BACKGROUND & PURPOSE: Alveolar bone grafting is an operative procedure traditionally requiring general anesthia, the placement of scars on the hip, and often significant post-operative pain. 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 cleft lip repair reduces the need for alveolar bone grafting in patients with bilateral clefts of the lip, alveolus and palate (BCLP).

METHODS: This is a retrospective chart review of all patients with BCLP who underwent presurgical infant alveolar molding followed with GPP by a single surgeon. A combination of clinical examination, panoramic and periapical radiographs, and/or dental CT scans were used to assess alveolar bone formation. The criterion for bone grafting was inadequate bone stock to permit the eruption and maintenance of permanent dentition. All patients with BCLP that presented to our institution from 1988 - 1998 were included.

RESULTS: 27 patients were identified with a follow up of 8 - 16 years (Average 10.9 y). 11 of 27 patients (41%) did not require alveolar bone grafting.

CONCLUSIONS: In this series of 27 patients with BCLP, treatment with presurgical alveolar molding followed by GPP was successful in preventing the need for alveolar bone grafting, in 41% of patients. These patients are spared the cost of an additional surgery, the risk of a general anesthetic and the significant post-operative pain of the alveolar bone graft procedure. In addition, benefits were seen in those children who went on to undergo an alveolar bone graft. In many of these children, one side of the GPP was successful, allowing for stabilization of the premaxilla. The stabilization of the premaxilla allows the child functional use of the central incisors. The subsequent use of the central incisors, then allows the child to develop a healthy, hearty premaxillary bone which is important functionally and aesthetically for support of the alar base.