Autelitano Luca, Hamaui Daniele, Battista Valeria M A, Biglioli Federico, Meazzini Maria C
From the Cleft Lip and Palate Regional Center, Operation Smile, San Paolo University Hospital, ASST Santi Paolo e Carlo Milano.
Plast Reconstr Surg. 2025 Mar 1;155(3):523e-532e. doi: 10.1097/PRS.0000000000011684. Epub 2024 Aug 20.
The aim of this study was to conduct a comparative analysis, using computed tomographic scans, of ossification patterns in unilateral cleft lip and palate patients who underwent early secondary gingivoalveoloplasty (esGAP) versus those who underwent traditional alveolar bone grafting harvested from the iliac crest (IC).
Computed tomographic scans of 22 consecutively treated patients with esGAP were compared with those of 21 patients treated with bone grafting from the IC. Inclusion criteria were nonsyndromic unilateral cleft lip and palate patients in permanent dentition. Two parameters were considered: the alveolar thickness, measured at 3 levels, and the nasoalveolar height. All measurements were normalized and ratios of the affected versus nonaffected sides were provided as in addition to the statistical comparison between the 2 groups' ossification outcomes.
In the esGAP sample, nasoalveolar height was categorized as ideal and good in 86.36% and in 13.64% of the cases, and no mediocre or insufficient ossification was detected; whereas in the bone grafting sample, 38.10% had ideal and good ossification, 14.29% had mediocre ossification, and 9.52% had insufficient ossification. As regards the alveolar thickness, when we consider the average of 3 levels, the esGAP sample was ideal and good in 57.57% and in 30.30% of the cases; for the IC sample, the alveolar thickness was ideal and good 41.27% and in 25.40% of the cases, respectively. The analysis detected a statistically significant difference in the ossification outcomes in the 2 samples.
The esGAP yields superior ossification grades in comparison to IC bone grafting.
In unilateral cleft lip and palate patients, esGAP seems to allow for a higher grade of ossification compared to IC bone grafting.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
本研究的目的是利用计算机断层扫描，对接受早期二期牙龈牙槽成形术（esGAP）的单侧唇腭裂患者与接受取自髂嵴（IC）的传统牙槽骨移植的患者的骨化模式进行对比分析。
将22例连续接受esGAP治疗的患者的计算机断层扫描结果与21例接受IC骨移植治疗的患者的扫描结果进行比较。纳入标准为恒牙列期的非综合征性单侧唇腭裂患者。考虑了两个参数：在三个水平测量的牙槽厚度和鼻牙槽高度。所有测量值均进行了标准化处理，并提供了患侧与非患侧的比值，以及两组骨化结果之间的统计比较。
在esGAP样本中，86.36%的病例鼻牙槽高度被归类为理想和良好，13.64%为中等或不足，未检测到中等或不足的骨化情况；而在骨移植样本中，38.10%的病例骨化理想和良好，14.29%为中等骨化，9.52%为骨化不足。关于牙槽厚度，当考虑三个水平的平均值时，esGAP样本中57.57%的病例为理想和良好，30.30%为中等；对于IC样本，牙槽厚度理想和良好的病例分别为41.27%和25.40%。分析发现两个样本的骨化结果存在统计学显著差异。
与IC骨移植相比，esGAP产生的骨化等级更高。
在单侧唇腭裂患者中，与IC骨移植相比，esGAP似乎能实现更高等级的骨化。
临床问题/证据水平：治疗性，III级
