Considerazioni sul parodonto di pazienti con labiopalato schisi senza intervento di innesto osseo.

After primary surgery most cleft lip and palate patients present an alveolar bone defect and need bone grafting. However using simple radiographic (PA, occlusal, panoramic views) and clinical examination some cleft lip and palate patients seem to be free of alveolar defect. If the latter, “borderline” patients, are also free of oro-nasal fistula they do not receive bone grafting. This study aims to evaluate the periodontal conditions, after canine eruption and orthodontic treatment, in the “borderline” group in order to clarify the need for bone grafting in these cleft lip and palate patients. 10 (6 females and 4 males, mean age 16, 8 years) non bone-grafted cleft lip and palate patients of the orthodontic department in Brescia are included in the study. Probing depth, keratinized gingival width, recessions and gingiva / mucosa aspect in the cleft area have been evaluated after canine eruption and orthodontic treatment. The periodontal status has been evaluated by clinical examination (probing) and radiographic examination (PA, occlusal, panoramic views). The radiographic and clinical examination have highlighted that 6 of the 10 “borderline” patients have significant periodontal defects. Based on the results of the present study a bi-dimensional radiographic examination is not always enough accurate when we have to evaluate the bone grafting need in cleft lip and palate patient. Alternative to the usual radiographic examination is being considered in Brescia: 1) CT examination to locate precisely the bone defect 2) a stem-cells grafting or just a remodelling of the alveolar gingiva and mucosa if a bone defect is not found.