Masticatory Function Assessment of Adult Patients With Cleft Lip and Palate After Orthodontic Treatment

Factors Influencing Parental Satisfaction in Children with Cleft Lip and Palate Repair Based on Comprehensive Plastic Surgery Procedures at the Senyum Bali Foundation

Analyze contributing factors toward satisfaction after cleft lip and palate treatments in Senyum Bali Foundation. Qualitative case study, an interview with a semi-structured question from February to April 2023 by purposive sampling informants including parents, foundation staff, and plastic surgeon. Unsatisfying nose and teeth appearance due imperfect effects after surgery and requirement of more procedures. Mini model theory study that includes the appearance of the face and lips; speech and hearing; the functions of feeding, masticatory, breathing; psychosocial, quality of life, treatment cost-effectiveness, funding, health services, physician, implementing cultural contexts, surgical outcomes, and parents' feedback.

Mandibular Radiomorphometric Characteristics of Individuals with Bilateral or Unilateral Cleft Lip and Palate

OBJECTIVE

This study aimed to investigate and compare the mandibular radiomorphometric characteristics of patients with unilateral or bilateral cleft lip and palate (CLP) with those of individuals without CLP and to determine whether there was a difference.

DESIGN

Retrospective cohort study.

SETTING

Orthodontic Department in Faculty of Dentistry.

PATIENTS AND INTERVENTIONS

Mandibular cortical bone thickness was measured on high-quality panoramic radiographs taken from 46 patients with unilateral or bilateral CLP aged 13-15 years and 21 control patients.

MAIN OUTCOME MEASURES

Three radiomorphometric indices [antegonial index (AI), mental index (MI), and panoramic mandibular index (PMI)] were measured bilaterally. AutoCAD software was used for MI, PMI, and AI measurements.

RESULTS

Left MI values were significantly lower in individuals with unilateral cleft lip and palate (UCLP; 0.029 ± 0.04) than in individuals with bilateral cleft lip and palate (BCLP; 0.033 ± 0.07). In addition, right MI values of individuals with right UCLP (0.26 ± 0.06) were significantly lower than those of individuals with left UCLP (0.34 ± 0.06) or BCLP (0.32 ± 0.08). No difference was observed between individuals with BCLP and left UCLP. These values did not differ between groups.

CONCLUSIONS

Antegonial index and PMI values did not differ between individuals with different types of CLP or when compared with control patients. In patients with UCLP, cortical bone thickness was found to be reduced on the cleft side compared to the intact side. Patients with UCLP with a right-sided cleft had a more substantial decrease in cortical bone thickness.

Correction of Severe Skeletal Class II High Angle with Mandibular Retrusion and Gummy Smile by Double-Jaw Surgery

This report describes the treatment of severe skeletal Class II malocclusion in a young woman with a gummy smile and pronounced lower anterior facial height. Overjet and overbite were +12.0 mm and -1.0 mm, respectively. Cephalometric analysis revealed inferior positioning of the maxilla and severe mandibular retrusion with clockwise rotation. Both the upper and lower anterior teeth showed labial inclination. Based on a diagnosis of a skeletal Class II high angle with mandibular retrusion and a gummy smile, double-jaw orthognathic surgeries for upper and lower premolar extraction were chosen to gain ideal occlusion and an improvement in the esthetic facial profile. Le Fort I osteotomy was performed to move the anterior and posterior teeth upward by 4.0 mm and achieve mandibular counterclockwise rotation. Short lingual sagittal split ramus osteotomy was performed to move the mandible forward by 3.0 mm. As a result, normal overjet and overbite were achieved together with a straight profile and a good smile. After surgery, electromyographic evaluation of anterior temporal muscle activity showed an improvement in the percentage overlapping coefficient value (a symmetric index of bilateral muscle activity) from 28.1% to 63.2% compared to at pre-treatment. The pattern of jaw movement also showed an improvement. These results suggest that orthognathic surgery in skeletal Class II cases can improve not only malocclusion and the skeletal relationship of the jaws, but also masticatory function and jaw movement.

Masticatory path pattern and masticatory performance while chewing gummy jelly

The purpose of this study was to clarify masticatory path pattern and masticatory performance during gummy jelly chewing. A total of 235 healthy adults were asked to chew gummy jelly for 20 s on each side, and the masticatory movement was recorded using a Motion Visi-Trainer (MVT V1). Next, the amount of glucose extraction was measured as a parameter of masticatory performance. The masticatory path was classified into one of five patterns newly devised: normal pattern (N, opening: straight or concave, closing: convex) and abnormal patterns (A1-A4). The number of occurrences of each pattern was investigated and compared by sex and path pattern. Next, masticatory performance was compared between the normal pattern and the abnormal patterns by sex. Pattern N was the most frequently expressed in 346 cases out of 470 cases (73.6%), followed by patterns A1, A4, A2, and A3 in that order. Regarding the number of patterns observed, pattern N was the most common in both sexes, followed by pattern A1, with no significant difference between sexes. The amount of glucose extraction in each pattern was the highest in pattern N for both sexes, followed by A2 and others in that order, and a significant difference was observed between the normal pattern and the abnormal patterns. From these results, the existence of sex difference in masticatory path patterns during gummy jelly chewing was not proven, and that masticatory performance was higher with normal patterns than with abnormal patterns.

The Impact of Orthodontic Treatment on Masticatory Performance: A Literature Review

The aim of this narrative review was to evaluate the possible association between orthodontic therapy and improved masticatory function. A search strategy was conducted using the PubMed database for up to January 2020 using the keywords "mastication" and "orthodontics". Only human studies investigating mastication in orthodontics settings were selected. The search strategy resulted in 1,011 articles, out of which 57 were included in the final analysis. Investigations have generally agreed that masticatory and chewing functions improved post-orthodontic and orthognathic treatments. Studies also showed improvement in the quality of life of patients' post-orthodontic treatment. The articles examined reinforced that besides esthetic reasons, orthodontic therapy does improve the masticatory and chewing functions of individuals, ultimately enhancing their health-related quality of life.

Anxiety and depression mediate the relationship between digestive tract conditions and oral health-related quality of life in orthodontic patients

Background

Anxiety and depression are common psychological problems in orthodontic patients whose diet habits and oral health status change frequently during treatment. However, relationships between anxiety and depression, digestive tract condition, and impaired oral health-related quality of life remain unknown.

Materials and methods

In this study, clinical assessments, including anxiety, depression, digestive tract condition, and oral health-related quality of life, were collected from 769 outpatients in the orthodontic department using three self-reported questionnaires. Correlation analysis was used to investigate the relationships among different clinical assessments. A chained mediation analysis model was further conducted to explore the direct and indirect effects of these various clinical factors.

Results

Changes in digestive tract conditions were positively correlated with the psychological status and oral health-related quality of life. Anxiety and depression partially mediated the relationship between them, and the indirect effect was 0.68 (30%), of which the mediation effect of anxiety accounted for 56%.

Conclusion

Anxiety and depression mediate the relationship between gastrointestinal conditions and oral health. In particular, anxiety seems to play a significant mediating role. Our findings indicate that psychological status must be paid more attention to in future clinical practices and supervision for digestive tract symptoms of orthodontic patients.