Fetal dental panorama on three-dimensional ultrasound imaging of cleft lip and palate and other facial anomalies

An effective ultrasound fetal palate screening software based on the "sequential sector scan through the oral fissure" and three-dimensional ultrasound

BACKGROUND

Orofacial clefts are one of the most common congenital malformations of the fetal face and ultrasound is mainly responsible for its diagnosis. It is difficult to view the fetal palate, so there is currently no unified standard for fetal palate screening, and the diagnosis of cleft palate is not included in the relevant prenatal ultrasound screening guidelines. Many prenatal diagnoses for cleft palate are missed due to the lack of effective screening methods. Therefore, it is imperative to increase the display rate of the fetal palate, which would improve the detection rate and diagnostic accuracy for cleft palate. We aim to introduce a fetal palate screening software based on the "sequential sector scan though the oral fissure", an effective method for fetal palate screening which was verified by our follow up results and three-dimensional ultrasound and to evaluate its feasibility and clinical practicability.

METHODS

A software was designed and programmed based on "sequential sector scan through the oral fissure" and three-dimensional ultrasound. The three-dimensional ultrasound volume data of the fetal face were imported into the software. Then, the median sagittal plane was taken as the reference interface, the anterior upper margin of the mandibular alveolar bone was selected as the fulcrum, the interval angles, and the number of layers of the sector scan were set, after which the automatic scan was performed. Thus, the sector scan sequential planes of the mandibular alveolar bone, pharynx, soft palate, hard palate, and maxillary alveolar bone were obtained in sequence to display and evaluate the palate. In addition, the feasibility and accuracy of the software in fetal palate displaying and screening was evaluated by actual clinical cases.

RESULTS

Full views of the normal fetal palates and the defective parts of the cleft palates were displayed, and relatively clear sequential tomographic images and continuous dynamic videos were formed after the three-dimensional volume data of 10 normal fetal palates and 10 cleft palates were imported into the software.

CONCLUSIONS

The software can display fetal palates more directly which might allow for a new method of fetal palate screening and cleft palate diagnosis.

Overview of Ultrasound in Dentistry for Advancing Research Methodology and Patient Care Quality with Emphasis on Periodontal/Peri-implant Applications

BACKGROUND

Ultrasound is a non-invasive, cross-sectional imaging technique emerging in dentistry. It is an adjunct tool for diagnosing pathologies in the oral cavity that overcomes some limitations of current methodologies, including direct clinical examination, 2D radiographs, and cone beam computerized tomography. Increasing demand for soft tissue imaging has led to continuous improvements on transducer miniaturization and spatial resolution. The aims of this study are (1) to create a comprehensive overview of the current literature of ultrasonic imaging relating to dentistry, and (2) to provide a view onto investigations with immediate, intermediate, and long-term impact in periodontology and implantology.

METHODS

A rapid literature review was performed using two broad searches conducted in the PubMed database, yielding 576 and 757 citations, respectively. A rating was established within a citation software (EndNote) using a 5-star classification. The broad search with 757 citations allowed for high sensitivity whereas the subsequent rating added specificity.

RESULTS

A critical review of the clinical applications of ultrasound in dentistry was provided with a focus on applications in periodontology and implantology. The role of ultrasound as a developing dental diagnostic tool was reviewed. Specific uses such as soft and hard tissue imaging, longitudinal monitoring, as well as anatomic and physiological evaluation were discussed.

CONCLUSIONS

Future efforts should be directed towards the transition of ultrasonography from a research tool to a clinical tool. Moreover, a dedicated effort is needed to introduce ultrasonic imaging to dental education and the dental community to ultimately improve the quality of patient care.

A Deliberate Practice-Based Ultrasound Training Program for Fetal Palate Screening Using a Sequential Sector Scan Through the Oral Fissure

OBJECTIVES

To introduce an ultrasound training program for fetal palate screening by using a sequential sector scan through the oral fissure to train less experienced doctors and to investigate its effectiveness.

METHODS

Twenty doctors and several women at approximately 20-28 weeks of gestation with singleton pregnancies who provided informed consent were enrolled. The training program consisted of theory and practice training, several tests, and two surveys. Trainees were tested before training and immediately after training; for the latter, each item with a score that was less than 60% of the full score was again used for training with a reconstructed plan. Finally, a post-training test was completed.

RESULTS

The median theory scores, median practice scores, median language competence scores, and median self-assessment scores all increased significantly from the pre-training to post-training tests (P < .01). The median completion time for fetal palate scans decreased significantly from the pre-training to post-training tests (P < .01). The median questionnaire scores were 5.00 for pragmatism, 4.00 for content, 4.00 for scientific nature, and 5.00 for effectiveness.

CONCLUSIONS

The training program for fetal palate screening can effectively standardize and improve doctors' scans for fetal palates. In addition, the program feasibly allows for the incorporation of the scan sequence into fetal palate screening.

The application of three-dimensional ultrasound with reformatting technique in the diagnosis of fetal cleft lip/palate

OBJECTIVE

To evaluate the clinical value of three-dimensional ultrasound (3D-US) with reformatting technique in the diagnosis of fetal cleft lip/palate (CL/P), especially those involving the secondary palate.

METHODS

A total of 113 fetuses suspected with cleft lip (CL) on two-dimensional ultrasound (2D-US) were further evaluated by 2D-US and 3D-US with reformatting technique, in order to clarify the type of oral cleft. Lesions were classified as cleft lip (CL), cleft lip and alveolus (CLA), and cleft lip and palate (CLP) (including primary and secondary palate). All fetuses were followed until birth or termination of pregnancy. The diagnostic accuracies of 2D-US and 3D-US with reformatting technology were compared.

RESULTS

Both 2D-US and 3D-US with reformatting successfully detected CLs in the final 103 participants. Among these, 29, 25, and 49 cases were confirmed to have CL, CLA, and CLP, respectively. CL, CLA, and CLP were diagnosed by 2D-US in 34, 66, and 3 cases, respectively, and by 3D-US with reformatting technology in 31, 27, and 45 cases, respectively. The sensitivities of 2D-US and 3D-US with reformatting technology in the diagnosis of CLA were 80% (20/25) and 92.0% (23/25), respectively, and the difference was not statistically significant. For CLP, however, the sensitivities were 6.1% (3/49) and 91.8% (45/49), respectively (P < .001).

CONCLUSIONS

Both 2D-US and 3D-US with reformatting technique have high diagnostic accuracy for CL and CLA. However, 3D-US has a much higher diagnostic accuracy for CLP.

Frequency of Different Dental Irregularities Associated With Cleft Lip and Palate in a Tertiary Care Dental Hospital

Background

Oro-facial clefts (OFCs) are formed due to a combination of genetic factors and environmental factors. Treatment is usually extensive and lasts till adult age. The treatment also includes a large portion of dental rehabilitation.

Objective

This study aims to look at the different dental anomalies associated with OFCs.

Methods

A total of 100 participants with OFCs were randomly selected from Clap centre Lahore. They were categorized into cleft lip (CL), cleft palate (CP), and both. Dental anomalies were recorded clinically and family history for OFCs was also recorded.

Results

Out of the 100 participants, 15 had CL only, 37 had a CP, and 48 had both CL and CP. Missing teeth and hypodontia were significantly associated with all OFCs (p-value > 0.05). Supernumerary teeth were only significantly associated with CP (p-value: 0.04). Other dental anomalies were not significant for OFCs.

Conclusion

OFCs in all its three forms are associated with dental irregularities. They can either be missing teeth or extra teeth. There is a strong need for dentists to be a part of the treatment planning of OFCs and to treat dental anomalies alongside the clefts.