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Experiences with infant and delayed periosteoplasty.

At the Cleft Palate Centre, Uppsala, Sweden, the periosteoplasty procedure had been used since 1964 to obtain bone continuity in the maxillary alveolar cleft area. This operation is performed either in infancy or as an early secondary (delayed) procedure. The amount of new bone formed in the alveolar cleft area was classified in 4 types according to Hellquist & Skoog 1976. The influence of the periosteoplasty on craniofacial growth and dental occlusion was studied longitudinally in different series of patients from the Uppsala region of Sweden, operated on with either infant or delayed periosteoplasty. As a result of delayed periosteoplasty, good bone formation in the alveolar cleft area was noted in 80% of the cases in patients younger than 7 years of age at the time of operation, compared with 47% after infant periosteoplasty. In the patients subjected to delayed periosteoplasty, the frequency of anterior crossbite was lower than that reported for other Scandinavian cleft lip and palate materials of the same age and type of cleft. Cephalometric analysis indicated that growth of the facial skeleton of the patients subjected to delayed periosteoplasty was well within the limits reported for other Scandinavian cleft lip and palate materials of the same age and type of cleft, subjected neither to periosteoplasty nor to primary bone-grafting.

Age Factors↗

Long term evaluation of osseous grafts in periodontal therapy.

Osseous grafting therapy has been shown to be clinically successful for time intervals exceeding 20 years when encompassed in a comprehensive care programme based on effective daily plaque control by the patient and a professionally supervised periodontal maintenance programme. Although other treatment modalities have also yielded favourable clinical results over varying time intervals, only osseous grafting therapy has demonstrated histologic regeneration of lost periodontium consisting of new cementum, alveolar process and a functionally orientated periodontal ligament in the human. While the frequency of such regeneration is only speculative at this time, studies to identify factors enhancing favourable reponse will hopefully afford the practitioner a predictable technique for periodontal reconstruction in the future. For the present, biometric and histometric data assure osseous grafting a place in currently accepted therapy for the pocket-osseous defect.

Alveolar Process↗

Alveolar reconstruction in adolescent patients with cleft palates.

Treatment of patients with cleft palates requires optimal interdisciplinary care. The efforts of the entire team treating the patient with cleft palate must be closely coordinated, even when the deformity is confined to the alveolus. In a significant number of patients with cleft palate, surgical reconstruction of the alveolus and adjacent soft tissue is a necessary adjunct to orthodontic, prosthetic, and facial soft tissue management. Surgical treatment and its complications are discussed, with specific case examples.

Adolescent↗

A cephalometric study of the effects of primary osteoplasty in unilateral cleft lip and palate individuals.

Nine Caucasians with unilateral clefts of the lip and palate, treated with primary bone graft of the alveolus, were compared cephalometrically to a similar number of cases treated with soft tissue surgery but no primary osteoplasty. There were no significant differences between the two groups, except for the following: 1. The mandibular apical base was positioned more posteriorly in the bone-grafted group. 2. The ramal inclination angle was significantly smaller in the bone-grafted group. 3. The absolute depth of the mandible was significantly smaller in the bone-grafted group. Generally speaking, although these individuals were characterized by retrognathic faces, there was no significant difference in the anteroposterior and vertical growth of the middle face in patients with unilateral cleft lip and palate treated with the two different approaches. In contrast, there were significant differences between the two groups in mandibular depth and position, with mandibles in the bone-grafted group being shorter and more distally positioned. Maintenance of harmonious relationships of the dental bases was, however, achieved.

Adolescent↗

Canine eruption into grafted bone in maxillary alveolar cleft defects.

Forty-six patients with clefts of the alveolus who had received alveolar bone grafts (secondary osteoplasties) at ages 7-14 years, were studied. A total of 64 affected canines from 18 bilateral and 28 unilateral alveolar cleft patients was available. Follow up orthopantomographs were examined to determine the state of root development and spontaneous canine movement through the grafted site. The postoperative observation period ranged from 2-8 years (mean 4.3 +/- 1.5). All test canines erupted through the graft. Spontaneous eruption occurred for 27% of test canines, 17% required surgical uncovering (either bony or soft tissue), and 56% required surgical uncovering and orthodontic assistance to accomplish eruption. All patients required orthodontic treatment to accomplish arch alignment. The prognosis for canine eruption through a graft site is most favorable if the graft is performed at 1/4-1/2 canine root formation and when the patient is aged 9-12 years. The post graft observation period is very important and requires complete cooperation between the orthodontist and the surgeon.

Adolescent↗