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Marcin M, Katarzyna C. Stress and displacement patterns during orthodontic intervention in the maxilla of patients with cleft palate analyzed by finite element analysis: a systematic review. BMC Oral Health 2023; 23:93. [PMID: 36782289 PMCID: PMC9926813 DOI: 10.1186/s12903-023-02714-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 01/03/2023] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVE Rationale for the review in the context of what is already known about the evaluation of stress and displacement patterns using finite element analysis in the maxilla of patients with cleft palate after orthodontic intervention. METHODS This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). The protocol for this systematic review was registered with PROSPERO (CRD42020177494). The following databases were screened: Medline (via PubMed), Scopus, Embase, and Web of Science. RESULTS The search identified 31 records. 15 articles were retrieved for full texts and 11 of them were considered eligible for inclusion by 2 authors. Eventually, 11 articles were included in the qualitative analysis. CONCLUSIONS Finite element analysis is an appropriate tool for studying and predicting force application points for better controlled expansion in patients with UCLP.
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Affiliation(s)
- Mikulewicz Marcin
- Division of Facial Abnormalities, Department of Dentofacial Orthopaedics and Orthodontics, Medical University of Wroclaw, ul. Krakowska 26, 50-425, Wrocław, Poland.
| | - Chojnacka Katarzyna
- grid.7005.20000 0000 9805 3178Department of Advanced Material Technologies, Faculty of Chemistry, Wroclaw University of Technology, Wrocław, Poland
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Preston K, Chen L, Brennan T, Sheller B. Orthodontic treatment protocols in patients with alveolar clefting: a survey of ACPA-approved cleft teams in the United States. Angle Orthod 2023; 93:88-94. [PMID: 36228143 DOI: 10.2319/051522-357.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/01/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To describe pre- and post-alveolar bone graft (ABG) practice protocols of orthodontists associated with American Cleft Palate-Craniofacial Association-approved cleft and cleft/craniofacial teams. MATERIALS AND METHODS Electronic survey responses from team orthodontists were evaluated regarding pre-ABG orthodontic treatment type(s), timing of post-ABG imaging and post-ABG orthodontic treatment, and craniofacial orthodontic fellowship training status of the team orthodontists. A P value of <.05 was considered significant. RESULTS Of 31 responding orthodontists, 54.8% had fellowship training and 45.2% did not. Pre-ABG orthodontic preparation ranged from solely maxillary expansion for alveolar segment alignment (35.5%) to a combination of maxillary expansion for both alveolar segment alignment and posterior crossbite correction, anterior tooth alignment, and anterior crossbite correction (19.4%). Most captured post-ABG radiographs prior to orthodontic tooth movement (90.3%). Orthodontists began treatment at least 6 months (35.5%), 2-4 months (32.3%), or 4-6 months (29%) post-ABG. No significant differences were found when comparing fellowship subgroups. In addition, 47.1% of fellowship-trained orthodontists deferred post-ABG orthodontic treatment to at least 6 months post-operatively, vs 21.4% of non-fellowship trained orthodontists (P = .14). CONCLUSIONS A large variation in approaches is evident in pre-ABG orthodontic treatment types and timing of post-ABG treatment. Post-operative imaging is pursued by most orthodontists to assess graft status prior to initiating orthodontic treatment. Additional clinical research is needed to support providers in their decision-making with regard to evidence-based approaches.
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Tian T, Huang HY, Wang W, Shi B, Zheng Q, Li CH. Three-dimensional finite element analysis of the effect of alveolar cleft bone graft on the maxillofacial biomechanical stabilities of unilateral complete cleft lip and palate. Biomed Eng Online 2022; 21:31. [PMID: 35596229 PMCID: PMC9123812 DOI: 10.1186/s12938-022-01000-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 05/16/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The objective is to clarify the effect of alveolar cleft bone graft on maxillofacial biomechanical stabilities, the key areas when bone grafting and in which should be supplemented with bone graft once bone resorption occurred in UCCLP (unilateral complete cleft lip and palate). METHODS Maxillofacial CAD (computer aided design) models of non-bone graft and full maxilla cleft, full alveolar cleft bone graft, bone graft in other sites of the alveolar cleft were acquired by processing the UCCLP maxillofacial CT data in three-dimensional modeling software. The maxillofacial bone EQV (equivalent) stresses and bone suture EQV strains under occlusal states were obtained in the finite element analysis software. RESULTS Under corresponding occlusal states, the EQV stresses of maxilla, pterygoid process of sphenoid bone on the corresponding side and anterior alveolar arch on the non-cleft side were higher than other maxillofacial bones, the EQV strains of nasomaxillary, zygomaticomaxillary and pterygomaxillary suture on the corresponding side were higher than other maxillofacial bone sutures. The mean EQV strains of nasal raphe, the maximum EQV stresses of posterior alveolar arch on the non-cleft side, the mean and maximum EQV strains of nasomaxillary suture on the non-cleft side in full alveolar cleft bone graft model were all significantly lower than those in non-bone graft model. The mean EQV stresses of bilateral anterior alveolar arches, the maximum EQV stresses of maxilla and its alveolar arch on the cleft side in the model with bone graft in lower 1/3 of the alveolar cleft were significantly higher than those in full alveolar cleft bone graft model. CONCLUSIONS For UCCLP, bilateral maxillae, pterygoid processes of sphenoid bones and bilateral nasomaxillary, zygomaticomaxillary, pterygomaxillary sutures, anterior alveolar arch on the non-cleft side are the main occlusal load-bearing structures before and after alveolar cleft bone graft. Alveolar cleft bone graft mainly affects biomechanical stabilities of nasal raphe and posterior alveolar arch, nasomaxillary suture on the non-cleft side. The areas near nasal floor and in the middle of the alveolar cleft are the key sites when bone grafting, and should be supplemented with bone graft when the bone resorbed in these areas.
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Affiliation(s)
- Tao Tian
- West China School of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China
| | - Han-Yao Huang
- West China School of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China.,West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China
| | - Wei Wang
- Urumql DW Innovation InfoTech Co., Ltd., Urumqi, 830000, Xinjiang Uygur Autonomous Region, The People's Republic of China
| | - Bing Shi
- West China School of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China.,West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China
| | - Qian Zheng
- West China School of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China. .,West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China.
| | - Cheng-Hao Li
- West China School of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China. .,West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan Province, The People's Republic of China.
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Zygomaticomaxillary suture maturation evaluation in patients with and without cleft lip and palate. Am J Orthod Dentofacial Orthop 2022; 162:162-172. [DOI: 10.1016/j.ajodo.2021.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 01/01/2021] [Accepted: 01/01/2021] [Indexed: 11/24/2022]
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Biomechanical behavior of an alveolar graft under maxillary therapies. Biomech Model Mechanobiol 2021; 20:1519-1532. [PMID: 33893875 DOI: 10.1007/s10237-021-01460-6] [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: 05/21/2020] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
Cleft lip and palate is a congenital defect that affects the oral cavity. Depending on its severity, alveolar graft surgery and maxillary orthopedic therapies must be carried out as a part of the treatment. It is widely accepted that the therapies should be performed before grafting. Nevertheless, some authors have suggested that mechanical stimuli such as those from the maxillary therapies could improve the success rate of the graft. The aim of this study is to computationally determine the effect of maxillary therapies loads on the biomechanical response of an alveolar graft with different degrees of ossification. We also explore how the transverse width of the cleft affects the graft behavior and compare results with a non-cleft skull. Results suggest that stresses increase within the graft as it ossifies and are greater if maxillary expansion therapy is applied. This has consequences in the bone remodeling processes that are necessary for the graft osseointegration. Maxillary orthopedic therapies after graft surgery could be considered as a part of the treatment since they seem to act as a positive extra stimulus that can benefit the graft.
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Parveen S, Husain A, Gosla Reddy S, Mascarenhas R, Shenoy S. Three-dimensional finite element analysis of initial displacement and stress on the craniofacial structures of unilateral cleft lip and palate model during protraction therapy with variable forces and directions. Comput Methods Biomech Biomed Engin 2020; 23:1360-1376. [PMID: 32873066 DOI: 10.1080/10255842.2020.1803844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Maxillary protraction and expansion is recommended to treat midfacial deficiency in patients with cleft lip and palate (CLP), where amount and direction of forces can change displacement and stress. This study assessed the initial displacement and stresses using Facemask and Maxgym forces with and without RME at +20∘, 0∘, and -20∘ angulation using a finite element (FE) model of unilateral cleft lip and palate (UCCLP). The Initial displacement and stress were more for protraction with expansion as compared to only protraction. Asymmetric displacement was observed with more on cleft than on noncleft side and more on dental than skeletal structures. Palatal plane rotated less upward, increased arch width and decreased arch length was observed with protraction with expansion.
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Affiliation(s)
- Shahistha Parveen
- Department of Orthodontics and Dentofacial Orthopedics, Yenepoya Dental College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - Akhter Husain
- Department of Orthodontics and Dentofacial Orthopedics, Yenepoya Dental College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - Srinivas Gosla Reddy
- GSR Institute of Craniomaxillofacial and Facial Plastic Surgery, Hyderabad, Telangana, India
| | - Rohan Mascarenhas
- Department of Orthodontics and Dentofacial Orthopedics, Yenepoya Dental College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India.,Manipal Institute of Technology, Department of Aeronautical & Automobile Engineering, MAHE (Deemed to be University), Manipal, Karnataka, India
| | - Satish Shenoy
- Manipal Institute of Technology, Department of Aeronautical & Automobile Engineering, MAHE (Deemed to be University), Manipal, Karnataka, India
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Three-Year Follow-Up of a Patient With Unilateral Cleft Lip and Palate Treated With Maxillary Protraction and Alveolar Bone Grafting: An Approach Exploring the Potential Power of Growth. J Craniofac Surg 2018; 29:e818-e824. [PMID: 30320686 DOI: 10.1097/scs.0000000000004865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Clinically, patients with operated unilateral cleft lip and palate always present with a concave profile, depressed midface, maxillary hypoplasia, narrow upper dental arch, and class III malocclusion. In this clinical report, the authors describe the successful orthodontic treatment of a patient with unilateral cleft lip and palate. A boy, 7 years 11 months of age, with a history of unilateral cleft lip and cleft palate presented with a Class I malocclusion on Skeletal Class III base. A satisfactory occlusion and a favorable lateral profile were achieved after maxillary protraction (face mask) combined with fixed appliance treatment, including alveolar bone grafting surgery. An acceptable occlusion and facial proportion were maintained after a 3-year retention period. These results suggest orthodontic treatment with growth interference is an effective option for a patient with cleft lip and palate.
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Zhang Y, Jia H, Fu Z, Huang Y, Wang Z, Guo R, Shen J, Li W. Dentoskeletal effects of facemask therapy in skeletal Class III cleft patients with or without bone graft. Am J Orthod Dentofacial Orthop 2018; 153:542-549. [DOI: 10.1016/j.ajodo.2017.07.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 07/01/2017] [Accepted: 07/01/2017] [Indexed: 10/17/2022]
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Evaluation of Protraction Face-Mask Therapy on the Craniofacial and Upper Airway Morphology in Unilateral Cleft Lip and Palate. J Craniofac Surg 2017; 28:e627-e632. [DOI: 10.1097/scs.0000000000003652] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Tome W, Yashiro K, Kogo M, Yamashiro T. Cephalometric Outcomes of Maxillary Expansion and Protraction in Patients With Unilateral Cleft Lip and Palate After Two Types of Palatoplasty. Cleft Palate Craniofac J 2015; 53:690-694. [PMID: 26406555 DOI: 10.1597/15-082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To clarify the differences in the long-term effects of maxillary expansion (ME) and protraction (MP) in patients with complete unilateral cleft lip, alveolus, and palate (UCLP) undergoing two types of palatoplasty. DESIGN Retrospective longitudinal study. SETTING Institutional study. PATIENTS AND INTERVENTIONS Thirty-eight patients with UCLP treated at Osaka University Dental Hospital, Japan, were divided into two groups: 19 patients were treated using Wardill-Kilner push-back palatoplasty (PB), and 19 patients were treated with early two-stage palatoplasty according to the modified Furlow technique (ETS). All patients exhibited a short maxilla at the initial orthodontic visit and were treated with ME using a quad helix appliance and MP with a face mask. Lateral cephalometric data recorded in the initial stage were compared with those obtained at the end of treatment. MAIN OUTCOME MEASUREMENTS The dentoskeletal features and facial soft tissue profile were evaluated before and after orthodontic treatment. The variation and rate of change during treatment were also calculated. The Mann-Whitney U test was used for the statistical analyses. RESULTS The ETS group showed significantly greater SNA, SNB, and U1-Pp angles and smaller SN-Mp angles than the PB group after face mask treatment. The variation in the anteroposterior length of the maxilla during treatment was significantly greater in the ETS group than in the PB group. CONCLUSIONS Maxillary protraction was more efficiently accomplished in the patients with UCLP after early two-stage palatoplasty compared with push-back palatoplasty.
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Displacements prediction from 3D finite element model of maxillary protraction with and without rapid maxillary expansion in a patient with unilateral cleft palate and alveolus. Biomed Eng Online 2015; 14:80. [PMID: 26285822 PMCID: PMC4541727 DOI: 10.1186/s12938-015-0074-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 08/10/2015] [Indexed: 11/10/2022] Open
Abstract
Background Both maxillary protraction and rapid expansion are recommended for patients with cleft palate and alveolus. The aim of the study is to establish a three-dimensional finite element model of the craniomaxillary complex with unilateral cleft palate and alveolus to simulate maxillary protraction with and without rapid maxillary expansion. The study also investigates the deformation of the craniomaxillary complex after applied orthopaedic forces in different directions. Methods A three dimensional finite element model of 1,277,568 hexahedral elements (C3D8) and 1,801,945 nodes was established based upon CT scan of a patient with unilateral cleft palate and alveolus on the right side in this study. A force of 4.9 N per side was directed on the anatomic height of contour on the buccal side of the first molar. The angles between the force vector and occlusal plane were −30°, −20°, −10°, 0°, 10°, 20°, and 30°. A force of 2.45 N on each loading point was directed on the anatomic height of contour on the lingual side of the first premolar and the first molar to simulate the expansion of the palate. Results The craniomaxillary complex displaced forward under any of the loading conditions. The sagittal and vertical displacement of the craniomaxillary complex reached their peak at the protraction degree of −10° forward and downward to the occlusal plane. There were larger sagittal displacements when the maxilla was protracted forward with maxillary expansion. The palatal plane rotated counterclockwise under any of the loading conditions. Being protracted without expansion, the dental arch was constricted. When supplemented with maxillary expansion, the width of the dental arch increased. Transverse deformation of the dental arch on affected side was different from that on unaffected side. Conclusions Protraction force alone led the craniomaxillary complex moved forward and counterclockwise, accompanied with lateral constrain on the dental arch. Additional rapid maxillary expansion resulted in a more positive reaction including both larger sagittal displacement and the width of the dental arch increase.
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Asymmetric Maxillary Protraction for Unilateral Cleft lip and Palate Patients Using Finite Element Analysis. J Craniofac Surg 2015; 26:388-92. [DOI: 10.1097/scs.0000000000001337] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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