Evaluating the Success of Gingivoperiosteoplasty versus Secondary Bone Grafting in Patients with Unilateral Clefts

T article by Matic and Power is of interest for what it says about gingivoperiosteoplasty and as a demonstration of how clinical outcomes are impacted by the subtle variations in the way we perform specific surgical procedures. In addition, it shows that when performing the same procedure, outcomes may vary considerably between different teams of surgeons. The Intercenter Scandinavian and European Cleft studies have shown that variability in clinical outcomes was related not only to procedures and treatment protocols but to variability in experience and practice of procedures among different surgical teams. Although Matic and Power found that their surgeons were calibrated to perform equally well, they have demonstrated that when compared with another cleft center, their clinical outcomes for the same procedure (gingivoperiosteoplasty) are quite different. On close examination of this article, we note that the surgical team had an unusually high fistula rate (33 percent) for the patients on whom they have performed gingivoperiosteoplasty. Our fistula rate following gingivoperiosteoplasty is 0 percent. The difference between clinical outcomes and surgical teams requires close examination.