Outcome of gingivoperiosteoplasty for the treatment of alveolar clefts in patients with unilateral cleft lip and palate.

Gingivoperiosteoplasty (GPP) has produced inconsistent outcomes. The purpose of this prospective study was to investigate the effects of GPP on the production of bone and maxillary growth. We analysed postoperative cone-beam computed tomographic (CT) scans and intraoral dental photographs of 25 children with complete unilateral cleft lip and palate (UCLP) who were treated with GPP at the same time as their primary repair of the lip. Residual cleft defects and unsupported root ratios of central incisors adjacent to clefts were measured from scans. Dental arch relations were assessed from photographs using the Goslon (Great Ormond Street London and Oslo) yardstick. Eighteen children did not require secondary alveolar bone grafts. Residual cleft defects varied by site (20.4mm(3), 38.6mm(3), 88.2mm(3), and 135.2mm(3) for buccal coronal, palatal coronal, buccal apical, and palatal apical defects, respectively; p<0.001). Unsupported root ratios did not differ significantly between coronal and apical central incisors adjacent to clefts. The mean (SD) Goslon score was 4.52 (0.51). Most participants (n=18) who had a GPP did not need secondary alveolar bone grafting. GPP resulted in least bone on the palatal apical portion of the previous alveolar cleft and relatively good periodontal bony support of central incisors adjacent to the cleft. We no longer use GPP because of our concerns about maxillary growth.