Surgical Outcomes of Secondary Alveolar Bone Grafting and Extensive Gingivoperiosteoplasty Performed at Mixed Dentition Stage in Unilateral Complete Cleft Lip and Palate

Abstract

Secondary alveolar bone grafting (SABG) is associated with donor site morbidities. We aimed to compare the outcomes of SABG and extensive gingivoperiosteoplasty (EGPP) at the mixed dentition stage. This single-blinded, randomized, prospective trial enrolled 50 consecutive patients with unilateral complete cleft lip and palate who had residual alveolar bone cleft, of which 44 (19 SABG, 25 EGPP) completed the study. Bone volumes before surgery, 6 months postoperatively, and 1-year postoperatively were compared using computed tomography. The Bergland scale score was recorded at 6 months postoperatively. Both groups had the same preoperative alveolar cleft volume. On the Bergland scale, 21, 3, and 1 patient in the EGPP group and 16, 2, and 1 patient in the SABG group were classified as types I, II, and IV, respectively, which did not show significant difference. With perioperative orthodontic treatment, the 1-year residual bone defect volume in both groups did not show significant difference (SABG 0.12 cm3 vs. EGPP at 0.14 cm3, p > 0.05). The study was not able to reveal much difference between SABG and EGPP combined with perioperative orthodontic treatment.

Extensive Gingivoperiosteoplasty Versus Secondary Alveolar Bone Grafting in Patients With Complete Bilateral Cleft Lip and Palate During the Mixed Dentition Period

“…This prompted the team to use GPP as a surgical armamentarium for management of alveolar clefts. The prospective study by Chu et al 10 in 2020 comparing extensive GPP and ABG in unilateral alveolar cleft in mixed dentition has already shown comparative results. We suppose that the patients in the mixed dentition period still have significant growth potential and osteogenic activity so that similar mechanism of action of bone bridging as in primary GPP can be expected in this group of patients 20 .…”

“…However, deep dissection to the posterior part of the cleft and maximum possible excision of redundant tissue create a soft tissue tension preventing collapse and favoring bone apposition. 10 We assume that the protocol for management of cleft patients in the author's center, which involves NAM before primary lip surgery and orthodontic treatment before and after GPP, is largely responsible in making the alveolar gap favorable for bone apposition. We thus recommend that the technique be carefully evaluated in cases of difficult fistula with no provision of orthodontic treatment.…”

“…Occlusal radiographs were taken as primary radiographs for the evaluation and were complemented secondarily by orthopantomogram. A minimum of 1 year is advisable to evaluate bony bridge formation across alveolar cleft gap after GPP procedure, 10 and ABG is considered to remain fairly constant after 1 year even after cleft tooth eruption 14 . Thus, we used 1-year follow-up radiographs to evaluate bone formation in ABG and GPP.…”

A New Technique of Two Iliac Cortical Bone Blocks Sandwich Technique for Secondary Alveolar Bone Grafting in Cleft Lip and Palate Patients

“…To evaluate the results of bone grafting in the alveolar cleft, most studies combined two-dimensional film (periapical radiography, bite-wing radiography) and Cone Beam CT radiography [33,37]. The formation of bone bridge in the graft area was evaluated two-dimensionally using Enermark scale [17], Bergland scale [38], Kindelan scale [39], Witherow scale [40], and Long scale [41]; while the size and volume of grafting bone was evaluated three-dimensionally in Cone Beam CT radiography [16,37,38].…”

“…In the autogenous cancellous bone grafting technique, most authors used iliac crest cancellous bones to place directly on the graft base, then added cancellous bones to fill the cleft site and suture the vestibular flap without using any synthetic materials [33]. This was a technique commonly used in decades for bone grafting.…”