap, greater/lesser segment overlap, alveolar segment alignment, greater segment horizontal rotation, and alveolar segment width following nasoalveolar molding were significant predictors of gingivoperiosteoplasty success (86.5 percent predictive power). Greater segment vertical rotation and proper alveolar segment anatomical alignment are positive predictors of the decision to perform gingivoperiosteoplasty. Post-nasoalveolar molding evidence of proper alignment and direct contact between the alveolar segments were significant predictors of successful gingivoperiosteoplasty. Risk, III.

Alveolar ridge notching as a predictor for secondary bone grafting in incomplete alveolar clefts.

To clarify the need for secondary alveolar bone grafting (ABG) in incomplete alveolar clefts identified clinically from its appearance and test the usefulness of alveolar ridge notching in the edentulous stage as a predictor for ABG. A prospective, cross-sectional study comparing three groups of patients at two stages. Twenty-four patients with unilateral incomplete cleft of primary palate who underwent either no surgery or cheiloplasty only. Cleft severity was assessed at two stages. Initially, the appearance of untreated clefts was assessed before cheiloplasty or at 3 months of age in the patient without cheiloplasty and graded by severity into three groups. Later alveolar bone defects were assessed with computed tomography in the primary or mixed dentition period. A decision regarding the requirement for ABG was then made. Finally, the relationship between untreated clefts and the need for ABG was determined. Nine (75%) of 12 patients with alveolar ridge notching in the edentulous stage were diagnosed as fulfilling the criteria for ABG. The alveolar bone defects correlated with the severity of untreated cleft conditions (Spearman r = 0.65, p =.002). The need for ABG was greater in patients with alveolar ridge notching, compared with those without notching (9/12 versus 0/12, p =.00034). Most patients with incomplete alveolar clefts clinically identified in the edentulous stage required ABG, and alveolar ridge notching in the edentulous stage could therefore serve as a predictor for ABG.

Long Term Effects of the Latham Presurgical Maxillary Orthopedic Appliance, Including Effects on Tooth Growth

Reported beneficial effects of presurgical maxillary orthopedics in cleft lip include reduction of the cleft width, alignment of the maxillary segments, elevation of the alar base on the cleft side, diminished need for alveolar bone grafting and lip closure without tension. Possible adverse effects of presurgical maxillary orthopedics include tooth root damage and inability of periosteoplasty to make bone over the cleft. A series of wide cleft lip patients (n=15) treated with the Latham appliance at the time of lip closure were retrospectively compared with a similar group treated without the Latham appliance. The Latham appliance group (seven unilateral clefts, eight bilateral clefts; mean follow-up 9.5 years; range four to 18 years) was treated between the years 1980 and 1994. None of the 15 patients treated with the appliance had any tooth loss or damage attributable to the pins, and bone formation in the alveolar cleft was observed radiographically in all 13 of the patients who had a periosteoplasty at the time of lip repair, possibly obviating the need for secondary bone grafting. Five of these Latham group patients demonstrated clinical and radiographic evidence of tooth eruption into the periosteoplasty-formed bone. There was no consistent difference in the level of nasal alar base elevation in the two groups.

Reduced Need for Alveolar Bone Grafting by Presurgical Orthopedics and Primary Gingivoperiosteoplasty

Reduced Need for Alveolar Bone Grafting by Presurgical Orthopedics and Primary Gingivoperiosteoplasty

Reduced Need for Alveolar Bone Grafting by Presurgical Orthopedics and Primary Gingivoperiosteoplasty

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. 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. This study was performed at the Institute of Reconstructive Plastic Surgery by the members of the Cleft Palate Team. 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. 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. 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. 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. 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.