1
|
Heliövaara A, Küseler A, Skaare P, Bellardie H, Mølsted K, Karsten A, Marcusson A, Rizell S, Brinck E, Sæle P, Chalien MN, Mooney J, Eyres P, Shaw W, Semb G. Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: comparison of dental arch relationships and dental indices at 5, 8, and 10 years. Eur J Orthod 2021; 44:258-267. [PMID: 34476476 PMCID: PMC9127717 DOI: 10.1093/ejo/cjab055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background and trial design The Scandcleft intercentre study evaluates the outcomes of four surgical protocols (common method Arm A, and methods B, C, and D) for treatment of children with unilateral cleft lip and palate (UCLP) in a set of three randomized trials of primary surgery (Trials 1, 2, and 3). Objectives To evaluate and compare dental arch relationships of 5-, 8-, and 10-year-old children with UCLP after four different protocols of primary surgery and to compare three dental indices. The results are secondary outcomes of the overall trial. Methods Study models taken at the ages of 5 (n = 418), 8 (n = 411), and 10 years (n = 410) were analysed by a blinded panel of orthodontists using the Eurocran index, the 5-year-olds’ (5YO) index, and the GOSLON Yardstick. Student’s t-test, Pearson’s correlation, chi-square test, and kappa statistics were used in statistical analyses. Results The reliability of the dental indices varied between moderate and very good, and those of the Eurocran palatal index varied between fair and very good. Significant correlations existed between the dental indices at all ages. No differences were found in the mean 5-, 8-, and 10-year index scores or their distributions within surgical trials. Comparisons between trials detected significantly better mean index scores in Trial 2 Arm C (at all ages) and in Trial 1 Arm B (at 5 and 10 years of age) than in Trial 3 Arm D. The mean Eurocran dental index scores of the total material at 5, 8, and 10 years of age were 2.50, 2.60, and 2.26, and those of the 5YO index and GOSLON Yardstick were 2.77, 2.90, and 2.54, respectively. At age 10 years, 75.8% of the patients had had orthodontic treatment. Conclusions The results of these three trials do not provide evidence that one surgical method is superior to the others. The reliabilities of the dental indices were acceptable, and significant correlations existed between the indices at all ages. The reliability of the Eurocran palatal index was questionable. Trial registration ISRCTN29932826.
Collapse
Affiliation(s)
- Arja Heliövaara
- Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Hospital and Helsinki University, Finland
| | - Annelise Küseler
- Cleft Palate Center and University Hospital Aarhus and University of Aarhus, Denmark
| | - Pål Skaare
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital Rikshospitalet, Norway
| | - Haydn Bellardie
- Dental School, University of Manchester, UK.,University of the Western and Cape, Cape Town, South Africa
| | - Kirsten Mølsted
- Copenhagen Cleft Palate Center, University Hospital of Copenhagen, Denmark
| | - Agneta Karsten
- Section for Orthodontics, Division of Orthodontics and Pedodontics, Department of Dental Medicine, Karolinska Institutet and Stockholm Craniofacial Team, Sweden
| | - Agneta Marcusson
- Maxillofacial Unit and Department of Clinical and Experimental Medicine, Linköping University, Sweden
| | - Sara Rizell
- Specialist Clinic for Orthodontics, University Clinics of Odontology, Public Dental Health Service, Västra Götaland Region, Sweden
| | - Eli Brinck
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital Rikshospitalet, Norway
| | - Paul Sæle
- Oral Health Center of Expertise/Western Norway, Bergen, Norway
| | - Midia Najar Chalien
- Specialist Clinic for Orthodontics, University Clinics of Odontology, Public Dental Health Service, Västra Götaland Region, Sweden
| | | | - Phil Eyres
- Dental School, University of Manchester, UK
| | | | - Gunvor Semb
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital Rikshospitalet, Norway.,Dental School, University of Manchester, UK
| |
Collapse
|
2
|
Shetty V, Sreekumar C, Patteta NK, Bahl D, Sailer HF. Correlation between surgical protocols for palatoplasty and midfacial growth in cleft lip and palate patients: A long-term, single centre study. J Craniomaxillofac Surg 2021; 49:1010-1019. [PMID: 34238633 DOI: 10.1016/j.jcms.2021.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 05/26/2021] [Accepted: 06/15/2021] [Indexed: 11/25/2022] Open
Abstract
To evaluate and compare the outcomes of two different surgical protocols for palatoplasty for midfacial growth in patients with cleft lip and palate. A retrospective observational cohort study was conducted in 80 patients with cleft lip and palate, who were divided into two groups. Group 1 comprised patients who underwent operation between 9 and 11 months of age using the Bardach two-flap technique without a palatal pushback. Group 2 comprised patients who had undergone operation between 18 and 20 months of age using either a Bardach two-flap technique with a palatal pushback or a von Langenbeck technique. Patient follow-up was done between 8 and 9 years of age when they reported to the centre for secondary alveolar bone grafting. Post-surgical cephalometric measurements were taken for midfacial growth analysis. Group 1 underwent palatoplasty at significantly younger ages than Group 2 (p < 0.01). A statistically significant difference(p < 0.01) was found between the two groups of patients on comparison of cephalometric parameters such as SNA, ANB, CoA, NperpA ANS-PNS, N-ANS, N-Me, Witt's (AO-BO). Group 2 had more positive cephalometric values as compared to Group 1, thereby implying that there was less incidence of midfacial hypoplasia in patients treated at the age of 18-20 months. Between the types of palatoplasty techniques within Group 2, i.e., Bardach two-flap and von Langenbeck, there was no statistical difference found in the post-opertative cephalometric values, i.e., SNA, ANB, CoA, ANS-PNS, N-ANS, N-Me, Witt's (AO-BO) except for Nperp-A, which showed a statistical difference (p = 0.03). Within the limitations of the study which is only a single center experience it seems that palatal closure should be carried out at 18-20 months of age for better midfacial growth, leading to decreased incidence of maxillary hypoplasia at a later stage in life. Repair at less than 18 months of age is also associated with mid-facial hypoplasia.
Collapse
Affiliation(s)
- Vikram Shetty
- Nitte Meenakshi Institute of Craniofacial Surgery, Nitte Deemed to be University, India
| | - Chandni Sreekumar
- Dept. of Periodontics, Srinivas Inst. of Dental Sciences, RGUHS, India
| | - Nanda Kishore Patteta
- Dept. of Cleft and Craniofacial Orthodontics, Nitte Meenakshi Institute of Craniofacial Surgery, Nitte Deemed to be University, India.
| | - Devyani Bahl
- Dept. of Oral and Maxillofacial Surgery, A.B.Shetty Memorial Inst. of Dental Sciences, Nitte Deemed to be University, India
| | | |
Collapse
|
3
|
Shetty V, Patteta NK, Yadav A, Bahl D, Sailer HF. Does the Timing of 1-Stage Palatoplasty With Radical Muscle Dissection Effect Long-Term Midface Growth? A Single-Center Retrospective Analysis. Cleft Palate Craniofac J 2021; 59:239-245. [PMID: 33955252 DOI: 10.1177/10556656211013174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the long-term effect of timing of 1-stage palatoplasty on midfacial growth in patients with cleft lip and palate (CLP). DESIGN Retrospective observational cohort study. STUDY SETTING Institutional hospital. PATIENTS One hundred twelve patients with CLP who underwent palatoplasty and were divided into 3 groups: group I: operated between 9 and 11 months; group II: operated between 18 and 20 months; and group III: operated between 21 and 24 months. INTERVENTIONS All patients underwent von Langenbeck palatoplasty technique, which was converted to a Bardach 2-flap technique in case of any technical difficulties. The patients were followed up between 8 and 9 years when they reported for secondary alveolar bone grafting. Postsurgical cephalometric and dental casts measurements were taken for midfacial growth analysis. MAIN OUTCOME MEASURES The cephalometric measures were analyzed for midfacial growth and compared within the groups. RESULTS Statistically significant difference (P < .01) was found on comparing the cephalometric parameters such as sella-nasion-A point angle (SNA), A point-nasion-B point angle (ANB), n toperpendicular to point A (N-perpA), condylon to point A (Co-A), anterior nasal spine to posterior nasal spine (ANS-PNS), nasion to Anterior nasal spine (N-ANS), nasion to menton (N Me), and witts appraisal (Witt (AO-BO)) in group I when compared to both group II and group III patients, implying deficient midfacial growth in group I. No statistical difference was found in the cephalometric values between group II and group III. Group II had better cephalometric measurements than group III, showing better growth in group II than group III. Overall, there was less incidence of midfacial hypoplasia in patients treated between 18 and 20 months (group II). CONCLUSION We conclude that palatal closure carried out at 18 to 20 months and 21 to 24 months is associated with better midfacial growth when compared to closure at 9 to 11 months. The best time to operate would be between 18 and 20 months to avoid speech disturbances. Midfacial growth can be greatly influenced by the timing of 1-stage palatoplasty.
Collapse
Affiliation(s)
- Vikram Shetty
- Nitte Meenakshi Institute of Craniofacial Surgery, NITTE Deemed to be University, Mangalore, India
| | - Nanda Kishore Patteta
- Department of Cleft and Craniofacial Orthodontics, NITTE Meenakshi Institute of Craniofacial Surgery, NITTE Deemed to be University, Mangalore, India
| | - Anirudh Yadav
- Department of Oral and Maxillofacial Surgery, A.B. Shetty Memorial Institute of Dental Sciences, NITTE Deemed to be University, Mangalore, India
| | - Devyani Bahl
- Department of Oral and Maxillofacial Surgery, A.B. Shetty Memorial Institute of Dental Sciences, NITTE Deemed to be University, Mangalore, India
| | | |
Collapse
|
4
|
Heliövaara A, Leikola J. Prediction of orthognathic surgery need in children with unilateral cleft lip palate: Dental arch relationships and 5-year-olds' index. Orthod Craniofac Res 2021; 24:528-535. [PMID: 33440074 DOI: 10.1111/ocr.12467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/29/2020] [Accepted: 12/29/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate whether dental arch relationships at 6 years of age can categorize treatment outcome and predict later need for orthognathic surgery in children with unilateral cleft lip and palate (UCLP). SETTING AND SAMPLE POPULATION A retrospective longitudinal single-centre study. The study sample comprised 70 consecutive non-syndromic children (47 boys) with complete UCLP operated on by pushback techniques during 1981-1989 and followed until early adulthood in the same cleft centre. MATERIALS AND METHODS Dental casts and maxillomandibular relationships were assessed before orthodontic treatment and secondary alveolar bone grafting at mean age 6.1 years (range 5.6-6.8) using the 5-year-olds' index and lateral cephalograms. The need for orthognathic surgery was retrieved from patient files. Student's t test, Pearson's correlation, and Kappa statistics were used in statistical analyses. RESULTS Orthognathic surgery frequency was 41% (29/70). Those needing orthognathic surgery comprised all 3 patients with an index score of 5 (very poor), 14 of 17 (82%) scoring 4 (poor), 10 of 26 (38%) scoring 3 (fair), and 2 of 19 (11%) scoring 2 (good). Of the five patients with index score 1 (excellent), none needed osteotomies. The mean index score was 2.9. The score was significantly better in those without orthognathic surgery (2.4 versus 3.6). A significant negative correlation existed between the 5-year-olds' index and cephalometric angles ANB and anb. CONCLUSION The use of 5-year-olds' index may help to predict treatment outcome and the clinical need for orthognathic surgery especially in patients with the lowest and highest index scores.
Collapse
Affiliation(s)
- Arja Heliövaara
- Department of Plastic Surgery, Cleft Palate and Craniofacial Center, Helsinki University Hospital, Helsinki, Finland
| | - Junnu Leikola
- Department of Plastic Surgery, Cleft Palate and Craniofacial Center, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
5
|
Pegelow M, Klintö K, Stålhand G, Lemberger M, Vesterbacka M, Rizell S, Chalien MN, Björnström L, Becker M, Lindberg M, Marcusson A, Karsten A. Validation of reported dentoalveolar relationships in the Swedish Quality Registry for Cleft Lip and Palate. Eur J Orthod 2020; 42:30-35. [PMID: 31586178 DOI: 10.1093/ejo/cjz069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The present study validated data that had been reported to the Swedish Quality Registry for Cleft Lip and Palate (CLP) under new requirements from 2016, when use of the 5-year-old (5YO) and the Modified Huddart and Bodenham (MHB) indices for rating occlusion in children born with unilateral CLP (UCLP) was introduced. MATERIALS AND METHODS The sample included blinded study casts (n = 97) and photos (n = 4) of 5-year-old children who had been born with UCLP in 2009-2011 and were enrolled at one of six cleft centres in Sweden. Fourteen orthodontists from the centres assessed the patients (n = 101) using the 5YO and the MHB indices. Median 5YO and MHB scores of the 14 assessments were compared with original registry data (n = 61). Each centre devised code keys to protect the identities of their patients in the registry. RESULTS Interrater agreement among the 14 orthodontists was good for the 5YO index (quadratic-weighted kappa: 0.72-0.92) and the MHB index (intraclass correlation coefficient: 0.991-0.994). Comparisons of median 5YOs for each identifiable child with their registry data (n = 61) found total agreement for 70.5 per cent. Comparisons between median MHBs and registry data showed very good or good agreement in 93.4 per cent of the cases. LIMITATIONS Two teams lost their code keys, which reduced the sample to 61 patients. CONCLUSIONS The dentoalveolar outcome data in the CLP registry was trustworthy. There was good agreement among the Swedish cleft teams assessing the 5YO and MHB indices in children born with UCLP at age 5 years.
Collapse
Affiliation(s)
- Marie Pegelow
- Stockholm Craniofacial Team, Division of Orthodontics, Department of Dental Medicine, Karolinska Institutet, Stockholm
| | - Kristina Klintö
- Department of Otorhinolaryngology, Division of Speech and Language Pathology, Skåne University Hospital, Malmö
| | - Gudrun Stålhand
- Department of Dentofacial Orthopedics, Maxillofacial Unit, Linköping University Hospital, Malmö
| | - Mathias Lemberger
- Stockholm Craniofacial Team, Division of Orthodontics, Department of Dental Medicine, Karolinska Institutet, Stockholm
| | - Malin Vesterbacka
- Stockholm Craniofacial Team, Division of Orthodontics, Department of Dental Medicine, Karolinska Institutet, Stockholm
| | - Sara Rizell
- Department of Odontology, Sahlgrenska Academy, University of Gothenburg
| | | | | | - Magnus Becker
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | | | - Agneta Marcusson
- Department of Dentofacial Orthopedics, Maxillofacial Unit, Linköping University Hospital, Malmö
| | - Agneta Karsten
- Stockholm Craniofacial Team, Division of Orthodontics, Department of Dental Medicine, Karolinska Institutet, Stockholm
| |
Collapse
|
6
|
Anthropometric Analysis of the Dental Arches of Five-Year-Old Children With Cleft Lip and Palate. J Craniofac Surg 2018; 29:1657-1660. [PMID: 30028406 DOI: 10.1097/scs.0000000000004806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study aimed to analyze the dimensional alterations of the dental arches of 5-year-old children with cleft lip and palate and to compare these dimensions with children without oral clefts. One hundred twenty children were divided into the following groups: unilateral cleft lip (UCL), unilateral cleft lip and palate (UCLP), cleft palate (CP), and control (C). A specific software was used to digitize the dental casts and perform the anthropometric analyses through the measurement of transversal linear intercanine and intermolar distances on the maxilla and mandible. The intergroup comparisons of the maxillary dimensions exhibited that the intercanine distances of groups C and UCL were statistically greater than that of groups UCLP and CP. The intermolar distance was significantly smaller in group UCLP than in the other groups. No statistically significant difference occurred in the mandibular intercanine and intermolar distance among groups. The analysis of the superposition of the maxillary over the mandibular transversal distances showed statistically significant differences among groups. This study showed that at 5-year old, the children with cleft involving the palate had more maxillary dimensional alterations than those without cleft palate.
Collapse
|
7
|
Siegenthaler M, Bettelini L, Brudnicki A, Rachwalski M, Fudalej PS. Early versus late alveolar bone grafting in unilateral cleft lip and palate: Dental arch relationships in pre-adolescent patients. J Craniomaxillofac Surg 2018; 46:2052-2057. [PMID: 30416034 DOI: 10.1016/j.jcms.2018.09.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/30/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To evaluate the dental arch relationship in preadolescent children with complete unilateral cleft lip and palate after early secondary alveolar bone grafting (E-ABG) by comparing to late bone grafting (L-ABG). MATERIAL AND METHODS Two raters blindly assessed the dental arch relationship with the modified Huddart-Bodenham (HB) Index for 2 groups: E-ABG group (36 children, mean age 9.6 years) and L-ABG group (56 children, mean age 11.1 years). The groups differed with respect to age at which alveolar bone grafting was performed: between 1.4 and 4.1 years (mean 2.2 years, E-ABG group) and after 8 years (L-ABG group). T-test was run to compare scores between 2 groups. Regression analysis was carried out to evaluate gender, age at cleft repair, age at ABG, and age at assessment with the HB index. RESULTS The overall HB scores were -6.77 and -4.25 in the E-ABG and L-ABG groups, respectively (p = 0.025). Regression analysis showed that only the age at cleft repair influenced the HB scores. CONCLUSION ABG carried out between 2 and 4 years of age does not seem to negatively affect the dental arch relationship at the age of 10 years in comparison to L-ABG.
Collapse
Affiliation(s)
| | - Lisa Bettelini
- Private Practice, Winkelstrasse 22, 1716 Plaffeien, Switzerland
| | - Andrzej Brudnicki
- Department of Paediatric Surgery (Head of the Department: Prof. Ewa Sawicka), Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland
| | - Martin Rachwalski
- Department of Maxillofacial and Plastic Surgery (Head of the Department: Prof. Arnaud Picard), National Reference Center for Cleft Lip and Palate, Hôpital Universitaire Necker-Enfants Malades, 149 Rue de Sèvres, 75015 Paris, France
| | - Piotr S Fudalej
- Department of Orthodontics (Head of the Department: Doc. Milos Spidlen), Institute of Dentistry and Oral Sciences, Palacky University Olomouc, Palackeho 12, 771 00 Olomouc, Czech Republic; Department of Orthodontics and Dentofacial Orthopaedics (Head of the Department: Prof. Christos Katsaros), University of Bern, Freiburgstrasse 9, 3010 Bern, Switzerland.
| |
Collapse
|
8
|
Thierens LA, Lewyllie A, Temmerman L, De Roo NM, Verdonck A, Cadenas de Llano Perula M, Willems G, De Pauw GA. A retrospective intercenter comparison of two surgical protocols through the dental arch relationship of 5- to 6-year-old unilateral cleft patients. Clin Oral Investig 2018; 23:1777-1784. [PMID: 30171346 DOI: 10.1007/s00784-018-2601-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The objectives of this retrospective equivalence trial were to assess the dental arch relationship of 5- to 6-year-old patients with unilateral cleft lip and palate (UCLP) treated in two specialized cleft centers with a different surgical protocol using the 5-Year-Olds' Index and the modified Huddart/Bodenham scoring system, and to determine the correlation between these two scoring indices. MATERIALS AND METHODS The dental arch relationship of seventy-three 5- to 6-year-old patients with complete UCLP was evaluated on plaster casts using the 5-Year-Olds' Index and the modified Huddart/Bodenham scoring system. The sagittal occlusion, overbite, and overjet were also recorded. Inter- and intra-examiner agreement was determined using Intraclass Correlation Coefficients. RESULTS A good to very good inter- and intra-examiner agreement was found. No significant mean difference in outcome based on the 5-Year-Olds' Index, the modified Huddart/Bodenham scoring system, overjet, or overbite was detected. For mean difference in sagittal occlusion, the hypothesis that both centers are clinically equivalent was confirmed. A strong negative correlation (rs = - 0.832) between the 5-Year-Olds' Index and the modified Huddart/Bodenham scoring system was found. CONCLUSIONS The dental arch relationship of 5- to 6-year-old unilateral cleft patients treated in two Belgian cleft centers is clinically equivalent based on sagittal occlusion, despite substantial differences in their treatment protocol. Clinical equivalence for other parameters was not confirmed. There is a strong correlation between the 5-Year-Olds' Index and the modified Huddart/Bodenham scoring system. CLINICAL RELEVANCE A well-implemented treatment protocol for cleft patients is of the utmost importance, but case load and skill of the surgeon are also important factors for the quality of the results.
Collapse
Affiliation(s)
- Laurent Am Thierens
- Oral Health Sciences, Department of Orthodontics, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium. .,Centre for Congenital Facial Anomalies, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Arianne Lewyllie
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Liesbeth Temmerman
- Oral Health Sciences, Department of Orthodontics, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Noëmi Mc De Roo
- Oral Health Sciences, Department of Orthodontics, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - An Verdonck
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium.,Leuven Cleft Lip and Palate Team, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Maria Cadenas de Llano Perula
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium.,Leuven Cleft Lip and Palate Team, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Guy Willems
- Department of Oral Health Sciences-Orthodontics, KU Leuven and Dentistry, University Hospitals Leuven, Kapucijnenvoer 7, 3000, Leuven, Belgium
| | - Guy Am De Pauw
- Oral Health Sciences, Department of Orthodontics, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium.,Centre for Congenital Facial Anomalies, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| |
Collapse
|