Identification of a de novo PUF60 variant associated with craniofacial microsomia

Craniofacial microsomia (CFM), also known as the oculo-auriculo-vertebral spectrum, is a congenital disorder characterized by hypoplasia of the mandible and external ear due to tissue malformations originating from the first and second branchial arches. However, distinguishing it from other syndromes of branchial arch abnormalities is difficult, and causal variants remain unidentified in many cases. In this report, we performed an exome sequencing analysis of a Brazilian family with CFM. The proband was a 12-month-old boy with clinical findings consistent with the diagnostic criteria for CFM, including unilateral mandibular hypoplasia, microtia, and external auditory canal abnormalities. A heterozygous de novo nonsense variant (c.713C>G, p.S238*) in PUF60 was identified, which was predicted to be pathogenic in silico. PUF60 has been reported as a causal gene in Verheij syndrome, but not in CFM. Although the boy showed craniofacial abnormalities and developmental delay that overlapped with Verheij syndrome, the facial asymmetry with unilateral hypoplasia of the mandible observed in this case did not match the previously reported phenotypes of PUF60 variants. Our findings expand the phenotypic range of PUF60 variants that cover CFM and Verheij syndrome.

Robin Sequence Facial Profile After Conservative Treatment: A Long-Term Follow-Up

INTRODUCTION

Robin sequence (RS) is a congenital clinical condition characterized by micrognathia, glossoptosis, and respiratory distress. Conservative methods could be responsible for releasing feeding and respiratory impairment but little information about mandibular growth is known in long-term follow-up.

OBJECTIVE

Assessing the longitudinal behavior of the facial profile of individuals with isolated RS who underwent conservative micrognathia treatment using photographs during the whole craniofacial growth.

METHODS

Photographs of the right facial profile of 100 patients were used (50 individuals with isolated RS and 50 individuals without craniofacial anomaly). The individuals with RS were evaluated at 3 different times (T1: infant, T2: mixed dentition, T3: permanent dentition) by measuring the facial convexity angle (FCA; G.Sn.Pog´). A comparison between T3 and control group (C), individuals without craniofacial anomalies and in permanent dentition, was also performed, checking the FCA, nasolabial angle (Ls.Sn.Cm), mentolabial fold (Li.Si.Pog´), facial inferior third (Sn.Gn´.C) angles and the ratio between middle anterior facial height and lower anterior facial height.

RESULTS

The T3 group showed an increased angle of facial convexity and increased facial inferior third angle and middle anterior facial height/lower anterior facial height ratio compared with the control group. In the longitudinal evaluation of individuals with isolated RS, significant differences were identified between T1 and T2 groups and T1 and T3 groups showing that the increased facial convexity was higher in the infants and that did not change significantly between the phases of mixed and permanent dentition.

CONCLUSIONS

RS showed increased facial convexity in all phases evaluated, but their convexity decreased with growth. When compared with individuals without craniofacial anomalies, the individuals continue to exhibit retrognathism in the permanent dentition. The lack of a mandible projection has led to a considerable number of orthognathic surgeries for the correction of discrepancies.

Core outcomes for orofacial clefts: reconciling traditional and ICHOM minimum datasets

OBJECTIVE/DESIGN/SETTING

This retrospective study sought voluntary participation from leading cleft centres from Europe and Brazil regarding core outcome measures. The results of this study would inform the debate on core outcome consensus pertaining to the European Reference Network for rare diseases (ERN CRANIO) and achieve a core outcome set for cleft care providers worldwide.

INTERVENTION/METHOD

Five orofacial cleft (OFC) disciplines were identified, within which all of the International Consortium of Health Outcomes Measurement (ICHOM) outcomes fall. One questionnaire was designed for each discipline and comprised 1. the relevant ICHOM's outcomes within that discipline, and 2. a series of questions targeted to clinicians. What core outcomes are currently measured and when, did these align with the ICHOM minimum, if not how did they differ, and would they recommend modified or additional outcomes?.

RESULTS

For some disciplines participants agreed with the ICHOM minimums but urged for earlier and more frequent intervention. Some clinicians felt that some of the ICHOM standards were compatible but that different ages were preferred and for others the ICHOM standards were acceptable but developmental stages should be preferred to absolute time points.

CONCLUSION/IMPLICATIONS

Core outcomes for OFC were supported in principle but there are differences between the ICHOM recommendations and the 2002 WHO global consensus. The latter are established in many centres with historical archives of OFC outcome data, and it was concluded that with some modifications ICHOM could be moulded into useful core outcomes data for inter-centre comparisons worldwide.

Growth Outcomes Audit for Unilateral Cleft Lip and Palate (UCLP) After 2-stage Palate Repair

PURPOSE

To assess the impact of 1 and 2-stage palatoplasty protocol on the dental arch relationships in unilateral cleft lip and palate (UCLP) in a single center.

METHODS

Our study consisted of 349 individuals divided into 2 groups according to the palatoplasty protocol. Two-stage group comprised 169 subjects with UCLP (mean age: 6.9 y, 110 male and 59 female) who underwent lip, nasal ala, and anterior palate repair with vomer flap from 3 to 6 months (first surgery stage). Soft palate repair occurred from 12 to 18 months (second surgery stage). The one-stage group comprised 180 subjects with UCLP (mean age: 7.2 y, 108 male and 72 female) who underwent 1-stage palatoplasty. Dental models were evaluated by 3 experienced orthodontists applying Goslon Yardstick and the 5-year-old index (FYOI). The influence of the palatoplasty technique and surgeon factor on the interarch relationship was evaluated. The weighted Kappa was used to assess intraexaminer and interexaminer agreements for comparisons of dental arch relationships. Intergroup comparisons were conducted using the χ 2 test ( P <0.05).

RESULTS

The intraexaminer reliability was very good (0.81 to 0.98) and interexaminer reliability varied from satisfactory to very good (0.56 to 0.83). The mean occlusal index of the 2-stage and 1-stage groups was 2.77 and 3.03, respectively. The variability of the mean index between surgeons varied from 2.38 to 3.2 in the 2-stage group and 2.91 to 3.2 in the 1-stage group. There were significant differences in the frequency of Goslon 5 index ( P =0.002) between groups, with the 2-stage group presenting less cases (1.18%) than the group 1-stage (11.11%).

CONCLUSION

The interarch relationship was similar for both palate repair protocols. Two-stage palatoplasty showed a decreased prevalence of Goslon index 5.

Speech Outcomes Audit for Unilateral Cleft lip and Palate After 2-Stage Palate Repair: Preliminary Results

Primary cleft lip and palate surgeries can interfere with speech status, facial appearance, maxillary growth, and psychosocial and academic development. Therefore, different surgical protocols and techniques have been proposed, and adequate velopharyngeal function and speech is the main goal for the treatment success. The present study aimed to report preliminary speech results of the 2-stage palate repair of children with unilateral cleft lip and palate. One hundred seventy nonsyndromic patients with unilateral cleft lip and palate were included in this report, 35% males and 65% females, submitted to the 2-stage palatoplasty protocol, composed by lip, nasal ala, and hard palate repair at 3 to 6 m (stage 1) and soft palate repair at 12 to 18 m (stage 2). The target age range for speech recording was 5 to 10 years, and the speech material included repetition of Brazilian Portuguese sentences. These samples were obtained over 5 years and assessed by 3 of 14 experienced speech pathologists. When discordant, the majority rate was adopted. Average velopharyngeal dysfunction (VPD) rates were 19,5%, varying according to the soft palate technique, with better results when the Sommerlad technique was performed (VPD=11%), followed by Braithwaite (VPD=15%) and then Von Langenbeck (VPD=25%). Passive errors were observed in 32% and active errors in 25%. Speech results reflect the outcomes of an interdisciplinary team's work, where facial growth and nasolabial appearance must also be considered. Further analysis and a wider casuistic are recommended. Hence outcomes audit needs to be a permanent process, providing solid and updated evidence for optimal cleft care.

Evaluation of Radiographic Outcomes of Alveolar Graft Associated with Premaxillary Osteotomy Performed with rhBMP-2

OBJECTIVE

To evaluate the influence of filling material and timing of surgery on radiograph outcomes of alveolar grafting with premaxillary osteotomy. The null hypothesis was that radiographic outcomes would be similar with both rhBMP-2 (rhBMP-2G) and cancellous bone from the iliac crest (IG), regardless of the timing of surgery.

DESIGN

Cross-sectional study with consecutive sampling of 56 periapical or occlusal radiographs taken 12 months after surgery.

SETTING

A single tertiary craniofacial center.

PATIENTS/PARTICIPANTS

Twenty-eight patients with complete bilateral cleft lip and palate and mean age of 13 years. The individuals underwent bilateral alveolar grafting associated with premaxillary osteotomy (AG + PO) with rhBMP-2 or cancellous bone from the iliac crest.

INTERVENTIONS

Experienced maxillofacial surgeons used the same surgical technique in both groups. AG + PO were assigned as success or failure by 3 blinded raters based on modified Bergland and SWAG scales.

MAIN OUTCOME MEASURES

The influence of filling materials and timing of surgery on radiographic outcomes was verified by Fisher's exact test and chi-square test (P < .05).

RESULTS

There was no significance variation between the mean age of participants in the rhBMP-2G and IG (P = .471). Scales showed almost perfect reliability (agreement rate = 96.4%; K = 0.85). rhBMP-2G and IG had similar success rates with modified Bergland scale (85.7% and 82.1%) and SWAG scale (92.9% and 82.1%), respectively. However, only modified Bergland scale found influence of age on radiographic outcomes (P = .025).

CONCLUSIONS

AG + PO performed with rhBMP-2 and iliac crest bone showed similar radiographic success rates, regardless of the timing of surgery.

Outcomes of permanent canines on the cleft side after secondary alveolar grafting using different materials in complete unilateral cleft lip and palate

The prevalence of impaction of the permanent canine on the cleft side (PCCS) ranges from 12-35% after alveolar bone grafting (ABG). PCCSs usually develop above other permanent teeth in the alveolar process, gradually becoming vertical until they reach the occlusal plane. The type of cleft, hypodontia of lateral incisor on the cleft side, slower PCCS root development, and genetic factors are predictors of impaction and/or its ectopic eruption. To compare the behavior of PCCS in individuals with complete unilateral cleft lip and palate (UCLP) subjected to secondary alveolar grafting (SAG) with different materials. This retrospective longitudinal study analyzed 120 individuals undergoing SAG with iliac crest bone, rhBMP-2, and mandibular symphysis. The individuals were selected at a single center and equally divided into three groups. Panoramic radiographs were analyzed by the Dolphin Imaging 11.95 software to measure PCCS angulation and PCCS height from the occlusal plane at two different timepoints. No statistical significance was found between grafting materials (P=0.416). At T1, the PCCS height from the occlusal plane was greater for rhBMP-2 and mandibular symphysis compared to iliac crest bone. The lateral incisor on the cleft side was not related to success or lack of eruption of PCCS (P=0.870). Impaction rates of PCCS were similar for the materials studied. Absence of the lateral incisor on the cleft side did not prevent spontaneous eruption of PCCSs.

Late alveolar bone grafting in complete unilateral cleft lip and palate (UCLP): Biomechanical considerations for the success of orthodontic finishing

Orthodontic treatment in patients with cleft lip and palate (CLP) is challenging. Alignment of the maxillary segments and orthodontic levelling of the teeth adjacent to the cleft area are important before alveolar bone grafting (ABG), in the permanent dentition. In this clinical report, orthodontic procedures, before and after late ABG, are described as an alternative that can optimise the orthodontic and periodontal results. The gingival margins of the teeth adjacent to the cleft area were levelled. Root divergence was corrected. Interdental papilla and improvement of the periodontal condition were obtained.

Cephalometric predictors of hypernasality and nasal air emission

BACKGROUND

During times of increasingly recognized importance of interprofessional practices, professionals in Medicine, Dentistry, and Speech Pathology areas cooperate to optimize treatment of velopharyngeal dysfunction (VPD), after primary palatoplasty for correction of cleft palate.

OBJECTIVE

Our study aims to compare velar length, velar thickness, and depth of the nasopharynx of patients with unilateral cleft lip and palate (UCLP) with the presence, or absence, of hypernasality and nasal air emission; and to verify if the depth:length ratio, between nasopharynx and velum, would be predictive of consistent hypernasality and nasal air emission (speech signs of VPD).

METHODOLOGY

Cephalometric radiographs and outcome of speech assessment were obtained from 429 individuals, between 6 and 9 years of age, with repaired unilateral cleft lip and palate. Velar length, velar thickness, depth of the nasopharynx, depth:length ratio, scores of hypernasality, and scores of nasal air emission were studied and compared; grouping the radiographs according to presence or absence of hypernasality and nasal air emission.

RESULTS

For the group with speech signs of velopharyngeal dysfunction (those with consistent hypernasality and nasal air emission), the velums were shorter and thinner; the nasopharynx was deeper and the depth:length ratio was larger than the group without hypernasality and nasal air emission. Velar length was significantly shorter in individuals with consistent hypernasality and nasal air emission (p<0.001) and with history of palatal fistula (p=0.032). Depth of nasopharynx was significantly greater in individuals with consistent hypernasality and nasal air emission (p<0.001). Depthlength ratio was significantly larger in individuals with consistent hypernasality and nasal air emission (p<0.001). A depth:length ratio larger than 0.93 was always associated with speech signs of VPD.

CONCLUSION

Estimated with cephalometric radiographs, a depth:length ratio greater than 0.93, between the nasopharyngeal space and the velum, was 100% accurate in predicting hypernasality and nasal air emission after primary repair of unilateral cleft lip and palate.

A Cleft-Customized Occlusal Rating System to Assess Orthodontic Occlusal Improvement in Patients With Unilateral Cleft Lip and Palate

Objective:

This study aimed to develop a new method to quantify occlusal improvement in patients with unilateral cleft lip and palate (UCLP) who had undergone orthodontic treatment and to evaluate its reproducibility.

Design:

A panel of orthodontists decided on the relevance of different occlusal features to score initial and final 3-dimensional study models and panoramic radiographs. A subsequent subjective analysis was later performed by a local orthodontic panel.

Setting:

The sample was obtained from the orthodontic clinical archives of a hospital known for the treatment of patients with craniofacial differences.

Patients:

Thirty-one nonsyndromic patients, 17 males and 14 females, were randomly selected according to preestablished inclusion/exclusion criteria.

Interventions:

The records corresponded to the period during which the patients were treated with conventional multibracket mechanics and adjunctive restorative procedures.

Main Outcome/Measures:

The intraclass correlation coefficient measured intraexaminer and interexaminer agreements. The Spearman correlation test assessed the relationship between the local orthodontic panel perception and the improvement scores.

Results:

Inter- and intra-rater ICCs varied between fair/good to excellent. There was a strong correlation between the Cleft-Customized Occlusal Rating system classification of occlusal improvement and the local orthodontic panel’s perception, thereby enabling the utilization of the interpretation scale by the panel.

Conclusions:

The method showed to be a useful tool in quantifying and classifying occlusal improvement in this specific population. As any other method, some limitations apply and need to be accounted for.

Influence of surgical technique and timing of primary repair on interarch relationship in UCLP: A randomized clinical trial

OBJECTIVE

To compare dental arch relationships in children with unilateral cleft lip and palate (UCLP) between two surgical techniques for repair of cleft lip/palate and two ages of palate repair.

SETTINGS AND SAMPLE

Dental models were taken for a group of 448 subjects at a mean age of 7 years and were evaluated by means of the Goslon Yardstick. The patients studied consisted of an initial group of 673 infants with complete UCLP randomized into 8 study groups according to lip repair procedures (Millard versus Spina techniques); palate repair procedures (von Langenbeck versus Furlow techniques); and palate repair timing (early: 9 to 12 months versus late: 15-18 months).

METHODS

Four surgeons performed all surgeries. Dependent variables included the following: lip repair technique, palate repair technique, age at time of palate repair and surgeon; with sex as an independent variable. The data were analysed using a general linear model (P < .05).

RESULTS

There were no significant differences for occlusal index scores as a function of lip or palate surgical technique, palatal repair timing and sex. Significant differences were found for occlusal index scores as a function of the surgeon.

CONCLUSION

Dental arch relationships were not influenced by lip and palatal repair techniques or patient age at palatal repair. The surgeon was the major factor that influenced the dental arch relationship outcome.

Influence of bone-anchored maxillary protraction on secondary alveolar bone graft status in unilateral complete cleft lip and palate

INTRODUCTION

Our objective was to evaluate the effects of bone-anchored maxillary protraction (BAMP) on the status of the secondary alveolar bone graft in patients with unilateral complete cleft lip and palate (UCLP).

METHODS

The experimental group (EG) comprised 26 patients with UCLP, mean age of 11.9 years, submitted to secondary alveolar bone grafting (SABG) with recombinant bone morphogenetic protein, and BAMP therapy, using miniplate-borne Class III intermaxillary elastics. Cone beam computed tomography (CBCT) examinations were taken 6 months after SABG and before BAMP (T1) and after 18 months of BAMP therapy (T2). The control group (CG) was composed of 24 patients with UCLP submitted only to SABG with recombinant bone morphogenetic protein or autogenous bone from iliac crest without BAMP therapy, matched by initial age and sex with the EG. In the CG, CBCT examinations were performed 6 months (T1) and 12 months (T2) after SABG surgery. CBCT axial sections were analyzed using Garib scores in both time points. Intra- and intergroup comparisons were performed using Wilcoxon and Mann-Whitney tests, respectively (P <0.05).

RESULTS

No intergroup differences were found at T1 and T2. The EG showed significant improvement of graft status from T1 to T2 at the cervical and middle levels of the alveolar cleft. No significant interphase differences were found for graft scores in the CG.

CONCLUSIONS

Despite loads of intermaxillary elastics applied to the maxilla, no harm to the grafted alveolar bone was observed after BAMP therapy in patients with UCLP.

Outcomes of Alveolar Graft With Rhbmp-2 in CLP: Influence of Cleft Type and Width, Canine Eruption, and Surgeon

OBJECTIVE

To evaluate the influence of cleft type and width, canine eruption stage, and surgeon on the outcomes of alveolar graft with rhBMP-2.

DESIGN

Cross-sectional.

SETTING

Tertiary craniofacial center.

PARTICIPANTS

Ninety individuals submitted to alveolar graft in late mixed or early permanent dentition.

INTERVENTIONS

The 90 individuals (mean age: 16.8 years) were submitted to alveolar graft with rhBMP-2. Periapical radiographs were obtained before and 6 months after surgery. Surgeries were performed by 4 experienced maxillofacial surgeons. The alveolar grafts were assigned as success or failure by 3 blinded raters based on the modified Bergland and Chelsea scales. Permanent canines adjacent to the defect were assigned as erupted and not erupted. The greatest cleft width was measured on preoperative periapical radiographs.

MAIN OUTCOME MEASURES

The influence of 4 independent variables (cleft type, cleft width, canine eruption phase, and surgeon) on the outcome of alveolar graft was analyzed by multivariate logistic regression ( P < .05).

RESULTS

All independent variables presented significant influence on alveolar graft outcome. The subgroup of unerupted maxillary canines demonstrated better outcomes than erupted canines ( P = .001). The group with cleft lip and alveolus (CL/A) demonstrated better outcomes than complete cleft lip and palate (CLP; P < .001). The greater the alveolar cleft width, the less favorable were the graft outcomes ( P = .027). The surgeon also had a significant influence on the surgery success ( P = .003 and .001).

CONCLUSION

The type and width of CLP, the eruption of permanent canines, and the surgeon influenced the outcome of alveolar graft surgeries performed with rhBMP-2.

Facial and Nasolabial Aesthetics of Complete UCLP Submitted to 2-Stage Palate Repair With Vomer Flap

OBJECTIVE

To evaluate the aesthetics of nasolabial appearance and facial profile of children with unilateral cleft lip and palate (UCLP) submitted to 2-stage palate repair with vomerine flap.

DESIGN

Retrospective.

SETTING

Single center.

PATIENTS

Forty patients with UCLP, mean age of 7.81 years of both sexes, rehabilitated at a single center by 1 plastic surgeon.

INTERVENTIONS

Lip and anterior palate repair with nasal alar repositioning was performed at 3 to 6 months of age by Millard technique and vomer flap, respectively. Posterior palate was repaired at 18 months by Von Langenbeck technique.

MAIN OUTCOME MEASURE(S)

Four cropped digital facial photographs of each patient were evaluated by 3 orthodontists to score the nasolabial aesthetics and profile. Frequencies of each score as well means and medians were calculated. Kappa test was used for evaluating inter- and intrarater reproducibility.

RESULTS

The nasal form and deviation was scored as good/very good in 70%, fair in 22.5%, and poor in 7.5% of the sample. The nasal-subnasal aesthetic was considered good/very good in 55%, fair in 30%, and poor in 15% of the sample. The lip vermilion border and the white part of surgical scar aesthetics were good/very good in 77.5% and 80%, fair in 17.5% for both categories, and poor in 5% and 2.5% of the cases, respectively. In all, 67.5% showed convex facial profile, 20% was straight, and 12.5% was concave profile.

CONCLUSIONS

Two-stage palatoplasty presented an adequate aesthetical results for the majority of patients with UCLP in the mixed dentition.

Dual embryonic origin of maxillary lateral incisors: clinical implications in patients with cleft lip and palate

Introduction:

Cleft lip and palate are craniofacial anomalies highly prevalent in the overall population. In oral clefts involving the alveolar ridge, variations of number, shape, size and position are observed in maxillary lateral incisors. The objective of this manuscript is to elucidate the embryonic origin of maxillary lateral incisors in order to understand the etiology of these variations.

Contextualization:

The hypothesis that orofacial clefts would split maxillary lateral incisor buds has been previously reported. However, recent studies showed that maxillary lateral incisors have dual embryonic origin, being partially formed by both the medial nasal process and the maxillary process. In other words, the mesial half of the lateral incisor seems to come from the medial nasal process while the distal half of the lateral incisor originates from the maxillary process. In cleft patients, these processes do not fuse, which results in different numerical and positional patterns for lateral incisors relating to the alveolar cleft. In addition to these considerations, this study proposes a nomenclature for maxillary lateral incisors in patients with cleft lip and palate, based on embryology and lateral incisors position in relation to the alveolar cleft.

Conclusion:

Embryological knowledge on the dual origin of maxillary lateral incisors and the use of a proper nomenclature for their numerical and positional variations renders appropriate communication among professionals and treatment planning easier, in addition to standardizing research analysis.

Evaluation of secondary alveolar bone grafting outcomes performed after canine eruption in complete unilateral cleft lip and palate

OBJECTIVES

Evaluate the results of secondary alveolar bone grafting (SABG) in patients with complete unilateral cleft lip and palate (UCLP), operated after permanent canine eruption (CE).

MATERIALS AND METHODS

Seventy-four periapical radiographs from patients with complete UCLP (mean age 14 years) submitted to SABG were retrospectively analyzed for the amount of bone in the cleft site through the Bergland and Chelsea scales.

RESULTS

Of the cases, 47.3 % was classified as Bergland type I and Chelsea type A, 35.2 % as type II/C, 6.7 % as type III/D, and 10.8 % as type IV/failure. When the canine was moved into the grafted area, the success rate (type I/A) was 56.8 %; for cases in which the space was maintained for an implant or prosthetic finishing, the index was 45.8 %; however, this difference was not statistically significant.

CONCLUSION

Even in advanced ages, after permanent canine eruption, SABG can be considered a highly successful procedure.

CLINICAL RELEVANCE

This research shows good results of secondary alveolar bone grafting performed in patients with unilateral complete cleft lip and palate, even when it was performed after eruption of the permanent canine in the cleft area.

Prevalence of mesiodens in orthodontic patients with deciduous and mixed dentition and its association with other dental anomalies

OBJECTIVE

To determine the prevalence of mesiodens in deciduous and mixed dentitions and its association with other dental anomalies.

MATERIAL AND METHODS

Panoramic radiographs of 1,995 orthodontic patients were analyzed retrospectively, obtaining a final sample of 30 patients with mesiodens. The following aspects were analyzed: gender; number of mesiodens; proportion between erupted and non-erupted mesiodens; initial position of the supernumerary tooth; related complications; treatment plan accomplished; and associated dental anomalies. The frequency of dental anomalies in the sample was compared to reference values for the general population using the chi-square test, with a significance level set at 5%.

RESULTS

The prevalence of mesiodens was 1.5% more common among males (1.5:1). Most of the mesiodens were non-erupted (75%) and in a vertical position, facing the oral cavity. Extraction of the mesiodens was the most common treatment. The main complications associated with mesiodens were: delayed eruption of permanent incisors (34.28%) and midline diastema (28.57%). From all the dental anomalies analyzed, only the prevalence of maxillary lateral incisor agenesis was higher in comparison to the general population.

CONCLUSIONS

There was a low prevalence of mesiodens (1.5%) in deciduous and mixed dentition and the condition was not associated with other dental anomalies, except for the maxillary lateral incisor agenesis.

Are there bone dehiscences in maxillary canines orthodontically moved into the grafted alveolar cleft?

INTRODUCTION

The aim of this study was to assess the bone morphology of teeth mesialized into the grafted region in patients with unilateral alveolar cleft.

METHODS

The sample comprised 30 patients with unilateral cleft lip and palate with a mean age of 20.5 years. High-resolution cone-beam computed tomography images of the maxilla were obtained 6 months to 2 years after comprehensive orthodontic treatment. The contralateral canines and lateral incisors were used as controls. Axial section was used to measure the bone thickness, and cross section was used to measure the alveolar crest height using the cementoenamel junction as a reference. Paired t tests and Wilcoxon tests were used to compare the cleft and noncleft sides (P <0.05).

RESULTS

High individual variability was found. In general, the canines in the cleft side had statistically thinner buccal bone plates than the contralateral teeth. No differences between the cleft and noncleft sides were found for the lingual bone plate thickness. The canine on the cleft side showed a slightly greater distance between the lingual alveolar crest and the cementoenamel junction than the lateral incisor in the noncleft side.

CONCLUSIONS

In patients with unilateral cleft lip and palate, mesial orthodontic movement of the maxillary canines into the grafted alveolar cleft results in acceptable buccal and lingual periodontal morphology.

Reconstruction of alveolar cleft with allogenous bone graft: clinical considerations

INTRODUCTION: Secondary bone grafting consists in a routine procedure on the treatment of patients with alveolar cleft. Usually, it is performed by the end of the mixed dentition, when the permanent canine is erupting, with autogenous cancellous bone from the iliac crest. OBJECTIVE: The present article discusses the alternative of autogenous bone grafting with allogeneic bone, obtained from human bone bank, illustrating the result with the presentation of a clinical case of left unilateral alveolar cleft.

Facial growth evaluation of complete unilateral cleft lip and palate operated patients: a cleft reference center in Paraíba, Brazil, using the "GOSLON" yardstick

OBJECTIVES

To evaluate the surgical outcomes of patients with complete unilateral cleft lip and palate (CUCLP) operated on by a single surgeon of the cleft reference center of the Lauro Wanderley University Hospital at the Federal University of Paraiba.

METHODS

Forty-four individuals' dental casts diagnosed with CUCLP, born between 1995 and 2002, mean age of 11 years, were evaluated by three calibrated orthodontic specialists and scored by the Great Ormond Street, London and Oslo (GOSLON) yardstick on two occasions. The scores were compared with those observed in other centers around the world. The Kappa test was applied to evaluate the intra- and inter-examiner agreement. Descriptive statistics was applied for the GOSLON yardsticks core.

RESULTS

The mean GOSLON score was 2.75. For the GOSLON yardstick, 43.2 % of the sample presented scores 1 and 2, 31.8 % had score 3, and 25 % were with scores 4 and 5. There was very good intra- and inter-examiner Kappa agreement in the application of the GOSLON yardstick.

CONCLUSIONS

The data suggest favorable outcomes, with 75 % of cases with no need of orthognathic surgery. The Kappa values confirmed the high reproducibility of the GOSLON yardstick.

Orthodontic treatment in adults: restoring smile esthetics

INTRODUCTION: The search for orthodontic treatment by adult patients is increasing. This demand may be explained by many reasons, but the most important was the change in the concept of normality, allowing the selection of simpler and more conservative and consistent therapeutic objectives. This conceptual evolution, combined with the technological advances allowed an improvement in orthodontic management, making it more effective, fast and comfortable. The promotion of awareness of the society on the advantages of this treatment and the increase in esthetic demands, with an increasingly longer and active social, affective and professional life, creates a context in which the need for Orthodontics is absolutely established for the adult individuals. OBJECTIVE: The objective of this article is to report the nuances in diagnosis and orthodontic treatment of an adult patient, in a different perspective. Within this approach, the objective is to recover the shape, i.e. to establish occlusal conditions that would probably be present if the patient had been assisted at the proper time, namely during growth and tooth irruption.

Facial Profile Evaluation of Isolated Pierre Robin Sequence

Objective

To evaluate numerically the facial profile of children with isolated Pierre Robin sequence (PRS) and to compare them with a control group that has no pathologies and exhibits regular and balanced facial growth, with no skeletal alterations.

Patients

Eighty-three children aged 5 to 10 years (PRS group, n = 60; control group, n = 23) were selected.

Setting

Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo (HRAC-USP). Children from the control group were taken from the program of Interceptive Orthodontics at HRAC-USP.

Design

Angular and ratio analyses of the facial profiles in both groups were realized through digital photographs. The PRS group was subdivided into two groups—complete and incomplete—according to the sagittal extension of the cleft palate, to investigate the possible influence of cleft extension on the face.

Results

The facial convexity angle and the facial inferior third angle were considerably higher in the PRS groups than in the control group and were not significantly different between PRS groups. Nasolabial angle did not differ between groups.

Conclusion

The facial profile was more convex in individuals with PRS than in those with regular facial growth and with no pathology. The mandible was responsible for the convexity of the profile in PRS because of its lack off anterior projection. An important relationship between the extension of the cleft palate and alterations in facial profile in PRS was not observed.

Bracket/wire play: what to expect from tipping prescription on pre-adjusted appliances

INTRODUCTION: The opinion on the 'straight-wire' concept has been evolving since its origin, characterized by faithful followers or absolute skepticism. Currently, it seems reasonable to state that most professionals have a more realistic and critical viewpoint, with an attitude that reveals Orthodontics' maturity and greater knowledge on the technique. The most relevant criticisms refer to the impossibility of the both the Straight-Wire and the Standard systems to completely express the characteristics related to the brackets due to mechanical deficiencies, such as bracket/wire play. OBJECTIVES: A critical analysis of this relationship, which is unclear due to lack of studies, was the scope of this paper. METHODS: The compensatory treatment of two patients, using Capelozza's individualized brackets, works as the scenery for cephalometric evaluation of changes in incisor inclination produced by different dimensions of leveling archwires. RESULTS: The evaluation of these cases showed that, while the introduction of a 0.019 x 0.025-in stainless steel archwire in a 0.022 x 0.030-in slot did not produce significant changes in incisor inclination, the 0.021 x 0.025-in archwire was capable of changing it, mainly in mandibular incisors, and in the opposite direction to the compensation. CONCLUSION: Considering compensatory treatments, even when using an individualized prescription according to the malocclusion, the bracket/wire play seems to be a positive factor for malocclusion correction, without undesirable movements. Therefore, it seems reasonable to admit that, until a bracket system can have absolute individualization, the use of rectangular wires that still have a certain play with the bracket slot is advisable.

Relationship between Occlusion and Lisping in Children with Cleft Lip and Palate

Introduction

The literature suggests that individuals with history of cleft lip and palate who present with midfacial growth deficiency are at higher risk of presenting lisping. The relationship between distortions during production of linguoalveolar fricative sounds and the severity of malocclusion, however, has not been established for the population with cleft.

Objective

To study the association between lisping and dental arch relationship.

Methodology

Speech samples and dental arch casts were obtained from 106 children with operated unilateral cleft lip and palate (UCLP) during the stage of mixed dentition and before orthodontic treatment. Videotaped productions of the phrase lu saci saiw sedul were rated by speech-language pathologists for the identification of lisping during [s]. Dental arch casts were rated by orthodontists using the Goslon Yardstick and the Five-Year Index to establish dental arch relationship.

Results

Multiple logistic regression showed no significant association between lisping and dento-occlusal index ( p = .802) and age ( p = .662). Substantial interjudge agreement during auditory-perceptual ratings was found (kappa = .63). Almost perfect agreement was found between orthodontists while establishing the dental arch relationship (kappa = .81).

Discussion

This study failed to reveal an association between lisping and dental arch relationship in children with operated UCLP. Multiple variables may play a role in determining occurrence of lisping, warranting further investigation.

Alveolar bone morphology in patients with bilateral complete cleft lip and palate in the mixed dentition: cone beam computed tomography evaluation

OBJECTIVES

To verify the thickness and level of alveolar bone around the teeth adjacent to the cleft by means of cone beam computed tomography (CBCT) in patients with complete bilateral cleft lip and palate prior to bone graft surgery and orthodontic intervention.

METHOD

The sample comprised 10 patients with complete bilateral cleft lip and palate (five boys and five girls) in the mixed dentition. The mean age was 9.5 years, and all subjects showed a G3 interarch relationship according to the Bauru index. The thickness of alveolar bone surrounding the maxillary incisors and the maxillary canines was measured in CBCT axial section using the software iCAT Xoran System. The distance between the alveolar bone crest and the cement-enamel junction (CEJ) was measured in cross sections.

RESULTS

The tomography images showed a thin alveolar bone plate around teeth adjacent to clefts. No bone dehiscence was observed in teeth adjacent to clefts during the mixed dentition. A slight increase in the distance between the alveolar bone crest and the CEJ was observed in the mesial and lingual aspects of canines adjacent to cleft.

CONCLUSION

In patients with BCLP in the mixed dentition, teeth adjacent to the alveolar cleft are covered by a thin alveolar bone plate. However, the level of alveolar bone crest around these teeth seems to be normal, and no bone dehiscence was identified at this age.

A New Yardstick for Rating Dental Arch Relationship in Patients with Complete Bilateral Cleft Lip and Palate

Objective

To develop yardsticks for assessment of dental arch relationship in young individuals with repaired complete bilateral cleft lip and palate appropriate to different stages of dental development.

Participants

Eleven cleft team orthodontists from five countries worked on the projects for 4 days. A total of 776 sets of standardized plaster models from 411 patients with operated complete bilateral cleft lip and palate were available for the exercise.

Statistics

The interexaminer reliability was calculated using weighted kappa statistics.

Results

The interrater weighted kappa scores were between .74 and .92, which is in the “good” to “very good” categories.

Conclusions

Three bilateral cleft lip and palate yardsticks for different developmental stages of the dentition were made: one for the deciduous dentition (6-year-olds’ yardstick), one for early mixed dentition (9-year-olds’ yardstick), and one for early permanent dentition (12-year-olds’ yardstick).

Evaluation of maxillary alveolar reconstruction using a resorbable collagen sponge with recombinant human bone morphogenetic protein-2 in cleft lip and palate patients

INTRODUCTION

A resorbable collagen matrix with recombinant human bone morphogenetic protein (rhBMP-2) was compared with traditional iliac crest bone graft for the closure of alveolar defects during secondary dental eruption.

METHODS

Sixteen patients with unilateral cleft lip and palate, aged 8 to 12 years, were selected and randomly assigned to group 1 (rhBMP-2) or group 2 (iliac crest bone graft). Computed tomography was performed to assess both groups preoperatively and at months 6 and 12 postoperatively. Bone height and defect volume were calculated through Osirix Dicom Viewer (Pixmeo, Apple Inc.). Overall morbidity was recorded.

RESULTS

Preoperative and follow-up examinations revealed progressive alveolar bone union in all patients. For group 1, final completion of the defect with a 65.0% mean bone height was detected 12 months postoperatively. For group 2, final completion of the defect with an 83.8% mean bone height was detected 6 months postoperatively. Dental eruption routinely occurred in both groups. Clinical complications included significant swelling in three group 1 patients (37.5%) and significant donor-site pain in seven group 2 patients (87.5%).

CONCLUSIONS

For this select group of patients with immature skeleton, rhBMP-2 therapy resulted in satisfactory bone healing and reduced morbidity compared with traditional iliac crest bone grafting.

Morfologia alveolar sob a perspectiva da tomografia computadorizada: definindo os limites biológicos para a movimentação dentária

INTRODUÇÃO: a tomografia computadorizada (TC) permite a visualização do osso alveolar que recobre os dentes por vestibular e lingual. OBJETIVO: o propósito deste estudo foi expor e discutir as implicações da morfologia do osso alveolar, visualizado por meio da TC, sobre o diagnóstico e plano de tratamento ortodôntico. MÉTODOS: foram descritas as evidências sobre a inter-relação entre características dentofaciais e a morfologia das tábuas ósseas vestibular e lingual, assim como evidências sobre a repercussão da movimentação ortodôntica sobre o nível e espessura dessas estruturas periodontais. RESULTADOS: pacientes adultos podem apresentar deiscências ósseas previamente ao tratamento ortodôntico, principalmente na região dos incisivos inferiores. Os pacientes com padrão de crescimento vertical parecem apresentar menor espessura das tábuas ósseas vestibular e lingual no nível do ápice dos dentes permanentes, comparados a pacientes com padrão de crescimento horizontal. O movimento dentário vestibulolingual descentraliza os dentes do rebordo alveolar e ocasiona deiscências ósseas. CONCLUSÃO: a morfologia do rebordo alveolar constitui um fator limitante para a movimentação dentária e deve ser considerada, de forma individual, na realização do plano de tratamento ortodôntico.

Anomalias dentárias associadas: o ortodontista decodificando a genética que rege os distúrbios de desenvolvimento dentário

O presente trabalho versa sobre o diagnóstico e a abordagem ortodôntica das anomalias dentárias, enfatizando os aspectos etiológicos que definem tais irregularidades de desenvolvimento. Parece existir uma inter-relação genética na determinação de algumas dessas anomalias, considerando-se a alta frequência de associações. Um mesmo defeito genético pode originar diferentes manifestações fenotípicas, incluindo agenesias, microdontias, ectopias e atraso no desenvolvimento dentário. As implicações clínicas das anomalias dentárias associadas são muito relevantes, uma vez que o diagnóstico precoce de uma determinada anomalia dentária pode alertar o clínico sobre a possibilidade de desenvolvimento de outras anomalias associadas no mesmo paciente ou em outros membros da família, permitindo a intervenção ortodôntica em época oportuna.

Dental arch dimensions in Class II division 1 malocclusions with mandibular deficiency

OBJECTIVE

To test the hypothesis that there is no difference in the dimensions of the upper and lower dental arches in Class II division 1 malocclusion with a mandibular deficiency compared to normal Class I occlusion dental arches.

MATERIALS AND METHODS

Photocopies of the dental arches of 48 patients exhibiting Class II division 1 malocclusion with mandibular deficiency and of 51 individuals with normal occlusion were compared. Mandibular deficiency was diagnosed clinically. All 99 individuals were in the permanent dentition. The ages of the subjects ranged from 11 years 4 months to 20 years (mean age = 12 years 5 months).

RESULTS

When compared to subjects with normal occlusion, the upper dental arches of the Class II division 1 patients presented reduced transverse dimensions and longer sagittal dimensions while the lower arches were less influenced.

CONCLUSION

The hypothesis is rejected. Significant differences are present between the dimensions of the upper and lower dental arches in Class II division 1 malocclusion (with a mandibular deficiency and in the permanent dentition) compared to normal Class I occlusion dental arches.

A influência da queiloplastia realizada em tempo único e em dois tempos cirúrgicos no padrão oclusal de crianças com fissura bilateral completa de lábio e palato

OBJETIVO: analisar a influência da queiloplastia realizada em tempo único e em dois tempos cirúrgicos no padrão oclusal de cirnaças com fissuras bilateral completa de lábio e palato. METODOLOGIA: a relação oclusal, de acordo com o índice Bauru, para a fissura bilateral completa de lábio e palato, foi estudada em uma amostra de 91 crianças nos estágios de dentadura decídua e mista. As crianças apresentavam fissura bilateral completa de lábio e palato e encontravam-se distribuídas na faixa etária compreendida entre 4 anos e 3 meses e 11 anos no momento do exame oclusal. Todas as crianças foram operadas na infância, no Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo (HRAC-USP), obedecendo dois protocolos de queiloplastia primária: 53 crianças foram submetidas à queiloplastia em tempo único (G1) e 38 crianças foram submetidas à queiloplastia em dois tempos cirúrgicos (G2). RESULTADOS E CONCLUSÕES: o padrão oclusal, mensurado com base numa escala de 1 a 5, de acordo com o índice Bauru para fissura bilateral completa de lábio e palato, obteve média de 2,28 e 2,51 para a queiloplastia realizada em tempo único e em dois tempos cirúrgicos, respectivamente. Os resultados permitem concluir que as cirurgias plásticas primárias comprometem a oclusão na dentadura decídua e mista, independentemente do número de etapas para a realização da queiloplastia.

A altura facial anterior inferior nas más oclusões do padrão II, deficiência mandibular

Controvérsias na leitura cefalométrica da AFAi (Altura Facial Anterior inferior) e no diagnóstico clínico baseado na análise facial em casos de más oclusões do padrão II por deficiência mandíbular, motivaram este artigo. Compusemos uma amostra formada por 26 pacientes portadores desta má oclusão, sem distinção de gênero e idade, tratados no curso de especialização da PROFIS do HRAC - USP, Bauru. A amostra foi caracterizada utilizando-se um conjunto de medidas cefalométricas clássicas (SNA, SNB, ANB, NAP, AFAi, SNPO, SNGoGn, CoA, CoGn) e testamos uma forma alternativa para medir a AFAi, onde os pontos espinha nasal anterior (ENA) e mentoniano (Me) foram projetados perpendicularmente a um plano frontal que passa por násio, perpendicular ao plano de Frankfurt (Nperp A) e a distância entre eles medida linearmente. Os resultados foram confrontados com os valores obtidos da medição da AFAi como preconizado por McNamara, em 1984. Encontrou-se uma relação inversa entre a AFAi convencional e a AFAi perpendicular. Esta diferença foi estatisticamente significante para toda a amostra e apresentou alta correlação. A AFAi perpendicular foi sempre menor em toda amostra e exibiu uma tendência de ser tanto menor quanto maior fosse o valor de SNGoGn. Estes achados levaram a crer que a AFAi perpendicular, medida como preconizada neste artigo, torna o triângulo de McNamara mais equilibrado. Isso confere à avaliação cefalométrica a capacidade de identificar a diminuição da AFAi, característica facial típica do portador de deficiência mandibular, além de permitir um entendimento mais claro dos efeitos do tratamento nessa dimensão.

Delayed formation of a lower second premolar

Delayed odontogenesis of a lower second premolar is presented in a case treated without extraction and focuses on the 7-year follow-up of the delayed tooth bud. The follow-up was initiated when the crown formation was diagnosed and was finished when the tooth erupted completely into the orthodontically provided space, which enabled the orthodontic leveling and alignment of the delayed premolar. The long follow-up indicates that delayed tooth buds may develop completely and normally.

Behavior of partially formed roots of teeth submitted to orthodontic movement

The occurrence of root resorption in orthodontically treated permanent incisors with partially formed roots was investigated using periapical radiographs taken before and after the orthodontic leveling in the mixed dentition. The mean age at the beginning of treatment was 9 years and the mean treatment time was 7.1 months. The findings showed that the orthodontic movement during root formation causes no root resorption. The longitudinal follow-up showed that incompletely formed roots developed normally.

Secondary bone graft and eruption of the permanent canine in patients with alveolar clefts: literature review and case report

This paper emphasizes the important role that secondary bone grafting plays on the treatment of patients with alveolar clefts. The authors present a literature review and, based on panoramic radiographs, retrospectively and longitudinally analyze the behavior of permanent canines after completion of secondary bone grafting in 50 patients at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Brazil. Twelve patients with unilateral cleft lip and alveolus and 38 patients with complete unilateral cleft lip and palate (n = 50) had undergone bone grafts to repair their residual alveolar clefts before the eruption of their permanent canines. These patients were observed over an average period of 3 years. In 94% of the sample (47 patients), the permanent canines presented intra-alveolar movement toward the oral cavity. In 72% of those 47 patients (36 patients), the permanent canines spontaneously erupted through the grafted area. In 6% of the 47 patients (3 patients), the permanent canines required orthodontic traction.