[Millard gingivoperiosteoplasty. An alternative to osteoplasty of alveolar clefts].

PURPOSE: The gingivoperiosteoplasty according to Millard is a possible alternative treatment modality to osteoplasty; no second operation for harvesting the bone graft is necessary. The goal of this investigation was the comparison of gingivoperiosteoplasty with osteoplasty and a search for factors that led to an improvement of the prognosis of both techniques.

MATERIAL AND METHODS: Long-term results of 53 patients with 72 alveolar clefts who underwent gingivoperiosteoplasty and 74 patients with 103 clefts of the alveolus were analyzed radiographically following an osteoplasty at the age of 12-14 years. The amount of bone in the alveolar cleft was determined and related to a number of factors such as number of teeth, unilateral or bilateral cleft, and orthodontic treatment. The statistical analysis was done with the Mann-Whitney U-test (p < 0.05).

RESULTS: The rate of success was similar following gingivoperiosteoplasty and osteoplasty with a range of 68% to 73%. A postsurgical orthodontic expansion of the alveolus and the existence of lateral incisors improved the prognosis for both techniques significantly (p < 0.05). Teeth erupted into the new periosteally formed bone. This was observed in 82% of those patients in whom enough bone was formed.

CONCLUSION: The gingivoperiosteoplasty according to Millard is a real alternative to a common osteoplasty at the age of 12-years if a lateral incisor is found at both cleft margins and if postsurgical orthodontic expansion of the upper jaw is performed.