This document summarizes a retrospective study that evaluated the clinical outcomes of gingivoperiosteoplasty in patients with bilateral cleft lips and palates. The study aimed to quantify bone formation at the alveolar cleft site, identify the location of bone, evaluate nasoalveolar fistula closure, and measure midfacial growth. Seventeen patients who underwent gingivoperiosteoplasty between ages 3-6 months were evaluated using three grading scales to assess bone formation and location at the cleft site. Cephalometric radiographs were also used to analyze midfacial growth.

1. Evaluation of clinical outcomes of
Gingivoperiosteoplasty in Patients with
Bilateral Cleft
Annual Report
Pang-Yun Chou
Philip KT Chen

2. Introduction
• Primary reconstruction of the alveolar cleft
– Bone grafting
– Gingivoperiosteoplasty
• Debate continuing
– Quantity and quality of the resulting bone
– Long-term repercussions to subsequent growth
– Development of the maxilla

3. Introduction
• Alveolar repair
– Secondary alveolar bone graft
• Current standard
– Gingivoperiosteoplasty
• Principal alternative
– Introduced by Skoog
– Modified by Millard and Latham
• Performed at 3 to 6 months of age
• Allows closure of the nasoalveolar fistula
• Aligns the cleft segments through early union of the dental arch
– Preventing collapse
• Reduce the need for future bone graft, and there is no donor site

4. Introduction
• The success rate of gingivoperiosteoplasty
– No need of additional alveolar bone grafting
– 60 percent by Santiago et al
– 73 percent by Sato et al
– In Chang-Gung Memorial Hospital
• Less need for alveolar bone grafting following gingivoperiosteoplasty
• In the past
– Patients, who underwent gingivoperiosteoplasty
• Maxillary retrusion
• Decreased vertical maxillary height
– However, the fact of growth disruption was not as significant as former
studies

5. Introduction
• Retrospective study
• Purpose
– Evaluation the clinical outcome of
gingivoperiosteoplasty
• (1) quantifying the amount of bone at the alveolar cleft site
• (2) identifying the location of the bone
• (3) evaluating the success of closure of the nasoalveolar
fistula
• (4) measuring the midfacial growth

6. Patient and Method
• This is a retrospective study of clinical evaluation was performed in
seventeen bilateral cleft patients underwent gingivoperiosteoplasty.
The surgical protocol for the gingivoperiosteoplasty group included
initial treatment with the Latham presurgical appliance, which
reduced the alveolar gap to 1 to 3 mm, minimizing cleft width
variability. Dr. R. A. Latham was the orthodontist and directly
supervised the fit, application, and use of the appliance in all
patients.
• Gingivoperiosteoplasty was performed at 3 months together with
either a lip adhesion or definitive lip repair. The technique
described by Millard was used for all gingivoperiosteoplasties.19
Palate surgery was performed at 12 months and formal lip repair
(for patients with a lip adhesion) was completed by 18 months.

7. Radiographic Evaluations
• Radiographs were obtained either from
orthodontic records or following study
participation during clinical examination. The
level of noncleft interdental alveolar
bone, adjacent tooth roots, and the contour of
alveolar bone at the former cleft site were
recorded. The rater evaluated the films
according to the scales of Bergland, Long et
al., and Witherow et al. and was blinded to
each patient’s surgical history.

8. • Fig.1 Cephalometric landmark
• For evaluation of midfacial growth, standard
cephalometric landmark was plotted, (Fig. 1) and
derived into specific statics . Linear and angular
measurements were based on both the anterior cranial
base using the sella turcica in addition to the basion.
Because the variable position of the sella turcica in
patient with clefts, the basion-nasion was used as an
additional reference plane to increase reliability of
measurement. Linear measurements were converted
into ratios to the basion-nasion.

9. Grading Scales
• Three grading scales were used within this
study to overcome limitations of any one
method and to provide internal correlation for
results.

10. Bergland
• The Bergland classification system is the
current standard for evaluating bone
production at the former cleft site.7,8,18 It is
based on the height of the interalveolar
septum. It is generally accepted that films
categorized as type I or II represent successful
bone production at the cleft site, whereas
types III and failure represent inadequate
bone production (Fig. 2)

11. Long et al.
• Long et al. developed a system to evaluate
alveolar ridge notching and bone support for cleft
adjacent teeth. The ratios B/A and C/A reflect
total bone support and height of the alveolar
crest bone, respectively, relating to the adjacent
tooth root length of the proximal segment. Ratios
F/E and G/E are analogous to ratios B/A and C/A
and are based on the cleft adjacent tooth of the
distal segment. Ratio D/A allows measurement of
the extent of alveolar ridge notching (Fig. 3).

12. Witherow et al.
• The classification of Witherow et al. assesses
two variables: bone area and location. The
eight point scale indicates the area of
ossification within the former cleft site based
on the cleft midline (Fig. 4). The location
classification supplements the other methods
by assigning one of six classes based on the
position of ossification (Fig. 5). Classifications
A and C are analogous to Bergland types I and
II.