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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.
Plast Reconstr Surg 2009; 124(2):573-82PR

Abstract

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.

Authors+Show Affiliations

Division of Plastic and Reconstructive Surgery, Department of Paediatrics, University of Western Ontario, London, Ontario, Canada.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19644277

Citation

Power, Stephanie M., and Damir B. Matic. "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." Plastic and Reconstructive Surgery, vol. 124, no. 2, 2009, pp. 573-82.
Power SM, Matic DB. 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. Plast Reconstr Surg. 2009;124(2):573-82.
Power, S. M., & Matic, D. B. (2009). 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. Plastic and Reconstructive Surgery, 124(2), pp. 573-82. doi:10.1097/PRS.0b013e3181addc37.
Power SM, Matic DB. 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. Plast Reconstr Surg. 2009;124(2):573-82. PubMed PMID: 19644277.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Power,Stephanie M, AU - Matic,Damir B, PY - 2009/8/1/entrez PY - 2009/8/1/pubmed PY - 2009/9/23/medline SP - 573 EP - 82 JF - Plastic and reconstructive surgery JO - Plast. Reconstr. Surg. VL - 124 IS - 2 N2 - 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. SN - 1529-4242 UR - https://www.unboundmedicine.com/medline/citation/19644277/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_ L2 - http://Insights.ovid.com/pubmed?pmid=19644277 DB - PRIME DP - Unbound Medicine ER -