Comparative Outcomes of Primary Gingivoperiosteoplasty and Secondary Alveolar Bone Grafting in Patients with Unilateral Cleft Lip and Palate

Background: The role of primary gingivoperiosteoplasty in the repair of alveolar clefts remains controversial. The aim of this study was to compare the outcomes of primary gingivoperiosteoplasty and secondary alveolar bone grafting in patients with unilateral cleft lip and palate. Methods: In this prospective study, the authors analyzed the postoperative cone-beam computed tomographic scans of 50 children with complete unilateral cleft lip and palate who underwent primary gingivoperiosteoplasty (n = 25) or secondary alveolar bone grafting (n = 25). These two methods of alveolar repair were compared by measuring residual cleft defect and unsupported root ratio of cleft-adjacent central incisors on patient scans. Results: Patients who underwent repair by primary gingivoperiosteoplasty presented more need for additional bone grafting than those undergoing repair by secondary alveolar bone grafting (28 percent versus 4 percent, respectively; p < 0.05). Residual cleft defect was greater in patients who underwent repair by primary gingivoperiosteoplasty than by secondary alveolar bone grafting (305.8 176.5 mm(3) versus 178.6 122.0 mm(3), respectively; p < 0.05). Patients who underwent repair by primary gingivoperiosteoplasty showed more residual palatal coronal and palatal apical defects than those who underwent repair by secondary alveolar bone grafting (p < 0.05 and p < 0.001, respectively). Conclusions: In patients with unilateral cleft lip and palate, primary gingivoperiosteoplasty can achieve 72 percent success. Primary gingivoperiosteoplasty results in less bone than secondary alveolar bone grafting, particularly on the palatal apical portion of the previous alveolar cleft. Clinical success is lower with primary gingivoperiosteoplasty than with secondary alveolar bone grafting. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.