Wang Yi-Chin, Liao Yu-Fang, Chen Philip Kuo-Ting
Taipei, Taoyuan, and Linkou, Taiwan From the Department of Craniofacial Orthodontics, the Craniofacial Center, the Craniofacial Research Center, and the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital; and the College of Medicine, Chang Gung University.
Plast Reconstr Surg. 2016 Jan;137(1):218-227. doi: 10.1097/PRS.0000000000001897.
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.
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.
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 versus 178.6 ± 122.0 mm, 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).
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.
一期牙龈骨膜成形术在牙槽嵴裂修复中的作用仍存在争议。本研究的目的是比较单侧唇腭裂患者一期牙龈骨膜成形术和二期牙槽骨植骨的效果。
在这项前瞻性研究中，作者分析了50例接受一期牙龈骨膜成形术（n = 25）或二期牙槽骨植骨（n = 25）的完全性单侧唇腭裂患儿的术后锥形束计算机断层扫描图像。通过测量患者扫描图像上的残余腭裂缺损和腭裂相邻中切牙的无根支持率，对这两种牙槽嵴修复方法进行比较。
与接受二期牙槽骨植骨修复的患者相比，接受一期牙龈骨膜成形术修复的患者更需要额外植骨（分别为28%和4%；p < 0.05）。接受一期牙龈骨膜成形术修复的患者残余腭裂缺损大于接受二期牙槽骨植骨修复的患者（分别为305.8±176.5 mm和178.6±122.0 mm；p < 0.05）。接受一期牙龈骨膜成形术修复的患者腭部冠部和腭部根尖部的残余缺损比接受二期牙槽骨植骨修复的患者更多（分别为p < 0.05和p < 0.001）。
在单侧唇腭裂患者中，一期牙龈骨膜成形术的成功率可达72%。一期牙龈骨膜成形术获得的骨量比二期牙槽骨植骨少，尤其是在前牙槽嵴裂的腭部根尖部分。一期牙龈骨膜成形术的临床成功率低于二期牙槽骨植骨。
临床问题/证据级别：治疗性，III级。
