Santiago P E, Grayson B H, Cutting C B, Gianoutsos M P, Brecht L E, Kwon S M
Department of Orthodontics, University of Puerto Rico School of Dentistry, USA.
Cleft Palate Craniofac J. 1998 Jan;35(1):77-80. doi: 10.1597/1545-1569_1998_035_0077_rnfabg_2.3.co_2.
The purpose of this study was to evaluate if narrowing and approximation of the alveolar cleft through presurgical alveolar molding followed by gingivoperiosteoplasty (GPP) at the time of lip repair reduces the need for a bone-grafting procedure.
This was a retrospective blind study of patients with unilateral or bilateral alveolar clefts who underwent presurgical infant alveolar molding and GPP by a single surgeon. Alveolar bone formation was assessed prior to the eruption of the maxillary lateral incisor or canine by clinical examination, panoramic and periapical radiographs, and/or a dental CT scan. The criterion for bone grafting was inadequate bone stock to permit the eruption and maintenance of the permanent dentition.
This study was performed at the Institute of Reconstructive Plastic Surgery by the members of the Cleft Palate Team.
All patients with unilateral (n = 16) or bilateral (n = 2) alveolar clefts who underwent presurgical infant alveolar molding and GPP by a single surgeon from 1985 to 1988 were studied. The control population consisted of all alveolar cleft patients (n = 14) who did not undergo alveolar modeling or GPP during the same time period.
Presurgical alveolar modeling was performed with an intraoral acrylic molding plate. This plate was modified on a weekly basis to align the alveolar segments and close the alveolar gap. The surgical intervention consisted of a modified Millard GPP.
The primary study outcome measure was the elimination of the need for a secondary bone graft in patients who underwent presurgical alveolar molding and GPP.
Of the 20 sites in the 18 patients who underwent GPP, 12 sites did not require an alveolar bone graft. Of the 8 sites requiring a bone graft, 4 presented minimal bony defects. All 14 patients in the control group required bone grafts.
In this series of 20 alveolar cleft sites treated with presurgical orthopedics and GPP, 60% did not need a secondary alveolar bone graft in the mixed dentition.
本研究旨在评估在唇裂修复时，先进行术前牙槽骨塑形，然后行牙龈骨膜成形术（GPP），使牙槽裂变窄并接近，是否能减少骨移植手术的需求。
这是一项对单侧或双侧牙槽裂患者的回顾性盲法研究，这些患者均由同一位外科医生进行术前婴儿牙槽骨塑形和GPP。在上颌侧切牙或尖牙萌出前，通过临床检查、全景和根尖X线片及/或牙科CT扫描评估牙槽骨形成情况。骨移植的标准是骨量不足，无法使恒牙萌出并维持。
本研究在重建整形外科研究所由腭裂治疗团队成员进行。
研究了1985年至1988年间由同一位外科医生进行术前婴儿牙槽骨塑形和GPP的所有单侧（n = 16）或双侧（n = 2）牙槽裂患者。对照组为同期未进行牙槽骨塑形或GPP的所有牙槽裂患者（n = 14）。
使用口腔内丙烯酸塑形板进行术前牙槽骨塑形。该板每周进行修改，以使牙槽段对齐并缩小牙槽间隙。手术干预包括改良的Millard GPP。
主要研究观察指标是接受术前牙槽骨塑形和GPP的患者是否无需进行二次骨移植。
在接受GPP的18例患者的20个部位中，12个部位无需进行牙槽骨移植。在需要骨移植的8个部位中，4个部位仅有轻微骨缺损。对照组的所有14例患者均需要骨移植。
在这组接受术前正畸和GPP治疗的20个牙槽裂部位中，60%在混合牙列期无需进行二次牙槽骨移植。
