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Rezende Pucciarelli MG, de Lima Toyoshima GH, Marchini Oliveira T, Marques Honório H, Sforza C, Soares S. Assessment of dental arch stability after orthodontic treatment and oral rehabilitation in complete unilateral cleft lip and palate and non-clefts patients using 3D stereophotogrammetry. BMC Oral Health 2020; 20:154. [PMID: 32460814 PMCID: PMC7254638 DOI: 10.1186/s12903-020-01143-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although arch stability has been studied in patients without a cleft, evidence for patients with a cleft is sparse. Therefore, we compared the dimensions and stability of dental arches in cleft lip and palate patients and those without a cleft. METHODS Forty participants, 20 with a complete unilateral cleft lip and palate and 20 non-cleft patients aged from 18 to 30 years, with anterior and/or posterior crossbite and receiving orthodontic treatment were evaluated retrospectively. Eighty gypsum casts were digitized using a laser model scanner casts for both groups made immediately after the orthodontic treatment was completed (T1). Also, for the Cleft Lip and Palate group, casts were obtained and digitized 1 year after implant-supported rehabilitation (T2) and for the Non-Cleft Lip and Palate group, 1 year after the conclusion of the orthodontic treatment (T2). The formula: Δ = T2-T1 evaluated the stability of dental arches for inter-canine distances (C-C'), inter-molar distances (M-M'), arch length (I-M), palate surface and volume. The dimensions of the dental arches were measured digitally. The independent t test was used for statistical analysis (α = 0.05). RESULTS A statistical difference was found in the stability of the groups for inter-canine (cleft area) measurement. At the times T1 and T2, a statistically significant difference was found in the arch length, surface and volume. CONCLUSIONS This study concluded that in the Cleft Lip and Palate group, the maxillary dimensions were not stabilized after 1 year of orthodontic and prosthodontic treatment (mainly for the inter-canine linear measurement) and that the transverse arch dimensions were smaller compared with those of non-cleft patients.
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Affiliation(s)
- Maria Giulia Rezende Pucciarelli
- Bauru School of Dentistry/Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | | | - Thais Marchini Oliveira
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry and Hospital of Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Heitor Marques Honório
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Chiarella Sforza
- Faculty of Medicine and Surgery, Department of Biomedical Sciences for Health, Functional Anatomy Research Center (FARC), Università degli Studi di Milano, Milan, Italy
| | - Simone Soares
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry and Hospital of Rehabilitation of Craniofacial Anomalies, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, São Paulo, 17012-901, Brazil.
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Unilateral Cleft Lip Nasal Deformity: Three-Dimensional Analysis of the Primary Deformity and Longitudinal Changes following Primary Correction of the Nasal Foundation. Plast Reconstr Surg 2020; 145:185-199. [PMID: 31592947 DOI: 10.1097/prs.0000000000006389] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Objective assessment of the unilateral cleft lip nasal deformity and the longitudinal changes with treatment is critical for optimizing cleft care. METHODS Consecutive patients undergoing cleft lip repair and foundation-based rhinoplasty were included (n = 102). Three-dimensional images preoperatively, postoperatively, and at 5 years of age were assessed and compared to age-matched controls. Images were normalized to standard horizontal, craniocaudal, and anteroposterior axes. RESULTS Cleft subalare was similar in position relative to controls but was 1.6 mm retrodisplaced. Subnasale was deviated 4.6 mm lateral to midline and had the greatest displacement of any landmark. Noncleft subalare was displaced 2.3 mm laterally. Regression analysis with deviation of subnasale from the midline as a dependent variable revealed progressive lateral displacement of noncleft subalare, narrowing of noncleft nostril, and intercanthal widening. Surgery corrected nasal base displacements along all axes, resulting in landmark positions similar to controls. Symmetry of nasal base correction persisted at 5-year follow-up, with no recurrent cleft alar base retrusion, regardless of initial cleft type. CONCLUSIONS Unilateral cleft lip nasal deformity may be "driven" by displacement of the anterior nasal spine and caudal septum. The cleft alar base is normal in position but retruded, whereas the noncleft alar base is displaced laterally. Changes with surgery involve anterior movement of the cleft alar base but also include medial movement of the noncleft alar base and columella. Symmetry of correction, including alar base retrusion, was stable over time and did not rely on alveolar bone grafting.
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Three-dimensional development of the palate in bilateral orofacial cleft newborns 1 year after early neonatal cheiloplasty: Classic and geometric morphometric evaluation. J Craniomaxillofac Surg 2020; 48:383-390. [PMID: 32184075 DOI: 10.1016/j.jcms.2020.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 01/31/2020] [Accepted: 02/24/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess palatal growth in newborns with complete bilateral cleft lip and palate (cBCLP) and bilateral cleft lip and palate with tissue bridges (BCLP + B) 1 year after early neonatal cheiloplasty (ENC). MATERIAL AND METHODS The methodology was based on classic and morphometric analysis of dental models of newborns with cBCLP or BCLP + B. These analyses included metric analysis, coherent point drift-dense correspondence analysis, superprojection methods, and multivariate statistics. Dental casts were observed in two age categories, which were compared with each other. The first cast was obtained from each patient before ENC (T0, 5 ± 5 days) and the second one prior to palatoplasty (T1, 12 ± 6 months). RESULTS Fifty-two dental models obtained from 26 newborns with cBCLP and BCLP + B were evaluated. The results showed that over the 12-month period, alveolar clefts were narrowed in both cleft types due to anterior growth combined with the formative effect of suturing. This was confirmed by decreases in the dimensions of the right (T0 9.93 ± 2.80 mm, T1 6.64 ± 2.43 mm; p ≤ 0.003) and left (T0 10.71 ± 4.13 mm, T1 6.69 ± 4.29 mm; p ≤ 0.003) alveolar clefts in cBCLP patients. Similar reductions in alveolar cleft widths occurred on the left side (T0 11.69 ± 4.75 mm, T1 4.34 ± 2.97 mm; p ≤ 0.001) of BCLP + B patients, while on the right side, which was connected by a combined tissue bridge, there was non-significant narrowing of the alveolar cleft (T0 1.61 ± 1.34 mm, T1 1.04 ± 0.70 mm; p = 0.120). The ENC did not restrict posterior palatal growth, meaning that intertuberosity width was extended in cBCLP (T0 32.80 ± 3.15 mm, T1 35.86 ± 2.80 mm; p ≤ 0.001) and in BCLP + B neonates (T0 34.01 ± 2.15 mm, T1 36.21 ± 2.14 mm; p ≤ 0.004). Width and length measurements in the observed groups showed growth tendencies equivalent to those in noncleft or LOP patients. Palatal variability was greater in neonatal cBCLP, but was reduced during the monitored period, approximating that for BCLP + B. Regions with the most notable palatal growth were located primarily at the premaxilla and at the anterior and partially posterior ends of the maxillary segments. CONCLUSION Early neonatal cheiloplasty had no negative effect on palatal growth in any direction. There was no reduction in the length or width of the palate during the first year of life, nor was there narrowing of the dentoalveolar arch. The formative effect of the operated lip on the anterior part of the palate was confirmed. This, in combination with the favorable growth, lead to closure of the alveolar cleft.
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Caballero JT, Pucciarelli MGR, Pazmiño VFC, Curvêllo VP, Menezes MD, Sforza C, Soares S. 3D comparison of dental arch stability in patients with and without cleft lip and palate after orthodontic/rehabilitative treatment. J Appl Oral Sci 2019; 27:e20180434. [PMID: 31215598 PMCID: PMC6559757 DOI: 10.1590/1678-7757-2018-0434] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/15/2018] [Indexed: 11/26/2022] Open
Abstract
This study aimed to compare the linear dimensions of the dental arches of adult patients with complete unilateral cleft lip and palate (UCLP) after orthodontic and prosthetic treatment with fixed partial dentures (FPD) to patients without clefts, using 3D technology. This retrospective longitudinal study sample consisted of 35 subjects divided into two groups. Included in this sample were 15 complete UCLP individuals who had received orthodontic treatment before rehabilitation with a fixed partial denture (FG), as well as 20 patients without cleft as control group (CG). All patients were aged between 18 and 30 years. Digital dental casts were obtained in two stages: (T1) end of orthodontic treatment and (T2) one year after prosthetic rehabilitation (FG); and (T1) end of orthodontic treatment and (T2) one year after removal of the orthodontic appliance (CG). Intercanine, interfirst premolar and intermolar distances, and incisor-molar length were obtained. A precalibrated and trained examiner performed the assessments. Intergroup differences between T2 and T1 were compared between the groups using the t test or Mann-Whitney test with a significance level of 5% (p<0.05). The intercanine distance variation (T2-T1) showed statistical difference (p=0.005) increasing in the FG group and decreasing in the CG group. In the interfirst premolar distance variation, FG decreased, while CG increased with statistically significant difference (p=0.008). The intercanine distance of individuals with cleft showed stability, while that of the CG had no stability. The CG showed stability in the interfirst premolar distance, while FG had no stability. These findings showed that the FPD is capable of restricting orthodontic results, leading to a stabilization of the dental arches.
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Affiliation(s)
| | | | | | - Victor Prado Curvêllo
- Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais, Bauru, São Paulo, Brasil
| | | | - Chiarella Sforza
- Università degli Studi di Milano, Facoltà di Medicina e Chirurgia, Dipartimento di Scienze Biomediche per la Salute, Functional Anatomy Research Center (FARC), Milan, Italy
| | - Simone Soares
- Universidade de São Paulo, Hospital de Reabilitação de Anomalias Craniofaciais, Departamento de Prótese e Periodontia, Bauru, São Paulo, Brasil
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A Digital Assessment of the Maxillary Deformity Correction in Infants With Bilateral Cleft Lip and Palate Using Computer-Aided Nasoalveolar Molding. J Craniofac Surg 2018; 28:1543-1548. [PMID: 28708645 DOI: 10.1097/scs.0000000000003812] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To evaluate the maxillary alveolar repositioning of the infants with bilateral cleft lip and palate (BCLP) undergoing computer-aided nasoalveolar molding (CAD-NAM). METHODS A total of 19 BCLP infants undergoing CAD-NAM were recruited as the treatment group, and 21 nonpresurgically treated BCLP patients served as controls. The upper alveolar morphology was measured and evaluated. Changes in all variables between pre- and post-CAD-NAM were compared. RESULTS By the end of CAD-NAM, significant difference was found in the P-A, P'-A', and L-ideal midline (P < 0.01); in the sagittal dimensions, significant difference was found in the P-TT', P'-TT', I-TT', A-X, and A'-X' (P < 0.01), while in the vertical dimensions, significant difference was found in the alveolus height in the bilateral canine regions (P < 0.01). CONCLUSION Computer-aided nasoalveolar molding can effectively reduce the cleft gap, correct the alveolar midline deviation, and retract the projection and outward rotation of the premaxilla segment, and normalize the contour of the alveolus.
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da Silva WS, de Almeida ALPF, Pucciarelli MGR, Neppelenbroek KH, da Silva de Menezes JD, Yaedú RYF, Oliveira TM, Cintra FMRN, Soares S. Relapse after Le Fort I surgery in oral cleft patients: a 2-year follow-up using digitized and 3D models. Odontology 2018; 106:445-453. [PMID: 29497867 DOI: 10.1007/s10266-018-0351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 02/11/2018] [Indexed: 11/25/2022]
Abstract
This retrospective observational study aimed to evaluate and identify the relapse rate after orthognathic surgery for maxillary advancement (Le Fort I maxillary osteotomy) in oral cleft patients through digitized cephalograms and 3D dental models, following 2 years. Lateral cephalograms and dental casts of 17 individuals, enrolled in Orthodontics Department in Hospital of Rehabilitation of Craniofacial Anomalies, were carried out. The digital cephalometric tracings were evaluated in: T1-before surgery, T2-immediate after surgery, T3-6-month to 1-year after surgery. The dental study casts were digitized and evaluated in: F1-before surgery; F2-3-month to 1-year after surgery; F3-1 to 2 years after surgery. The analyses of the dental arches were performed directly on the scanned images. A single examiner previously trained and calibrated performed all the assessments. Repeated measures ANOVA was applied to study the variables and compare the periods, followed by Tukey test to evaluate the statistically significant differences, with level of significance of 5%. The digital cephalogram results showed that the vertical movement statistically differed from T2 to T3 (p = 0.002). The right and left premolar relationship in digitized models revealed that at F2 the individuals exhibited ¼ Class II and Class I, in 29.4 and 23.5% of the cases, respectively; and at F3, Class I, 58.8 and 70.6% of the cases, respectively. The cephalometry showed the relapse in the vertical movement after orthognathic surgery for maxillary advancement, but no relapse in the other evaluated parameters.
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Affiliation(s)
- Willian Saranholi da Silva
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Al. Octávio Pinheiro Brisola, 9-75, Bauru, SP, 17012-901, Brazil
| | - Ana Lúcia Pompéia Fraga de Almeida
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Al. Octávio Pinheiro Brisola, 9-75, Bauru, SP, 17012-901, Brazil
| | - Maria Giulia Rezende Pucciarelli
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Al. Octávio Pinheiro Brisola, 9-75, Bauru, SP, 17012-901, Brazil
| | - Karin Hermana Neppelenbroek
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisola, 9-75, Bauru, SP, 17012-901, Brazil
| | - Juliana Dreyer da Silva de Menezes
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Al. Octávio Pinheiro Brisola, 9-75, Bauru, SP, 17012-901, Brazil
| | - Renato Yassutaka Faria Yaedú
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Al. Octávio Pinheiro Brisola, 9-75, Bauru, SP, 17012-901, Brazil
| | - Thais Marchini Oliveira
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Al. Octávio Pinheiro Brisola, 9-75, Bauru, SP, 17012-901, Brazil
| | - Flavia M R N Cintra
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Al. Octávio Pinheiro Brisola, 9-75, Bauru, SP, 17012-901, Brazil
| | - Simone Soares
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Al. Octávio Pinheiro Brisola, 9-75, Bauru, SP, 17012-901, Brazil.
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Jorge PK, Gnoinski W, Vaz Laskos K, Felício Carvalho Carrara C, Gamba Garib D, Okada Ozawa T, Andrade Moreira Machado MA, Pinelli Valarelli F, Oliveira TM. Comparison of two treatment protocols in children with unilateral complete cleft lip and palate: Tridimensional evaluation of the maxillary dental arch. J Craniomaxillofac Surg 2016; 44:1117-22. [DOI: 10.1016/j.jcms.2016.06.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/31/2016] [Accepted: 06/30/2016] [Indexed: 11/28/2022] Open
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Yu Q, Gong X, Shen G. CAD presurgical nasoalveolar molding effects on the maxillary morphology in infants with UCLP. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 116:418-26. [PMID: 24035109 DOI: 10.1016/j.oooo.2013.06.032] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 05/26/2013] [Accepted: 06/25/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study evaluated the effectiveness of computer-aided design-nasoalveolar molding (CAD-NAM) on maxillary alveolar morphology in infants with unilateral cleft lip and palate (UCLP). METHODS 15 infants with UCLP treated by CAD-NAM therapy composed the treatment group, and the control group consisted of 15 infants with non-presurgically treated UCLP. The maxillary morphology was analyzed by Rapidform XOR3 software. Differences in all variables pre- and post-CAD-NAM were discussed. RESULTS Significant difference was found in arch length, cleft gap, labial frenum deviation, A-X, A'-X, and alveolus height on both sides pre- and post-CAD-NAM. CONCLUSIONS This study suggests a trend toward morphological improvement in maxillary alveoli of infants with UCLP treated with CAD-NAM. The CAD-NAM effectively reduced the cleft gap, corrected the maxilla midline, and improved the sagittal length of the maxilla. The alveolar height decreased significantly after the treatment, which indicated that the traction force of the appliance may have obstructive effects on the vertical growth of the alveolar bone.
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Affiliation(s)
- Quan Yu
- Assistant Professor, Department of Orthodontics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology
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MELLO BZF, FERNANDES VM, CARRARA CFC, MACHADO MAAM, GARIB DG, OLIVEIRA TM. Evaluation of the intercanine distance in newborns with cleft lip and palate using 3D digital casts. J Appl Oral Sci 2013; 21:437-42. [PMID: 24212990 PMCID: PMC3881848 DOI: 10.1590/1679-775720130091] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 05/26/2013] [Accepted: 08/13/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The purpose of this present study was to compare, by means of 3D digital casts, the anterior transverse dimension of the dental arch of newborns with and without cleft lip and palate. MATERIAL AND METHODS The sample was composed of ninety-four children aged from 3 to 9 months divided into three study groups: Group I - children without craniofacial deformities (control group); Group II - children with unilateral cleft lip and palate; Group III - children with bilateral cleft lip and palate. Impressions were executed before lip and palate repair in patients with clefts. Dental casts were digitized using a 3D scanner linked to a computer. Measurements of the intercanine distance were measured on the digital casts. Intergroup comparisons were performed using ANOVA (p<0.05). RESULTS The results showed a mean of 36.5 mm for unilateral cleft lip and palate group, 34.8 mm for bilateral cleft lip and palate group and 27.52 mm for the control group. There was a statistically significant difference between the control group and both groups of patients with cleft lip and palate. There was no statistically significant difference between complete unilateral and bilateral cleft lip and palate groups. CONCLUSIONS Patients with complete cleft lip and palate were born with an increased anterior dimension of the maxillary dental arch compared to non cleft patients.
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Affiliation(s)
| | - Viviane Mendes FERNANDES
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São
Paulo, Bauru, SP, Brazil
| | | | | | - Daniela Gamba GARIB
- Department of Pediatric Dentistry, Orthodontics and Community Health,
Bauru School of Dentistry and Hospital for Rehabilitation of Craniofacial Anomalies,
University of São Paulo, Bauru, SP, Brazil
| | - Thais Marchini OLIVEIRA
- Department of Pediatric Dentistry, Orthodontics and Community Health,
Bauru School of Dentistry and Hospital for Rehabilitation of Craniofacial Anomalies,
University of São Paulo, Bauru, SP, Brazil
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