A Longitudinal Three-Center Study of Dental Arch Relationship in Patients With Bilateral Cleft Lip and Palate

Longitudinal Three-Dimensional Stereophotogrammetric Growth Analysis in Infants with Unilateral Cleft Lip and Palate from 3 to 12 Months of Age

This longitudinal study aimed to evaluate facial growth and soft tissue changes in infants with complete unilateral cleft lip, alveolus, and palate (CUCLAP) at ages 3, 9, and 12 months. Using 3D images of 22 CUCLAP infants, average faces and distance maps for the entire face and specific regions were created. Color-coded maps highlighted more significant soft tissue changes from 3 to 9 months than from 9 to 12 months. The first interval showed substantial growth in the entire face, particularly in the forehead, eyes, lower lip, chin, and cheeks (p < 0.001), while the second interval exhibited no significant growth. This study provides insights into facial soft tissue growth in CUCLAP infants during critical developmental stages, emphasizing substantial improvements between 3 and 9 months, mainly in the chin, lower lip, and forehead. However, uneven growth occurred in the upper lip, philtrum, and nostrils throughout both intervals, with an overall decline in growth from 9 to 12 months. These findings underscore the dynamic nature of soft tissue growth in CUCLAP patients, highlighting the need to consider these patterns in treatment planning. Future research should explore the underlying factors and develop customized treatment interventions for enhanced facial aesthetics and function in this population.

Dental arch relationship outcomes for children with complete unilateral and complete bilateral cleft lip and palate in New Zealand

OBJECTIVES

To evaluate dental arch relationships of patients with complete unilateral and complete bilateral cleft lip and palate (CUCLP/CBCLP) in New Zealand.

SETTING AND SAMPLE POPULATION

Retrospective nationwide observational outcomes study involving 100 CUCLP and 32 CBCLP non-syndromic patients.

MATERIAL AND METHODS

Four calibrated assessors, blinded to the origin of the randomized digital models, used the GOSLON (UCLP) and the Bauru-BCLP (BCLP) Yardsticks and a 100 mm visual analogue scale (VAS) (UCLP&BCLP) to assess dental arch relationships. Weighted Kappa statistics were used to determine the intra- and inter-rater reliability for the GOSLON/Bauru-BCLP Yardsticks and correlations for the VAS.

RESULTS

Intra-rater reliability ranged from 0.57 to 0.88 (GOSLON), 0.62-0.84 (Bauru-BCLP) and 0.45-0.93 (VAS). Inter-rater reliability ranged from 0.62 to 0.86, (GOSLON), 0.48-0.75 (Bauru-BCLP) and 0.64-0.93 (VAS). Of the 100 CUCLP models, 46% had poor/very poor, 28% fair and 26% had good/very good dental arch relationships. Of the 32 CBCLP models, 37.5% were poor/very poor, 40.6% fair and 21.9% had good/very good dental arch relationships. The mean CUCLP VAS score was 50.5 mm (SD 19.9 mm) whilst the mean CBCLP VAS score was 40.0 mm (SD 22.0 mm) and both showed a strong relationship with their respective Yardstick scorings.

CONCLUSION

The dental arch relationships of children in New Zealand with CUCLP are similar to those centres in the Eurocleft and Americleft studies which had less favourable outcomes. Those with CBCLP are inferior to those reported elsewhere. Continued monitoring will allow for tracking of improvement in outcomes.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies-USP (HRAC-USP)--part 2: pediatric dentistry and orthodontics

The aim of this article is to present the pediatric dentistry and orthodontic treatment protocol of rehabilitation of cleft lip and palate patients performed at the Hospital for Rehabilitation of Craniofacial Anomalies-University of São Paulo (HRAC-USP). Pediatric dentistry provides oral health information and should be able to follow the child with cleft lip and palate since the first months of life until establishment of the mixed dentition, craniofacial growth and dentition development. Orthodontic intervention starts in the mixed dentition, at 8-9 years of age, for preparing the maxillary arch for secondary bone graft procedure (SBGP). At this stage, rapid maxillary expansion is performed and a fixed palatal retainer is delivered before SBGP. When the permanent dentition is completed, comprehensive orthodontic treatment is initiated aiming tooth alignment and space closure. Maxillary permanent canines are commonly moved mesially in order to substitute absent maxillary lateral incisors. Patients with complete cleft lip and palate and poor midface growth will require orthognatic surgery for reaching adequate anteroposterior interarch relationship and good facial esthetics.

Photographs of dental casts or digital models: rating dental arch relationships in bilateral cleft lip and palate

Yardsticks have been developed to measure dental arch relations in cleft lip and palate (CLP) patients as diagnostic proxies for the underlying skeletal relationship. Travelling with plaster casts to compare results between CLP centres is inefficient so the aim of this study was to investigate the reliability of using digital models or photographs of dental casts instead of plaster casts for rating dental arch relationships in children with complete bilateral cleft lip and palate (CBCLP). Dental casts of children with CBCLP (n=20) were included. Plaster casts, digital models and photographs of the plaster casts were available for all the children at 6, 9, and 12 years of age. All three record formats were scored using the bilateral cleft lip and palate (BCLP) yardstick by four observers in random order. No significant differences were found for the BCLP yardstick scores among the three formats. The interobserver weighted kappa scores were between 0.672 and 0.934. Comparison between the formats per observer resulted in weighted kappa scores between 0.692 and 0.885. It is concluded that digital models and photographs of dental casts can be used for rating dental arch relationships in patients with CBCLP. These formats are a reliable alternative for BCLP yardstick assessments on conventional plaster casts.

A two-centre study on facial morphology in patients with complete bilateral cleft lip and palate at nine years of age

The aim of this study was to compare craniofacial morphology and soft tissue profiles in patients with complete bilateral cleft lip and palate at 9 years of age, treated in two European cleft centres with delayed hard palate closure but different treatment protocols. The cephalometric data of 83 consecutively treated patients were compared (Gothenburg, N=44; Nijmegen, N=39). In total, 18 hard tissue and 10 soft tissue landmarks were digitized by one operator. To determine the intra-observer reliability 20 cephalograms were digitized twice with a monthly interval. Paired t-test, Pearson correlation coefficients and multiple regression models were applied for statistical analysis. Hard and soft tissue data were superimposed using the Generalized Procrustes Analysis. In Nijmegen, the maxilla was protrusive for hard and soft tissue values (P=0.001, P=0.030, respectively) and the maxillary incisors were retroclined (P<0.001), influencing the nasolabial angle, which was increased in comparison with Gothenburg (P=0.004). In conclusion, both centres showed a favourable craniofacial form at 9-10 years of age, although there were significant differences in the maxillary prominence, the incisor inclination and soft tissue cephalometric values. Follow-up of these patients until facial growth has ceased, may elucidate components for outcome improvement.

Maxillary arch width in unoperated adult bilateral cleft lip and alveolus and complete bilateral cleft lip and palate

OBJECTIVES

To study maxillary arch width in adult patients with bilateral cleft lip and alveolus (BCLA) or with complete bilateral cleft lip and palate (BCLP), who have not had any surgery. SETTING AND SAMPLING POPULATION: Eighteen patients with BCLA, 13 patients with BCLP, and 24 controls from remote areas of Indonesia collected over 10 years.

MATERIALS AND METHODS

Dental casts were digitized three-dimensionally using an industrial coordinate measuring machine (CCM) (Zeiss Numerex; Carl Zeiss, Stuttgart, Germany). Transversal distance between molars was measured on the tip of the distobuccal cusp and the tip of the mesiobuccal cusp, and for premolars and canines, the tip of the buccal cusps was recorded. Means and standard deviations were calculated for all variables. t-Test was used to determine whether the mean values of the cleft groups showed significant differences from each other and from the controls. Level of significance was set at p < 0.05.

RESULTS

Transversal arch dimensions in the BCLA group were comparable to the controls except at the canine level. Intercanine distance, which is close to the alveolar cleft, was 4.3 mm (SE 1.4) smaller in the BCLA group (p = 0.002). In the BCLP group, a comparable pattern was found. At the canine level, mean transversal width was 7.2 mm (SE 1.9) smaller compared to the control group, but no significant differences were found in the other transversal dimensions.

CONCLUSIONS

Small differences are found in transversal dimensions in patients with BCLA and BCLP compared to a control group. Differences are most outspoken in the area near the cleft.