Evaluation of a Three-Dimensional Stereophotogrammetric Method to Identify and Measure the Palatal Surface Area in Children with Unilateral Cleft Lip and Palate

Palatal symmetry analysis of surgical protocols for oral clefts by 3D stereophotogrammetry

This study aimed to compare the dimensional alterations of the dental arches and the palate symmetry in patients with unilateral complete cleft lip and palate before and after the performance of primary surgeries by different surgical techniques. The sample was divided into Group 1, G1 - cheiloplasty (Millard technique) and single-stage palatoplasty (von Langenbeck technique); Group 2, G2 - cheiloplasty (Millard technique) and two-stage palatoplasty (Hans Pichler and Sommerlad techniques). The digital dental models were evaluated before (Time 1, T1) and after (Time 2, T2) primary surgeries. The straight linear (I-C, I-T, C-T, I-C', I-T', C'-T') and angular measurements (< ICT, < CTT', < IC'T', < C'T'T) were performed. Statistical analysis was applied with α = 5%. In the intragroup analysis, G1 and G2 showed a significant increase in T2 for all linear parameters except I-C' and I-T' and a decrease in all angular parameters except for < IC'T' in G1 and < CTT' in G2. In the intergroup analysis, at T2, there was an increase in C-T and I-T' and a decrease in < ICT for G2. Regarding the asymmetry in T1, for G1 and G2, we observed asymmetry in I-C vs I-C', I-T vs I-T', C-T vs C'-T', and < CTT' vs < C'T'T analyses. At T2, we observed asymmetry in all parameters except for I-T vs I-T' in G1 and for C-T vs C'-T' in G2. It is concluded that in following single-stage palatoplasty, there is symmetry in the total segment length, while two-stage palatoplasty is specifically effective in preserving symmetry in the posterior segment length.

Quantitative Assessment of Lip Morphology in Patients With and Without Cleft Lip and Palate Using 3-Dimensional Stereophotogrammetry

This study aimed to assess and quantify the morphologic characteristics of the lips and the lower third of the face in cleft and noncleft patients, utilizing three-dimensional (3D) stereophotogrammetry. Sixty patients were included in the study, comprising 30 unilateral cleft lip and palate patients (G1, 24 female, 6 male; aged 20 to 60 y, mean age 44.0±12.0 y) and 30 noncleft patients (G2, 23 female, 7 male; aged 20 to 59 y, mean age 43.5±12.0 y). Anthropometric landmarks were identified on the facial surface. Three-dimensional stereophotogrammetry was employed to capture images. Statistical analysis was conducted to compare the groups, with a significance level set at 0.05. The comparative analysis revealed statistically significant differences in 5 linear and 6 angular measurements. Linear measurements such as philtrum width, upper and lower cutaneous lip height, mandibular ramus length, and midfacial depth exhibited significant differences between cleft and noncleft patients. Similarly, angular measurements, including upper lip angle, Cupid's bow angle, lower/medium face convexity, lip seal, nasolabial angle, and left gonial angle, displayed statistically significant disparities. These findings underscore the ongoing surgical challenges in the comprehensive rehabilitation of patients with clefts, highlighting the critical need for continued advancements in treatment strategies.

Facial Analysis of Patients with Unilateral or Bilateral Cleft Lip and Palate Using 3D Stereophotogrammetry

OBJECTIVES

To evaluate the quantitative values of linear and angular facial anthropometrics in patients with unilateral cleft lip and palate (UCLP) and compare them with those of patients with bilateral cleft lip and palate (BCLP) using three-dimensional (3D) facial imaging.

DESIGN

Retrospective, observational, and cross-sectional study.

SETTING

Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP).

PATIENTS/ PARTICIPANTS

In total, 61 non-syndromic patients with CLP who underwent multidisciplinary treatment and rehabilitated with a prosthesis were enrolled and divided into those with UCLP (G1; n = 31) and those with BCLP (G2; n = 30).

INTERVENTION

Facial images were captured using a 3D camera after landmarks were marked on each patient's face. The software evaluated linear and angular parameters. Statistical tests were applied. Significance was determined as P < 0.05.

MAIN OUTCOME MEASUREMENTS

Overall, 22 linear and 13 angular measurements were evaluated.

RESULTS

The nasal length (P = 0.08), middle third of the face (P = 0.06), base nose width (P < 0.001), nasal root width (P < 0.001), nasal tip angle (P = 0.018), philtrum width (P < 0.001), lower face width (P = 0.039) and midfacial depth (P = 0.040) were significantly higher in G2; the upper cutaneous lip height was significantly higher in G1. Sexual dimorphism was observed except for linear measurements (linear distance between the labiale superius and labiale inferius landmarks, nasal root width, and upper cutaneous lip length) and angular measurements.

CONCLUSIONS

G2 had a greater length and width of nose and nasal root, nasal tip angle, philtrum width, and lower face width, midfacial depth, and midface third than G1. These findings also revealed the presence of sexual dimorphism.

Arch Symmetry in Patients Without and With Cleft Lip and Palate After Orthodontic/Rehabilitative Treatment-A Stereophotogrammetry Study

To evaluate and compare the dental arch symmetry of individuals with and without cleft lip and palate after orthodontic/rehabilitation treatment.

Cross-sectional study.

Tertiary cleft center in Brazil.

Fifty-five participants aged between 18 and 30 years were divided into 3 groups according to treatment. Patients that received either a fixed partial denture (FPD) or implant-supported crown (ISC) in the cleft area or only orthodontic treatment, noncleft patients (NC).

An analysis was performed using digitized dental casts scanned by laser and software. The following linear measurements were evaluated: incisor-canine; canine-molar; incisor-molar; surface and volume of the palatal region.

Three-way ANOVA was used to compare the study factors: group (FPD/ISC/NC) and side (right/left) followed by the Tukey test to verify their interaction (α = .05).

The results showed statistically significant differences among groups for the maxillary linear measurements canine-molar and incisor-molar, but not for incisor-canine. No statistically significant differences were found regarding the side for the maxillary measurements, while the factor interaction showed similarity only for incisor-canine. The mandibular measurements showed no statistical differences among groups, sides, or factor interactions. In surface and volume, all values in patients with cleft presented lesser than in without cleft patients.

Regardless of the rehabilitation, arch symmetry can be achieved in the incisor-canine dimension in the cleft area.

Measuring asymmetry in facial morphea via 3-dimensional stereophotogrammetry

BACKGROUND

Objectively determining tissue loss in craniofacial morphea is challenging. However, 3-dimensional (3D) stereophotogrammetry is a noninvasive modality that may be a useful adjunct.

OBJECTIVE

To prospectively evaluate 3D stereophotogrammetry in the assessment of craniofacial linear morphea.

METHODS

Participants underwent clinical, quality-of-life, and 3D-stereophotogrammetry assessments. Traditional photographs and 3D-stereophotogrammetry images were rated as mild, moderate, or severe by 2 experts and 2 nonexperts. In addition, interrater and intrarater reliability (on delayed rescoring) were calculated.

RESULTS

Of 23 patients with craniofacial morphea, 3D stereophotogrammetry detected pathologic asymmetry in 14 (20.6%) patients. Providers rated patients as more severely affected when using 3D stereophotogrammetry versus when using traditional photographs (19% severe on 3D stereophotogrammetry vs 0% severe on traditional photographs, P = .004). Qualitative ratings of both traditional and 3D images showed high inter- and intrarater reliability between experts and nonexperts alike. Physicians' Global Assessment of Damage scores correlated with mouth asymmetry (P = .0021), cheek asymmetry (P = .04), and 3D-stereophotogrammetry ratings (median, mild: 27.5 vs moderate: 46.5 vs severe: 64, P = .0152). Lower face asymmetry correlated with worse quality-of-life scores (P = .013).

LIMITATIONS

Small sample size and cross-sectional design.

CONCLUSION

3D stereophotogrammetry can reliably detect and quantify asymmetry in craniofacial morphea with greater sensitivity than that observed with traditional assessment alone. 3D stereophotogrammetry may be a useful adjunct to clinical examination.

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.

Evaluation of cheiloplasty and palatoplasty on palate surface area in children with oral clefts: longitudinal study

This study evaluated the palatal surface area in children with different oral clefts after primary surgeries and at five years of age. This longitudinal study was composed by 216 digital models: unilateral complete cleft lip (UCL), unilateral complete cleft lip and palate (UCLP), and complete cleft palate (CP). The models were analysed at four time periods: T1 (before cheiloplasty), T2 (before palatoplasty), T3 (after palatoplasty); and T4 - (at five years of age). Area of the dental arches was measured through stereophotogrammetry software. Measurements evaluated with Student's test and ANOVA followed by the Tukey test (p<0.05) (AQ 1). In the UCL group, the palatal surface area significantly increased among phases. In the primary surgery periods, UCLP and CP significantly decreased (p<0.001). Palatal area in the UCLP group was significantly greater than the CP group. Overall, no statistically significant differences occurred among groups. At T4, the area of the palate in the UCL group was significantly greater than the UCLP group and no significant differences occurred between UCLP and CP groups. This study suggests that cheiloplasty did not inhibit the growth of the palatal surface area in children with UCL and UCLP. Palatoplasty significantly decreased the palatal area in children with UCLP and CP, demonstrating a significant negative effect of palatal repair on maxillary growth. At five years, children with UCLP and CP had a significantly smaller palate area than those with UCL.

Innovative method to assess maxillary arch morphology in oral cleft: 3d-3d superimposition technique

This study aimed to analyze the maxillary growth and development of children with oral clefts using the innovative method of 3D-3D superimposition technique. Children with unilateral complete cleft lip (UCL) and unilateral cleft lip and palate (UCLP) participated in the study. The impressions of the dental arches were executed 1 day before and 1 year after lip repair surgery. A 3D laser scanner digitized the dental models and the stereophotogrammetry system software analyzed the 3D-3D superimpositions in two groups of matches (same child, UCL and UCLP) and one group of mismatches (different individuals). The differences were evaluated by Root Mean Square (RMS) and expressed in millimeters (mm). Kruskal-Wallis test followed by post-hoc Dunn test and Mann-Whitney test were assessed to compare the groups (α=5%). RMS was 1.34 mm (± 0.37) in UCL group, 1.41 mm (± 0.32) in UCLP group, and 3.38 mm (± 1.28) in mismatches group. RMS was significantly greater in mismatches than in matches groups (p<0.0001). No statistically significant differences occurred between genders. The 3D-3D superimposition technique showed the maxillary development after lip repair surgery in the anterior region of the palate. Thus, it is suggested that the cleft amplitude and the palatal segments proportion influenced the morphological heterogeneity and, consequently, the development and maxillary growth of children with orofacial cleft.

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

BACKGROUND

Cohort studies have evaluated dental arches of children.

AIM

To evaluate the volumetric, linear, palatal surface area, and the dental arch superimposition of participants with bilateral complete cleft lip (BCL) and bilateral cleft lip and palate (BCLP) surgically treated in a specialized hospital.

DESIGN

One hundred and thirty six digitized dental models evaluated before cheiloplasty (T1), after cheiloplasty (T2), and after palatoplasty (T3). The stereophotogrammetry software analysed the volume, palate superimposition, linear, and area measurements.

RESULTS

In BCL group, at T2, C-C', T-T', area, and volume significantly increased (P = .000, P < .000, P = .010 e P = .003, respectively). In BCLP group, the comparison T3 × T1 showed that C-C' decreased, whereas T-T' and the area increased (P < .000, P < .000, P = .000). The volume increased at T2, but decreased at T3 (P < .000) in participants with BCLP. The intergroup analysis revealed that C-C', T-T', I-C', and I-C were significantly smaller in participants with BCLP (P < .000, P = .016, P = .001 e P = .020, respectively), whereas the volume, superimposition, and area were statistically similar between groups (P > .05).

CONCLUSION

The comparison between bilateral orofacial clefts showed reduction in the transversal and anteroposterior linear measurements, but not in the area and volume, which was confirmed by the superimposition of the dental arches.

Arch Asymmetry in Patients With Cleft Lip and Palate After Rehabilitation Treatment Using Stereophotogrammetry

ABSTRACT

Arch asymmetry in cleft patients is a current problem that interdisciplinary treatment aims to solve. This research proposed to analyze the final rehabilitation, according to the arch symmetry of these patients. Thirty-five patients aged between 18 and 30 years, rehabilitated with a fixed partial denture or implants in the cleft area. The analysis was performed using digitalized dental casts with a laser model scanner (R700TM; 3Shape A/S, Holmens Kanal 7, 1060, Copenhagen/Denmark), analyzed with a Vectra Analysis Module software program (VECTRA H1; Canfield Scientific, 4 Wood Hollow Road, Parsippany, NJ 07054). Three linear measurements were evaluated, incisal-canine, canine-molar, and incisal-molar distance. The Student t test was applied to test the significance (P = 0.05) of an observed sample by correlation coefficient test (r-value). Female patients showed a significant correlation in arch symmetry. According to the rehabilitation treatment, patients who received implants showed a high correlation and significant symmetry at all maxillary distances. Finally, according to the cleft side in the maxillary dimensions, even though the majority of patients had clefts on the left side, only patients with a cleft on the right side showed symmetry in this area. Patients rehabilitated with implants in the cleft area showed a more symmetrical maxillary arch than those restored with fixed partial dentures.

Stereophotogrammetry to evaluate young adults with and without cleft lip and palate after orthodontic and restorative treatment

STATEMENT OF PROBLEM

Patients with cleft lip and palate generally present with lateral incisor agenesis, which may be treated with an implant-supported prosthesis. However, whether implants can stabilize the dental arches in patients with cleft lip and palate is unclear.

PURPOSE

The purpose of this retrospective clinical study was to analyze the stability of the maxillary dental arch after orthodontic treatment and oral rehabilitation in the cleft area with an implant-supported prosthesis or a fixed partial denture.

MATERIAL AND METHODS

Fifty-five participants, 20 with unilateral cleft lip and palate rehabilitated with implants (CLPI), 15 with unilateral cleft lip and palate rehabilitated with fixed partial dentures (CLPFP), and 20 in the noncleft group (NCLP) and their gypsum casts (N=110) were digitized and evaluated through 3D stereophotogrammetry. Measurements were made on casts obtained immediately after the orthodontic treatment (T1); for the cleft lip and palate group, casts were made 1 year after implant-supported restoration placement (T2), and for the noncleft group, 1 year after the conclusion of the orthodontic treatment (T2). The dimensions of the dental arches were measured digitally. Formula Δ=T2-T1 evaluated the stability of dental arches for intercanine distances, intermolar distances, arch length, palate surface, and volume (3D). Stability (Δ) was compared through 1-way ANOVA in all groups (α=.05).

RESULTS

A statistically significant difference was found in the stability of the CLPI and CLPFP groups for intercanine measurement (P=.002). For the intermolar measurement, a statistically significant difference was detected between the CLPFP and NCLP groups (P=.002). From the 3D measurements, the stability was similar in all groups.

CONCLUSIONS

In patients with clefts, a fixed partial denture may provide better stability of the orthodontic outcomes than an implant-supported prosthesis. However, greater instability occurred at the molar area.

Assessment of dental arch stability after orthodontic treatment and oral rehabilitation in complete unilateral cleft lip and palate and non-clefts patients using 3D stereophotogrammetry

BACKGROUND

Although arch stability has been studied in patients without a cleft, evidence for patients with a cleft is sparse. Therefore, we compared the dimensions and stability of dental arches in cleft lip and palate patients and those without a cleft.

METHODS

Forty participants, 20 with a complete unilateral cleft lip and palate and 20 non-cleft patients aged from 18 to 30 years, with anterior and/or posterior crossbite and receiving orthodontic treatment were evaluated retrospectively. Eighty gypsum casts were digitized using a laser model scanner casts for both groups made immediately after the orthodontic treatment was completed (T1). Also, for the Cleft Lip and Palate group, casts were obtained and digitized 1 year after implant-supported rehabilitation (T2) and for the Non-Cleft Lip and Palate group, 1 year after the conclusion of the orthodontic treatment (T2). The formula: Δ = T2-T1 evaluated the stability of dental arches for inter-canine distances (C-C'), inter-molar distances (M-M'), arch length (I-M), palate surface and volume. The dimensions of the dental arches were measured digitally. The independent t test was used for statistical analysis (α = 0.05).

RESULTS

A statistical difference was found in the stability of the groups for inter-canine (cleft area) measurement. At the times T1 and T2, a statistically significant difference was found in the arch length, surface and volume.

CONCLUSIONS

This study concluded that in the Cleft Lip and Palate group, the maxillary dimensions were not stabilized after 1 year of orthodontic and prosthodontic treatment (mainly for the inter-canine linear measurement) and that the transverse arch dimensions were smaller compared with those of non-cleft patients.

Analysis of Dental Arch in Children With Oral Cleft Before and After the Primary Surgeries

This study aimed to evaluate longitudinally the alteration of the dental arch dimensions of children with different oral cleft types, before and after the primary surgeries. Three-dimensional images of the maxillary dental casts of children with unilateral complete cleft lip (G1), unilateral complete cleft lip and palate (G2), and cleft palate (G3). The children were evaluated at pre-cheiloplasty (T1), pre-palatoplasty (T2), and 1 year after palatoplasty (T3). The measurements obtained: intercanine (C-C') and intertuberosity (T-T') distances, anterior (I-CC') and total (I-TT') arch lengths. To analyze the intraexaminer error, paired t-test was applied and Dahlbergh formula. The intragroups comparisons were applied: paired t-test, ANOVA followed by Tukey, Wilcoxon test, and Kruskal-Wallis test followed by Dunn test. The intergroup comparisons were performed by independent t-test and Mann-Whitney test. In G1, the C-C', T-T', and the I-TT' distances revealed a significant increase of the maxilla. In G2, the C-C' distance statistically decreased from T1 to T3, T-T' distance showed statistical increase from T1 to T3. The I-TT' length increased with statistically significant differences between T1 and T3, T2 and T3. In G3, the C-C', T-T', and I-TT' distance increased was statistically significant. The longitudinal evaluation of the changes occurred in the dental arches with different oral cleft types showed that cheiloplasty and palatoplasty caused the most alterations in the development of the maxillary dimensions of children with complete cleft lip and palate.

3D comparison of dental arch stability in patients with and without cleft lip and palate after orthodontic/rehabilitative treatment

This study aimed to compare the linear dimensions of the dental arches of adult patients with complete unilateral cleft lip and palate (UCLP) after orthodontic and prosthetic treatment with fixed partial dentures (FPD) to patients without clefts, using 3D technology. This retrospective longitudinal study sample consisted of 35 subjects divided into two groups. Included in this sample were 15 complete UCLP individuals who had received orthodontic treatment before rehabilitation with a fixed partial denture (FG), as well as 20 patients without cleft as control group (CG). All patients were aged between 18 and 30 years. Digital dental casts were obtained in two stages: (T1) end of orthodontic treatment and (T2) one year after prosthetic rehabilitation (FG); and (T1) end of orthodontic treatment and (T2) one year after removal of the orthodontic appliance (CG). Intercanine, interfirst premolar and intermolar distances, and incisor-molar length were obtained. A precalibrated and trained examiner performed the assessments. Intergroup differences between T2 and T1 were compared between the groups using the t test or Mann-Whitney test with a significance level of 5% (p<0.05). The intercanine distance variation (T2-T1) showed statistical difference (p=0.005) increasing in the FG group and decreasing in the CG group. In the interfirst premolar distance variation, FG decreased, while CG increased with statistically significant difference (p=0.008). The intercanine distance of individuals with cleft showed stability, while that of the CG had no stability. The CG showed stability in the interfirst premolar distance, while FG had no stability. These findings showed that the FPD is capable of restricting orthodontic results, leading to a stabilization of the dental arches.

Accuracy evaluation of tridimensional images performed by portable stereophotogrammetric system

Abstract Introduction Human facial characteristics vary according to individual dental occlusion, facial harmony, orofacial musculature and the format and configuration of craniofacial structures. Traditionally, anthropometric measurements have been acquired through direct evaluation of subjects in a clinical environment using calipers and metric tapes to measure distances between arches and landmarks. Scientific breakthroughs have enabled the digitization of data and introduced the possibility of quick, precise, radiation-free acquisitions; details can be archived for future analysis and easily shared with patients and colleagues. Among new facial analysis methods, the stereophotogrammetry technique has emerged, which uses a group of cameras to take many photographs of a subject in rapid succession from multiple angles. Nowadays, portable stereophotogrammetric systems are being proposed, as they are more practical and easier to use. Objective The aim of this work was to analyze the accuracy and reproducibility of a portable 3D stereophotogrammetric system (Vectra H1, Canfield, Fairfield, NJ, USA) in measuring soft facial tissues of 30 participants, defining measures of a cube and comparing these measurements with those obtained by a set 3D stereophotogrammetric system (Vectra M3, Canfield, Fairfield, NJ, USA) with previously validated accuracy and reproducibility through quantitative analysis of possible errors. Material and method Thirty temporary landmarks were used to measure (in mm) 34 distances in 30 participants (n = 30). Regarding the cube, 12 angles and 9 linear distances were evaluated. Result The results obtained by the established methodology indicated that the Vectra H1 portable system has shown accuracy and reproducibility equal to that of the Vectra M3 set system. Conclusion Data analysis and correlation to literature findings show Vectra H1's capability to reliably capture tridimensional images, which makes it practical for use in diverse clinical applications.

Post-surgical effects on the maxillary segments of children with oral clefts: New three-dimensional anthropometric analysis

This study aimed to use new three-dimensional (3D) anthropometric analyses to verify the post-surgical effects on the maxillary segments of children with unilateral cleft lip and palate. The sample was composed by digitized dental models of 60 children with unilateral complete cleft lip and alveolus (UCLA) and complete unilateral cleft lip and palate (UCLP). The impressions were taken before cheiloplasty (T1), after cheiloplasty (T2), and after palatoplasty (T3). The 3D anthropometric analyses of digitized dental casts were obtained through a specific software. Intragroup changes were applied paired t test and Wilcoxon test (UCLA group) and for the UCLP group, repeated-measures analyses of variance followed by the Tukey test. For intergroup analyses, an independent t test and Mann-Whitney test were used. The palatal dimensional changes of UCLA group showed that the distances IC, I-T', and I-T significantly increased after cheiloplasty (p = 0.0002, p = 0.0007 and p < 0.0001, respectively). In the UCLP group, the IC' distance statistically decreased in the post-surgical periods (p < 0.0001), while the I-T distance increased (p < 0.0001). The IC distance increased after cheiloplasty (p < 0.0001). The I-T' distance increased between T2 and T3 with statistically significant differences (p = 0.0037). The intergroup analysis of palatal development (T2-T1) showed that the distances IC' and I-T' demonstrated a reduction of the dental arches growth of UCLP group compared with the UCLA group, with statistically significant differences. The new 3D anthropometric analysis showed that the development of the maxillary segments changed after surgical repair. The UCLP group demonstrated a reduction of the dental arches growth compared with the UCLA group.

Novel 3-D Analysis for the Assessment of Cleft Dimensions on Digital Models of Infants With Unilateral Cleft Lip and Palate

Objective:

To present a 3-D standardized analysis of cleft dimensions.

Materials:

Thirty-one plaster casts of unilateral cleft lip and palate (UCLP) infants were laser scanned. Landmarks and coordinate system were defined. Linear distances and surfaces were measured, and the ratio between cleft and palatal area was calculated (3-D infant cleft severity ratio [3D ICSR]). The digitally measured areas were compared with silicone membranes, adapted to the plaster casts, and analyzed by optic microscopy.

Main Outcome Measures:

Repeatability, reproducibility, and validity.

Results:

Bland-Altman plots showed minor bias for anterior cleft width (0.16 mm), arch length (0.23 mm), and palatal surface (−9.18 mm2). The random error was maximum 0.78 mm for linear measurements and 12.1 mm2 for area measurements, reliability of 3D ICSR was 0.99 (intraclass correlation coefficient), differences between measurements on digital and plaster models were less than 2%.

Conclusions:

The method offers valid and reproducible 3-D assessment of cleft size and morphology. 3-D infant cleft severity ratio can be used as baseline value for surgical planning and may have a role in predicting dentofacial development.

Three-dimensional evaluation of surgical techniques in neonates with orofacial cleft

BACKGROUND

Individuals with cleft lip and palate have many anatomic and functional alterations compromising esthetics, hearing, speech, occlusion, and development/craniofacial growth. The rehabilitative treatment of these patients is very challenging and starts at birth aiming at the best treatment for all functional demands. This study aimed to evaluate the dimensional alterations of the dental arches of neonates with cleft lip and palate after two different primary surgical techniques.

MATERIALS AND METHODS

The sample comprised 114 digital models of children aged from 3 to 36 months, with unilateral complete cleft lip and palate divided into two groups. Two different phases were evaluated: precheiloplasty and 1 year after palatoplasty. The evaluation was performed through the digital models of each child obtained by scanning digitalization (3D Scanner). Dental arches measurements were accomplished through Appliance Designer software. The following measurements were assessed: dental arch area, anterior amplitude of the cleft, total length of dental arch, intercanine distance, and intertuberosity distance. t-test was applied to compare differences between groups.

RESULTS

No statistically significant differences were observed between groups at precheiloplasty phase. At 1 year after palatoplasty, the groups differed in the total length of dental arch (P = 0.002), with greater values for Group I.

CONCLUSION

This study suggests that the results of the different surgical techniques may alter the growth and development of the dental arches of neonates with cleft lip and palate.