Prospective cohort 3D study of dental arches in children with bilateral orofacial cleft: Assessment of volume and superimposition

Analysis of Dental Arch Symmetry of Children With Unilateral Cleft Lip and Palate: Seven-Year Follow-Up

BACKGROUND

Orofacial cleft is the most common craniofacial deformity, resulting in facial anatomical disorders.

AIM

To evaluate maxillary dental arch symmetry of children with unilateral complete cleft lip, alveolus, and palate before and after primary surgeries.

DESIGN

A total of 27 dental casts were analyzed: (T1) Presurgical; (T2) Postsurgical 1; and (T3) Postsurgical 2. Six linear measurements were analyzed (I-C', I-C, I-T', I-T, C'-T', and C-T). Paired t test, Pearson correlation, and ANOVA, followed by the Tukey test, were conducted (α = 5%).

RESULTS

The asymmetry was confirmed by I-C versus I-C' across all periods and I-T versus I-T' (at T1). The Pearson correlation test showed significant values for Δ1×Δ2 and Δ1×Δ3, but not for Δ2×Δ3. The longitudinal analysis showed that the I-C' mean was greater at T1 than at T2/T3 (p < 0.001). The I-C mean was smaller at T1 than at T2/T3 (p < 0.001). I-T' was greater only at T3 (p < 0.001). I-T, C'-T', and C-T means were greater at all periods.

CONCLUSION

The maxillary asymmetry of children with unilateral cleft lip and palate is inherent to the cleft type, evidenced by the maxillary hypoplasia in the smaller segment, probably higher in the anterior region (I-C').

Application of digital workflow and technologies in clinical paediatric dentistry: a scoping review

PURPOSE

The purpose of the present scoping review is to map the literature reporting on the application of digital workflows and digital technologies in the diagnosis, treatment, or management of dental conditions in paediatric patients. Furthermore, the review focuses on identifying possible knowledge gaps in the area and developing specific recommendations for future investigations.

METHODS

An electronic search was performed on 3 databases up to July 2023. After the authors independently screened the retrieved articles, they extracted the data and assessed the risk of bias using the JBI (The Joanna Briggs Institute) critical appraisal tools and the Cochrane Risk of Bias 1 tool, depending on the study design assessed.

RESULTS

After full-text assessment, 58 studies were identified that met the inclusion and exclusion criteria. The results were divided into two groups according to the study design: 36 were research articles, and 22 were case reports; only the research articles were included in the qualitative synthesis. The most common topic was Scanners/3 d digital model analysis (11 articles), followed by Digital Imaging (8 articles). Digital applications were also a popular topic, and tele-dentistry and artificial intelligence were also present in the included studies.

CONCLUSION

Studies investigating the use of digital workflows and digital technologies in the diagnosis, treatment or management of dental conditions in paediatric dentistry are lacking. In general, future investigations should be based on higher quality studies; furthermore, the lack of studies on the clinical validation of digitally fabricated orthodontic devices and restorations in paediatric patients provides insights for future research.

Volumetric Analyses of Dysmorphic Maxillofacial Structures Using 3D Surface-Based Approaches: A Scoping Review

Background/Objectives: Three-dimensional (3D) analysis of maxillofacial structures in dysmorphic patients offers clinical advantages over 2D analysis due to its high accuracy and precision in measuring many morphological parameters. Currently, no reliable gold standard exists for calculating 3D volumetric measurements of maxillofacial structures when captured by 3D surface imaging techniques. The aim of this scoping review is to provide an overview of the scientific literature related to 3D surface imaging methods used for volumetric analysis of the dysmorphic maxillofacial structures of patients affected by CL/P or other syndromes and to provide an update on the existing protocols, methods, and, when available, reference data. Methods: A total of 17 papers selected according to strict inclusion and exclusion criteria were reviewed for the qualitative analysis out of more than 4500 articles published between 2002 and 2024 that were retrieved from the main electronic scientific databases according to the PRISMA-ScR guidelines. A qualitative synthesis of the protocols used for the selection of the anatomical areas of interest and details on the methods used for the calculation of their volume was completed. Results: The results suggest a great degree of heterogeneity between the reviewed studies in all the aspects analysed (patient population, anatomical structure, area selection, and volume calculation), which prevents any chance of direct comparison between the reported volumetric data. Conclusions: Our qualitative analysis revealed dissimilarities in the procedures specified in the studies, highlighting the need to develop uniform methods and protocols and the need for comparative studies to verify the validity of methods in order to achieve high levels of scientific evidence, homogeneity of volumetric data, and clinical consensus on the methods to use for 3D volumetric surface-based analysis.

Comparative 3D study of dental arches in children with microcephaly associated with congenital Zika syndrome, orofacial cleft, and without craniofacial anomalies

INTRODUCTION

The dentist participates in the treatment protocol for craniofacial anomalies in individuals from the first months of life.

OBJECTIVE

to compare in a retrospective cohort study the morphometry of the edentulous palate of children microcephaly associated with congenital Zika syndrome (CZS), unilateral complete cleft lip and alveolus (UCL), and without craniofacial anomalies.

METHODS

Forty-five digitized dental molds composed the sample divided into three groups: CZS; UCL; and without craniofacial anomalies (control group). The following measurements were evaluated: intercanine and intertuberosity distances; dental arch length, area, volume, and mismatch superimposition. Parametric and non-parametric tests were applied (α = 5%).

RESULTS

CZS group showed the smallest means of intercanine distance and area than those of the other groups (p = .001 and p = .010, respectively). The dental arch length was greater in the CZS group than in the control group (p = .020). The evaluation of the mismatch superimposition showed that the CZS group had the lowest means of maximum distance and root mean square than that of the UCL group (p = .025 and p = .005, respectively).

CONCLUSION

CZS participants tended to palatal narrowing, while UCL individuals had parameters similar to those of the control group, despite the alveolus defect.

What Are the Effects on Palate of Early Lip Surgery in Children With Cleft Lip and Palate? Cross-Sectional Evaluation From 5-Year-Old

This study aimed to evaluate the postsurgical effects from 5 years on the palate after surgical repair of the lip at 3 or 9 months of age in children with cleft lip and palate. Eighty-four digitized dental impressions were divided into the following groups: group 1 (G1): lip surgery at 3 months of life; group 2 (G2): lip surgery at 9 months of life; group 3 (G3): without orofacial cleft. Five angular (C'IC, ICM, IC'M', CMM', and C'M'M) and 3 linear parameters (C-C', c-c', and M-M') were evaluated. Statistical analysis was applied with α=5%. Intraclass Correlation Coefficient was significantly smaller in G1 than in G3 ( P =0.005), while IC'M' was significantly smaller in G3 than in G1 ( P <0.001). C'M'M was significantly smaller in G1 than in G2 and G3 ( P <0.001). The distances C-C' and c-c' were significantly smaller in G1 than in G2 and G3 ( P <0.001). There was a statistically significant difference in both G1 and G2 ( P <0.001, in all) in the analysis of palatal symmetry. Linear regression analysis showed that the, 11.2% of outcomes determined by c-c' distance can be explained by the age of lip repair ( P =0.013). In conclusion, lip surgery at 3 months of life showed a tendency toward more restriction in 5-year postsurgery palate development. The age of cheiloplasty is one of the factors that can influence palatal development; however, other factors may be associated and should be studied.

Correlation between cleft width and dental arch symmetry in cleft lip and palate: a longitudinal study

This study aimed to evaluate the influence of cleft width on dental arch symmetry of children with unilateral cleft lip and palate. Forty-one children were subjected to impression preoperatively (T1; mean age = 0.31 ± 0.07 years) and postoperatively (T2; mean age = 6 .73 ± 1.02 years). Eighty-two digitized dental casts were analyzed by stereophotogrammetry software. The cleft palate width was measured in the anterior (P-P'), middle (M-M'), and posterior (U-U') regions. Also, the following measurements were obtained: anterior intersegment (I-C') and intrasegment (I-C); total intersegment (I-T') and intrasegment (I-T); cleft-side (C'-T') and non-cleft-side (C-T) canine tuberosity. Paired t test and Pearson correlation coefficient were applied (α = 5%). Cleft width had the following means: 10.16 (± 3.46) mm for P-P', 12.45 (± 3.00) mm for M-M', and 12.57 (± 2.71) mm for U-U'. In the longitudinal analysis, I-C' had a significant reduction, while the other measurements significantly increased (p < 0.001). Asymmetry was verified in the following analyses at T1: I-C' vs. I-C and I-T' vs. I-T (p < 0.001); at T2, only in I-C' vs. I-C (p < 0.001). At T1, P-P' vs. I-C' (r = 0.722 and p < 0.001), P-P' vs. I-T' (r = 0.593 and p < 0.001), M-M' vs. I-C' (r = 0.620 and p < 0.001), and M-M' vs. I-T' (r = 0.327 and p < 0.05) showed a positive and significant correlation. At T2, there was a correlation between M-M' and I-C' (r = 0.377 and p < 0.05). In conclusion, the anterior and middle cleft widths influenced palatal asymmetry in the first months of life, while middle width influenced residual asymmetry.

A Narrative Review on Non-Invasive Diagnostic Tools for the Analysis of Dental Arches in Orofacial Cleft Patients

BACKGROUND

It is necessary to analyze and monitor the facial growth of orofacial cleft patients. The documentation should therefore begin before and after primary surgeries. Technological evolution has transformed plaster models into 3D images through scanners that allow rational storage, manipulation, and rotation without the possibility of breakage or damage. Based on this fact, this narrative review aims to provide a feature on the three-dimensional tools available for the assessment of dental arches in children with orofacial cleft and mixed dentition.

MATERIAL AND METHODS

Three databases were chosen (PubMed, ScienceDirect, and Scopus) and keywords were used to select papers.

RESULTS

During the database screening, 292 potentially relevant papers were found. After removing duplicates, titles, and abstracts, 32 papers presented qualifications for analysis. Through evaluating each document by reading it one by one, 24 papers fulfilled the eligibility criteria.

CONCLUSIONS

It was concluded that digital tools-i.e., benchtop scanners which evaluate the dental arches of children with cleft lip, palate, and mixed dentition-are reproducible and reliable, without the use of ionizing radiation, allow storage, manipulation with sustainability, and help preserve the environment.

Six-year post-surgical evaluation in the treatment protocols in the dental arches of children with oral cleft: longitudinal study

OBJECTIVE

Oral cleft surgical repairs are performed using different techniques worldwide. To evaluate and compare the development of the dental arches of children with unilateral cleft lip and palate before and after the primary surgeries performed with different techniques at the first months and six years of life.

METHODOLOGY

This is a retrospective longitudinal study. The sample comprised 56 dental casts divided int the following groups: Group 1 (G1) - cheiloplasty (Millard technique) at three months and one-step palatoplasty (von Langenbeck technique) at 12 months; and Group 2 (G2) - cheiloplasty (Millard technique) and two-step palatoplasty: anterior hard palate closure (Hans Pichler technique) at three months and posterior soft palate closure (Sommerlad technique) at 12 months. The digitized dental casts were evaluated at three months - pre-surgical (T1) and six years of life- post-surgical (T2). The following linear measurements were analyzed: intercanine (C-C'), intertuberosity (T-T') distances; anterior dental arch (I-CC'), anterior intersegment (I-C'), and total arch (I-TT') lengths. The palate area was also measured. Parametric and non-parametric tests were applied (p<0.05).

RESULTS

In G1, the intragroup comparison showed statistically significant smaller I-CC' and I-C' at T2 (p=0.001 and p<0.001, respectively), while T-T', I-TT', and area comparisons were significantly greater (p<0.001, p=0.002, and p<0.001, respectively). In G2, the intragroup comparison exhibited statistically significant smaller C-C' and I-C' at T2 (p=0.004, for both), whereas T-T', I-TT' and area comparisons were significantly greater (p<0.001, p=0.004, and p<0.001, respectively). At T2, the intergroup analysis revealed that G1 had a statistically significant smaller I-CC' (p=0.014). The analysis of the intergroup differences (∆=T2-T1) showed that G1 had a statistically smaller I-CC' (p=0.043).

CONCLUSION

The two-step palatoplasty showed a more favorable prognosis for the maxillary growth than one-step palatoplasty in children with oral clefts.