Mothers' knowledge and experience concerning presurgical orthopedic management for infants with cleft lip and palate

Enhancing Presurgical Infant Orthopedic Appliances: Characterization, Mechanics, and Biofilm Inhibition of a Novel Chlorhexidine-Halloysite Nanotube-Modified PMMA

Objectives

This in vitro study aimed to develop a novel nanocomposite acrylic resin with inherent antimicrobial properties. This study evaluated its effectiveness against microbial biofilm formation, while also assessing its physical and mechanical properties.

Methods

Polymethylmethacrylate (PMMA) was modified with four different concentrations of chlorhexidine halloysite nanotubes (CHX-HNTs): 1%, 1.5%, 3%, and 4.5 wt.% by weight, along with a control group (0 wt.% CHX-HNTs). The biofilm inhibition ability of the modified CHX-HNTs acrylic against Candida albicans, Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus agalactiae was assessed using microtiter biofilm test. In addition, ten samples from each group were then tested for flexural strength, surface roughness, and hardness. Statistical analysis was performed using one-way ANOVA and Tukey's test for comparison (P < 0.05).

Results

CHX-HNTs effectively reduced the adhesion of Candida albicans and bacteria to the PMMA in a dose-dependent manner. The higher the concentration of CHX-HNTs, the greater the reduction in microbial adhesion, with the highest concentration (4.5 wt.%) showing the most significant effect with inhibition rates ≥98%. The addition of CHX-HNTs at any tested concentration (1%, 1.5%, 3%, and 4.5 wt.%) did not cause any statistically significant difference in the flexural strength, surface roughness, or hardness of the PMMA compared to the control group.

Conclusions

The novel integration of CHX-HNT fillers shows promising results as an effective biofilm inhibitor on acrylic appliances. This new approach has the potential to successfully control infectious diseases without negatively affecting the mechanical properties of the acrylic resin. Clinical Relevance. The integration of CHX-HNTs into presurgical infant orthopedic appliances should be thoroughly assessed as a promising preventive measure to mitigate microbial infections. This evaluation holds significant potential for controlling infectious diseases among infants with cleft lip and palate, thereby offering a valuable contribution to their overall well-being.

The accuracy and retention of presurgical infant orthopaedics constructed from different polymer materials: A comparative study

Objectives

This laboratory-based study aimed to evaluate and compare the accuracy and retention of moulding plates when used as pre-surgical orthopaedic appliances (PSIOs) for infants with cleft lip and/or palate (CL/P).

Methods

Ten moulding plates were fabricated from three different materials (total sample size: 30), including polymethyl methacrylate (PMMA), a hard clear aligner (PET-G polymer), and a dual-layered hard and soft clear aligner (mixed PET-G/EVA) on ten three-dimensional (3D) printed working models. Accuracy was evaluated by measuring the virtual gap between the data acquired from the moulding plate and the working model after the optical scanning at each of the designated 36 points for each plate. Exocad software was used to facilitate all virtual alignments and measurements. Retention was measured using a digital gauge that quantified the traction force required to separate the plates from the retention test cast (a soft resin printed cast).

Results

PET-G plates exhibited the best fit with the working cast, with overall adaptations of 0.146 ± 0.012 for PET-G, 0.250 ± 0.073 for PET-G/EVA, and 0.294 ± 0.113 for PMMA. For region-specific misfit, PET-G plates exhibited superior accuracy across all regions, with mean discrepancies of 0.16 ± 0.08 mm, 0.15 ± 0.061 mm, and 0.12 ± 0.128 mm in the anterior, middle, and posterior regions, respectively. Retention for PET-G was significantly higher than the other materials, with a mean of 3.34 N ± 0.487, as opposed to 1.65 N ± 0.331for PMMA and 1.27 N ± 0.239 for PET-G/EVA (P < 0.05).

Conclusions

Moulding plates constructed from PET-G exhibited a better fit and higher retention than those made from PET-G/EVA and PMMA.

Clinical significance

Collectively, our findings suggest that the selection of PET-G for PSIO appliances could have clinical significance by potentially improving treatment outcomes in infants with CL/P.

Oral flora and functional dysbiosis of cleft lip and palate patients: A scoping review

AIMS

This scoping review aimed to conduct an assessment of the current literature on specific ecological changes in the oral microbiota of individuals living with cleft lip and/or palate.

METHODS

All studies that assess oral microbiota and ecological changes distinct of individuals living with cleft lip and/or palate were included. Ovid MEDLINE and EMBASE databases were used, using planned search keywords. Included articles were grouped into cohort, cross-sectional, case-control, and retrospective reviews.

RESULTS

A total of 164 eligible title articles were recognized. Of these, 32 full-text studies were included in the present review. All the included articles were published between 1992 and 2022. These studies were two retrospective studies, two review studies, and the remaining (n = 28) were observational studies.

CONCLUSION

The oral flora of cleft lip and/or palate patients has been shown in scientific studies to have an increased frequency of potentially pathogenic fungal and bacterial colonization, particularly Candida species, Staphylococcus aureus, Lactobacili and Streptococci mutans. This may influence oral diseases and post-operative repair complications, potentially necessitating further surgical intervention.

Accuracy and Retention of Molding Plates Used for Infants with Cleft Lip and Palate Fabricated from Different Materials: A Cross-Sectional Clinical Study

OBJECTIVES

The study aimed to comparatively assess the accuracy and retention of molding plates made of polyethylene terephthalate modified with glycol (PET-G) and polymethyl methacrylate (PMMA) materials, while also investigating the effect of adhesive addition on retention.

DESIGN

A cross-sectional clinical study.

PATIENTS/SETTING

The study included 30 infants diagnosed with non-syndromic cleft lip and palate (16 unilateral, 14 bilateral). Two molding plates were fabricated for each infant, and their accuracy and retention were evaluated. The data were analyzed using independent t-tests, Mann-Whitney U tests, and Wilcoxon rank tests.

MAIN OUTCOME MEASURES

Accuracy: The accuracy of the molding plates was assessed by measuring the virtual gap between the inner surface of the plates and their working cast using Exocad software. The accuracy was evaluated in different regions (anterior, middle, and posterior) and compared between PET-G and PMMA materials. Retention: The retention of the molding plates was measured using a digital force gauge, which recorded the force required to dislodge the plates from the infant's mouth. The retention was compared between PET-G and PMMA materials, as well as the effect of adhesive addition on retention. Overall adaptation; PET-G plates showed a significantly smaller gap (mean= 0.264 ±0.106) compared to PMMA (mean= 0.362 ±0.130). Region-specific adaptation: PET-G plates demonstrated better accuracy in all regions (means of anterior =0.246, middle =0.262, posterior =0.282 µm). Significant differences in accuracy were observed in the middle and posterior regions compared to PMMA. Retention assessment revealed that the PET-G groups (with or without adhesive) exhibited significantly higher retention compared to the PMMA groups (P<0.01).

CONCLUSION

PET-G plates demonstrated superior accuracy and retention compared to PMMA, with a significant difference observed in both accuracy and retention. Furthermore, the addition of denture adhesive had a positive effect on retention for both materials.

The Perception and Experience of Parents of Children with Cleft Lip and Palate Concerning the Use Pre-Surgical Infant Orthopedics: A Questionnaire-Based Cross-Sectional Survey

Background: A transitory period prior to the surgical correction of cleft lip and palate (CLP) is associated with adverse impacts, which may require a medical intervention. Pre-surgical infant orthopedics (PSIO) is deemed to reduce the functional and psychological burden, offering a transition until the definite surgical intervention. Aim: To assess the attitude of Iraqi mothers concerning the application and management of pre-surgical orthopedic appliances in children with cleft lip and palate, taking consideration of the mothers’ occupational status. Methods: The cross-sectional study was conducted in the College of Dentistry at Baghdad University from 5 January 2020 to 4 December 2021. A questionnaire form was validated based on existing data related to the assessment of parents’ satisfaction concerning PSIO. Results: A concern related to the impression procedure was reported by a minority of the participants (6.8%) and it was associated mainly to the perceptions of housewives’ vs. working mothers (p < 0.05). The perceived infants’ discomfort during the impression procedure reported at 11.9% was significantly associated with housewives’ status (p < 0.05). In general, the vast majority of respondents considered the impression as being non-invasive (96.6%). Most mothers found no difficulties in following the instructions of the specialist regarding the insertion of the PSIO and/or taping the elastic bands (62.7%). Respondents believed that CLP infants routinely require PSIO treatment. Interestingly, only a minority of mothers performed an Internet search to look for information about PSIO (7%). The majority indicated the PSIO treatment as beneficial for their infant and a substantial proportion of respondents were satisfied with the outcomes of PSIO, encouraging other parents to consent the PSIO treatment. Conclusion: In general, mothers broadly acknowledged the primary concept of PSIO and accepted the proposed treatment, with a positive attitude towards pre-surgical CLP management, regardless their socio-economic status. They seemed to understand well the expected benefits of PSIO, including feeding improvement, normalization of speech, and optimization of future surgical outcomes.

Virtual Reality as parent education tool in pre-surgical management of cleft lip and palate affected infants-A pilot study

AIM

To assess the influence of virtual reality (VR) in parent acceptance of the pre-surgical nasoalveolar molding (PNAM) as a pre surgical care to the cleft lip and palate affected infants.

MATERIAL AND METHODS

Descriptive Cross sectional pilot study design was planned to assess the pre surgical management of the cleft lip and palate. Twenty parents/caregivers of the infants were randomly divided into two groups. Twelve participants received education through conventional education module (Group I) using verbal explanation supported by the photographs. Another 12 participants received education through customized VR based educational video (Group II). After the education, the parents were provided with questionnaire to assess the acceptance of the treatment procedure. The survey response rate was represented in percentage.

RESULTS

The results of the study indicated that most of the parents were aware of the feeding plate or obturators as an aid in assisting feeding practices among cleft lip and palate affected infants. However, only 33% of participants in Group I were able to understand the doctor's explanation regarding the PNAM whereas 100% of participants in Group II were able to visualize the benefits of PNAM. These participants were willingly accepting PNAM as essential pre-surgical care.

CONCLUSION

Innovative approaches are essential in patient education modalities as the success of any treatment outcome largely depends on the patient acceptance. Within the limits of this study, VR has been successful in the educating the parents and caregivers regarding the acceptance of PNAM therapy in cleft affected infants.