Does the rehabilitation treatment predispose the patient with cleft to endodontic treatment?

Aim: to verify the relation between endodontic treatment of teeth adjacent to the cleft area and the rehabilitation of patients with unilateral cleft lip and palate, at the Hospital for Rehabilitation of Craniofacial Anomalies. Methods: the present split-mouth study was composed of 406 individuals with complete unilateral cleft lip and palate who had completed the rehabilitation process in a single tertiary cleft center (55.9% males). The information was collected from the dental history on the patients' records and radiographs. The frequency of endodontic treatment in the upper incisors and canines was calculated for the cleft and non-cleft sides. The comparison between sides was performed by the chi-square test (p <0.05). Results: endodontic treatment was more frequent in teeth adjacent to the cleft than in contralateral teeth. The frequency of endodontic treatment in at least one tooth adjacent to the cleft was 18.97%, and 11.6% on the contralateral side. It was observed that endodontic treatment was necessary in 63.5% of patients who had been submitted to orthodontic treatment, 42.4% of those rehabilitated with fixed partial dentures and 12.0% of patients who underwent dental reshaping of teeth adjacent to the cleft. The treatments performed included vital pulp therapy (46.1%), non-vital pulp therapy (46.8%) and endodontic retreatment (7.1%). Conclusion: in individuals with complete cleft lip and palate, teeth close to the bone defect area and used for rehabilitation treatment presented greater need of endodontic intervention

Higher maternal age is associated with higher occurrence of cleft lip/palate in neonates under intensive care

Aim: To assess the prevalence of cleft lip and/or cleft palate (CL/P) and associated variables in neonates admitted to neonatal intensive care units (ICU). Methods: Medical charts for neonates born and admitted to the ICU between 2012 and 2018 were reviewed. Obstetric and neonatal variables were collected by a trained researcher. In the case group, all neonates with CL/P were included. The control group was formed by matching sex, prematurity and month of birth using random number generation. Neonates with congenital malformations were excluded from the control group. Adjusted logistic regression was used (p<0.05). Results: The prevalence of CL/P was 0.43% (n=15). Five cases were excluded, as pairing was not possible. Twenty neonates were included in the control group. In the final multivariate model, CL/P was only associated with increased maternal age. For each year of increase in maternal age, neonates had a 35.2% higher chance of presenting CL/P (95% confidence interval: 1.021­1.792). Conclusions: Higher maternal age was associated with higher occurrence of CL/P in neonates admitted to the ICU. No other neonatal or maternal independent variables were associated with CL/P. Due to missing data, interpretation of study results must be approached with caution

Surgical effects of rehabilitation protocols on dental arch occlusion of children with cleft lip and palate

Aim: to evaluate the surgical effects of two rehabilitation protocols on dental arch occlusion of 5-year-old children with or without cleft lip and palate. Methods: this is a retrospective longitudinal study the sample comprised 45 digitized dental casts divided into followed groups: Group 1 (G1) ­ children who underwent to cheiloplasty (Millard technique) at 3 months and to one-stage palatoplasty (von Langenbeck technique) at 12 months; Group 2 (G2) ­ children who underwent to cheiloplasty (Millard technique) and two-stage palatoplasty (Hans Pichler technique for hard palate closure) at 3 months and at 12 months to soft palate closure (Sommerlad technique); and Group 3 (G3) ­ children without craniofacial anomalies. Linear measurements, area, and occlusion were evaluated by stereophotogrammetry software. Shapiro-Wilk test was used to verify normality. ANOVA followed by posthoc Tukey test and Kruskal-Wallis followed by posthoc Dunn tests were used to compared groups. Results: For the measures intercanine distance (C-C'), anterior length of dental arch (I-CC'), and total length of the dental arch (I­MM'), there were statistical differences between G1x G3 and G2xG3, the mean was smaller for G1 and G2. No statistically significant differences occurred in the intermolar distance and in the dental arch area among groups. The occlusion analysis revealed significant difference in the comparison of the three groups (p=0.0004). Conclusion: The surgical effects of two rehabilitation protocols affected the occlusion and the development of the anterior region of the maxilla of children with oral clefts when compared to children without oral clefts.

Qualitative Assessment of Surgical Repair of Three Types of Unilateral Cleft Lip

Abstract Objective: To assess the effect of the three types of unilateral cleft lip (UCL) [cleft lip only, cleft lip and alveolus, and cleft lip alveolus and palate] on the outcome of the repair. Material and Methods: This study was a case series of effect of types of UCL on the outcome of the repair. Fifteen subjects each were in three UCL phenotypes groups. Evaluation of the scar, lip, and nose was done qualitatively by both parents/guardians and professionals using a modified form of the criteria described by Christofides et al. (2006). Results: In the assessment of the surgical scar, the parents found a difference between the three types of cleft in terms of texture, shape, and width of the scar and presence of columella deviation. The professional assessors, however, only found the three types of cleft to be different in the presence of alar flattening. Conclusion: Differences truly exist in the outcome of surgical repair of the three types of unilateral cleft lip, especially in the aesthetics of the nose and in the width and shape of the residual lip scar. Thus, it is important to consider this in the assessment of UCL repair because putting the subtypes together might have a negative impact on the assessment.

Evaluation of palatal volume in children with cleft lip and palate: a comparison of two surgical protocols / Avaliação volumétrica do palato em crianças com fissura labiopalatina: comparação de dois protocolos cirúrgicos

Objective: Compare the palatal volume in children with unilateral cleft lip and palate before and after two surgical protocols. Material and Methods: Retrospective data collection was performed in a specialized hospital. The sample comprised 120 digitized dental models divided into, Group 1 (G1) ­ participants submitted to cheiloplasty at 3 months (Millard technique) and one-step palatoplasty at 12 months (von Langenbeck technique); Group 2 (G2) ­ participants submitted to cheiloplasty (Millard technique) and hard palate closure (Hans Pichler technique) at 3 months and soft palate closure at 12 months (Sommerlad technique). The dental models were evaluated at Time 1 (T1): before primary plastic surgeries, Time 2 (T2): 1st post-surgical phase, and Time 3 (T3): 2nd post-surgical phase. The volume was measured through stereophotogrammetry system software. Parametric and non-parametric statistical tests were applied (α=5%). Results: The intragroup analysis revealed that G1 had a statistically significant increase in volume at T2 followed by a reduction at T3 (p=0.003); G2 showed a statistically significant increase of dental arch volume between T1 and T2 (p=0.001). There was no statistically significant difference in the intergroup and gender analyses (p>0.05). Conclusion: The surgical protocol influenced the palatal volume of children with unilateral cleft lip and palate. This study suggested that two-step palatoplasty protocol has a tendency to be more appropriate.(AU)

Objetivo: Comparar o volume palatino em crianças com fissura unilateral de lábio e palato antes e após dois protocolos cirúrgicos. Material e Métodos: A coleta de dados retrospectiva foi efetuada em um hospital especializado. A amostra foi composta por 120 modelos dentários digitalizados divididos em, Grupo 1 (G1) ­ participantes submetidos a queiloplastia aos 3 meses de vida (técnida de Millard) e a palatoplastia em única etapa aos 12 meses (técnica de von Langenbeck); Grupo 2 (G2) ­ participantes submetidos a queiloplastia (técnica de Millard) e fechamento do palato duro (técnica de Hans Pichler) aos 3 meses de vida e fechamento do palate mole aos 12 meses (técnica de Sommerlad). Os modelos dentários foram avaliados em Tempo 1 (T1): antes das cirurgias plásticas primárias, Tempo 2 (T2):1ª fase pós-cirúrgica e Tempo 3 (T3): 2ª fase pós-cirúrgico. O volume foi mensurado por meio do software do sistema de estereofotogrametria. Testes estatísticos paramétricos e não-paramétricos foram utilizados (α=5%). Resultados: As análises intragrupos indicaram que G1 apresentou aumento estatisticamente significante em T2 seguido de redução em T3 (p=0.003). G2 apresentou crescimento estatisticamente significativo do volume palatino entre T1 e T2 (p=0.001). Não houve diferença estatisticamente significante nas análises intergrupos e entre gêneros (p>0.05). Conclusão: O protocolo cirúrgico influenciou o volume palatino das crianças com fissura unilateral de lábio e palato. Este estudo sugeriu que o protocolo da palatoplastia em duas etapas possui uma tendência de ser mais apropriado.(AU)

NAM e queiloplastia promovem simetria na face e arco superior em pacientes com fenda unilateral completa / NAM and chiloplasty promote face and upper arch symmetry in patients with complete unilateral cleft

As fissuras congênitas de lábio e/ou palato, também conhecidas como fenda labial, fenda labiopalatina e fenda palatina, fazem parte de um conjunto de doenças que afetam a cavidade oral e os lábios. As causas ainda são desconhecidas, mas podem estar relacionadas a fatores genéticos e ambientais. As fendas orofaciais estão dentre as malformações crânio-faciais mais comuns presentes desde o nascimento. O bebê afetado precisará desde o seu nascimento até a sua vida adulta de acompanhamento e tratamento com equipes multidisciplinares, e dentre eles o tratamento ortodôntico é fundamental. O modelador nasoalveolar (NAM) consiste em uma placa intraoral onde o intuito é de diminuir a gravidade da deformidade da fenda original, no pré-cirúrgico e permitir que o cirurgião obtenha um melhor reparo do alvéolo, lábio e nariz nos pacientes que possuem a fissura. Sendo assim, o objetivo do seguinte trabalho é de avaliar o resultado do uso do NAM e da queiloplastia na obtenção da simetria facial e da maxila em bebês fissurados tratados na Faculdade de Odontologia da Universidade Federal de Minas Gerais, por meio de análise de imagens fotográficas realizadas durante os atendimentos clínicos num período de pré-cirúrgico, cirúrgico e pós-cirúrgico, além de modelos digitais moldados antes do tratamento e pós o uso do NAM.

Congenital cleft lip and/or palate, also known as cleft lip, cleft lip and palate, and cleft palate, are part of a set of diseases that affect the oral cavity and lips. The causes are still unknown, but they may be related to genetic and environmental factors. Orofacial clefts are among the most common craniofacial malformations present from birth. The affected baby will need, from birth to adulthood, follow-up and treatment with multidisciplinary teams, and among them, orthodontic treatment is essential. The Nasoalveolar Modeler (NAM) consists of an intraoral plate whose purpose is to reduce the severity of the deformity of the original cleft, in the pre-surgical period and allow the surgeon to obtain a better repair of the alveolus, lip and nose in patients with cleft. Therefore, the objective of the following work is to evaluate the result of using NAM and cheiloplasty in obtaining facial and maxillary symmetry in cleft babies treated at the Faculty of Dentistry, Federal University of Minas Gerais, through photographic image analysis performed during clinical care in a pre-surgical, surgical and post- surgical period, in addition to molded digital models before treatment and after the use of NAM.

Use of collaborative learning as atool to evaluate syndromic craniofacial anomalies / Uso da aprendizagem colaborativa como ferramenta para avaliar anomalias craniofaciais sindrômicas

Almost 30% of oral cleftsare associated with other structural abnormalities.However, little is known on orofacial characteristics related tothese cases since they are not systematically reported. To close this gap, we developed a collaborative learning approach supported by an interprofessional team aiming to systematicallydescribe oral findings and impactthe training of future professionals that hopefully will incorporate these descriptionsintotheir clinical practice. The methodological proposal consisted of small group sessions focusing on a particular syndrome or group of syndromes followed by examiningpatients with those conditions. Twenty cases were examined and studied over one semester andaset of conditions to be identified in the orofacial regionwasdefined. Here, we present a guideline that we suggest that dentists and dental institutions use. We also present the advantages of using collaborative learning as a tool in the training of the clinician (AU).

Quase 30% das fissuras orais estão associadas a outras anormalidades estruturais. No entanto, pouco se sabe sobre as características orofaciais relacionadas a esses casos, uma vez que não são relatados de forma sistemática. Para fechar essa lacuna, desenvolvemos uma abordagem de aprendizagem colaborativa apoiada por uma equipe interprofissional com o objetivo de descrever sistematicamente os achados orais e impactar o treinamento de futuros profissionais que, esperançosamente, irão incorporar essas descrições em sua prática clínica. A proposta metodológica consistia em sessões de pequenos grupos enfocando uma determinada síndrome ou grupo de síndromes seguidas de exame de pacientes com essas condições. Vinte casos foram examinados e estudados ao longo de um semestre e foi definido um conjunto de condições a serem identificadas na região orofacial. Aqui, apresentamos uma diretriz que sugerimos que os dentistas e instituições odontológicas utilizem. Também apresentamos as vantagens de usar a aprendizagem colaborativa como uma ferramenta no treinamento do clínico (AU).

Queiloplastia por técnica de Fisher: relato de caso / Fisher's cheiloplasty: case report

As fissuras labiopalatinas são as anomalias craniofaciais mais comuns, com uma prevalência mundial de 1 paciente para cada 1000 nascimentos, e de 1 para cada 650 nascidos no Brasil. O presente artigo relata um caso de um paciente com fissura labial unilateral completa, operado pela técnica de Fisher aos 10 meses, detalhando o método cirúrgico. Diversas técnicas de queiloplastias são descritas na literatura, com variáveis resultados estéticos e funcionais. No referido caso a técnica mostrou uma excelente qualidade de cicatriz, permitindo o trabalho fonoaudiológico para melhorar a motricidade oral... (AU)

As cleft lip and palate are the most common craniofacial anomalies, with a worldwide prevalence of 1 patient per 1000 births and 1 per 650 born in Brazil. This article reports a case of a patient with complete unilateral cleft lip, operated by Fisher's technique at 10 months, detailing the surgical method. Several cheiloplasty techniques are described in the literature, with several aesthetic and functional results. In this case, the technique showed an excellent quality of healing, allowing speech therapy to improve oral motor skills... (AU)

Agenesia e fatores associados em pacientes portadores de fissura labiopalatina: uma revisão de literatura / Agenesis and associated factors in patients with cleft lip and palate: a review of the literature

Objetivo: verificar as principais agenesias dentárias e os fatores associados em portadores de fissura labiopalatina por meio de uma revisão de literatura. Métodos: foi realizada uma revisão de literatura utilizando as bases de dados PubMed, SciELO e Google Acadêmico. Revisão de literatura: foram incluídos 34 artigos, sendo 2 casos clínicos, 15 estudos retrospectivos, 10 revisões de literatura, 4 estudos de caso-controle e 5 estudos transversais; além de 3 referências escolhidas através de outras buscas para complementar a revisão. A partir dos estudos incluídos no trabalho, foi possível verificar que a maior prevalência ocorre no sexo masculino. E a fissura que mais acomete a população é a transforame incisivo. Pôde-se analisar também que não há causa exata, porém, existem fatores predisponentes, como os ambientais e os hereditários. Considerações finais: esta revisão de literatura poderá auxiliar os profissionais de saúde para a realização de diagnóstico e planejamento precoces, a fim de encontrar o melhor e mais eficiente tratamento para cada caso. O tratamento precoce, por uma equipe multidisciplinar, certamente garantirá uma melhor qualidade de vida aos pacientes.(AU)

Objective: to verify the main dental agenesis and associated factors in cleft lip and palate through a literature review. Methods: a literature review was carried out using PubMed, SciELO and Google Scholar databases. Literature review: 34 studies were included, 2 clinical studies, 1 retrospective study, 10 literature reviews, 4 case-control studies and 5 cross-sectional studies. In addition to 3 references chosen through other searches complementary to the review. From the included studies, it was verified a higher frequency of cleft lift and palate for the male sex, and a higher frequency of more severe clefts, such as the incisive transformation, in comparison to the labiopalatine. It can also be analyzed that there is no exact cause; however, there are environmental and hereditary predisposing factors. Final considerations: this literature review may help health professionals to carry out early diagnosis and treatment planning, in order to find the best and most efficient treatment for each case. Early treatment by a multidisciplinary team will certainly guarantee a better quality of life for patients.(AU)

Atraso de escolaridade e dificuldade de socialização de pacientes com fissura labiopalatina não sindrômica / Scholar delay and socialization dificulty of patients with non syndromic cleft lip and palate

Dentre as principais consequências da fissura labial e/ou palatina não sindrômica (FL/ PNS) estão dificuldades com fonação e autoestima, a primeira uma questão funcional e a segunda um problema social derivado não raro de contextos de bullying que, dentre outros, podem levar o indivíduo à evasão escolar. O objetivo deste estudo foi avaliar o atraso de escolaridade e a dificuldade de socialização de pacientes com FL/PNS quando comparados a uma população não afetada da mesma faixa etária de 7 a 20 anos, atendidos na Universidade José do Rosário Vellano ­UNIFENAS, campus de Alfenas. Os sujeitos foram agrupados em duas categorias de indivíduos, o grupo caso composto por indivíduos com FL/PNS em tratamento no Centro Pró-Sorriso da UNIFENAS; e o grupo controle composto por indivíduos sem FL/PNS em tratamento nas clínicas de Odontopediatria e Integrada da UNIFENAS. Os resultados demonstraram que a proporção de pacientes com FL/PNS atrasados na escola foi de quase 5 vezes maior que o número de pacientes sem fissuras (p<0,01). Constatou-se que a presença da FL/PNS pode ser o ponto de partida para outros contribuintes, com interferências psicológicas e/ou sociais, interferindo negativamente no processo de socialização (bullying) do paciente (p=0,0018). Portanto devem ser tratadas com abordagem multidisciplinar, incluindo diversos profissionais, dentre eles pedagogos, psicólogos e odontólogos(AU)

Among the main consequences of Non Syndromic Cleft Lip and Palate (NSCLP) are the difficulties with phonation and self estime, the first being a functional issue na the later being social that is derived from, not rarely, bullying contexts, that among other things, may lead na individual to school evasion. The objective of this study was to avaluate the levels of scholarity of patients with NSCLP when compared to a non affected population of the same age in individuals from 7 to 20 years old, attended the Pediatric and Integrated Pediatric Clinic of UNIFENAS, Alfenas campus. The subjects were grouped into two categories of individuals, the case group was composed of individuals with FL/PNS with treatment at the ProSmile center at UNIFENAS. The control group was composed of individuals without FL/PNS in treatment at the clinics of pediatric and integrated denistry at UNIFENAS. The results demonstrated the number of patients with FL/PNS that presented scholar delay were almost 5 times the number of patients that didn't present FL/PNS (p<0,01). The presence of NFL/PNS may be the starting point for other contributors with psychological and/or social interferences, interfering negatively with the socialization process (bullying) of the patient (p=0,0018). They should be treated with a multidisciplinary manner, including multiple professionals, among them pedagogues, psychologist and dentist(AU)

A importância da Odontologia na assistência a indivíduos com defeitos congênitos / The importance of Dentistry in assisting individuals with birth defects

Introdução: Defeitos congênitos são alterações estruturais ou funcionais que acontecem durante a vida intrauterina. O cirurgião-dentista deve reconhecer os defeitos craniofaciais para complementar a caracterização fenotípica e manejá-los junto a uma equipe multiprofissional. A presente revisão tem como objetivo auxiliar o cirurgião-dentista para o diagnóstico desses achados e apresentar quadros sindrômicos tipicamente associados a malformações craniofaciais. Revisão de Literatura: Manifestações craniofaciais de defeitos congênitos são condições que devem ser reconhecidas pelos cirurgiões--dentistas, pois frequentemente estão presentes em sua prática diária, podendo ser este profissional o primeiro a identificar tais achados. Os principais quadros sindrômicos tipicamente associados a micrognatia, fendas orais e displasias esqueléticas com manifestação craniofacial são apresentados, assinalando suas características clínicas e genéticas. Discussão: O cirurgião-dentista deve realizar uma anamnese detalhada incluindo a história familiar, bem como reconhecer as dismorfias tanto clínica quanto radiograficamente, observando o paciente de forma sistêmica. Conclusão: Os profissionais da odontologia devem receber treinamento teórico-prático para o diagnóstico, tratamento e vigilância de indivíduos com defeitos congênitos, seja na avaliação individual ou como parte de uma equipe multiprofissional.

Introduction: Birth defects are structural or functional changes that occur during intrauterine life. The dentist must recognize the craniofacial defects, complement the phenotypic characterization and manage them within a multidisciplinary team. The present review aims to assist the dentist to diagnose these findings and present syndromic conditions typically associated with cranio-facial malformations. Literature Review: Craniofacial manifestations of birth defects are conditions that must be recognized by dentists, as they are frequently present in their daily practices, and this professional may be the first to identify such findings. The main syndromic clinical pictures typically associated with micrognathia, oral clefts and skeletal dysplasias with craniofacial man-ifestation are presented, pointing out their clinical and genetic features. Discussion: The dentist must perform a detailed anamnesis including family history, as well as should recognize both clinical and radiographically the dysmorphisms, observing the patient systemically. Conclusion: Dentistry professionals should receive the-oretical-practical training for the diagnosis, treatment and surveillance of individuals with congenital defects, either in individual assessment or as part of a multipro-fessional team.

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

Abstract 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.

Resumo O objetivo deste estudo foi analisar o crescimento e desenvolvimento maxilar de crianças com fissuras orais por meio de um método inovador da técnica de sobreposição 3D-3D. Participaram do estudo crianças com fissura unilateral completa de lábio (FL) e fissura unilateral de lábio e palato (FLP). As moldagens dos arcos dentários foram realizadas 1 dia antes e 1 ano após o reparo cirúrgico labial. Um scanner a laser 3D digitalizou os modelos dentários e o software do sistema de estereofotogrametria analisou as sobreposições 3D-3D em dois grupos correspondentes (mesmo indivíduo, FL e FLP) e um grupo não-correspondente (indivíduos diferentes). As diferenças foram avaliadas pelo Root Mean Square (RMS) e expressas em milímetros (mm). O teste de Kruskal-Wallis seguido do teste post-hoc de Dunn e teste de MannWhitney foram avaliados para comparar os grupos (α=5%). RMS foi de 1.34 mm (± 0.37) no grupo FL, 1.41 mm (± 0.32) no grupo FLP e 3.38 mm (± 1.28) no grupo não-correspondente. RMS foi significativamente maior no grupo não-correspondente (p <0.0001). Não houve diferenças estatisticamente significativas entre os gêneros. A técnica de sobreposição 3D-3D evidenciou o desenvolvimento da maxila após a cirurgia labial na região anterior do palato. Assim, sugere-se que a amplitude da fenda e a proporção dos segmentos palatinos influenciam na heterogeneidade morfológica e, consequentemente, no desenvolvimento e crescimento maxilar de crianças com fissura orofacial

Remoção de pré-maxila em paciente com fissura labiopalatina: relato de caso / Removal of the premaxilla in patient with cleft lip and palate: case report

Diversas anomalias craniofaciais acometem os seres humanos, dentre estas podem ser citadas as fissuras labiopalatinas. Ocorrem devido à mal formações congênitas e comprometem o desenvolvimento orofacial e maxilo-mandibular, gerando complicações estéticas e funcionais. O momento para abordagem cirúrgica em pacientes com deformidade deste tipo é crucial para atingir o melhor resultado. Entretanto, muitos deles não procuram atendimento ou não tem acesso aos centros especializados. A pré-maxila em portadores de fissura labiopalatina transforame bilateral, não submetidos a tratamento cirúrgico na infância, é comumente protruída, impedindo o desenvolvimento e função adequada da musculatura perioral/ Ainda, pode causar dificuldades alimentares,de fonação e, principalmente, estético. O objetivo do presente trabalho é relatar o caso de uma paciente acompanhada no serviço de cirurgia bucomaxilofacial OSID/UFBA, portadora de fissura labiopalatina, submetida à remoção de pré-maxila em idade adulta. O fechamento da fenda palatina não foi possível devido a idade da paciente e o grau de desenvolvimento do palato, tendo indicado tratamento com uso de prótese obturadora. Considera-se que quanto mais precoce e associado a uma boa técnica cirúrgica forem realizadas as intervenções primárias, menores serão as sequelas. Consequentemente, os resultados estéticos e funcionais serão mais prováveis, sendo desnecessária a remoção cirúrgica da pre-maxila(AU)

Several craniofacial anomalies affect humans and, among these, it can be cited the cleft lip and palate. These occur due to congenital malformations and compromise the orofacial and maxillo-mandibular development, causing aesthetic and functional complications. The moment of the surgical approach in patients with this type of deformities is crucial to achieve the best outcome, however, many of them do not seek care or have no access to specialized centers. The premaxilla in carries of bilateral cleft lip and palate when they are not submitted to a surgical treatment in childhood, is commonly protruding, impeding the development and function of the perioral musculature, besides difficult feeding, phonation and mainly aesthetic. The aim of this article is to report the case of a patient accompained with the Bucomaxillofacial Surgery Service from OSID / UFBA, with cleft lip and palate, submitted to pre-maxilla removal, in adulthood. The cleft palate closure was not possible due to the age of the patient and degree of development of the palate, indicating treatment with obturator prosthesis. It is considered that, the sooner and associated with a good surgical technique, primary interventions are performed, the fewer the sequelae and consequently the aesthetic and functional results, where, in most cases, surgical removal of the premaxilla will be unnecessary(AU)

Supernumerary teeth in patients with cleft lip and palate: the tooth germs do not separate

ABSTRACT Introduction: Supernumerary teeth in cases of cleft lip and palate do not result from the division of normal germs before the formation of hard tissue. Deciduous and permanent teeth odontogenesis begins after the face has formed, either with or without the cleft. Discussion: The most acceptable hypothesis to enable understanding of the presence of supernumerary teeth on one or both sides of the cleft palate is hyperactivity of the dental lamina in its walls. This hyperactivity, with the formation of more tooth germs, must be attributed to mediators and genes related to tooth formation, under strong influence of local epigenetic factors, whose developmental environment was affected by the presence of the cleft. Conclusion: The current concepts of embryology no longer support the fusion of embryonic processes for the formation of the face, but rather the leveling of the grooves between them. All human teeth have a dual embryonic origin, as they are composed of ectoderm and mesenchyme/ectomesenchyme, but this does not make it easy for them to be duplicated to form supernumerary teeth.

RESUMO Introdução: Os dentes extranumerários nas fissuras labiopalatinas não são resultado da divisão dos germes normais antes da formação do tecido duro. A odontogênese dos decíduos e permanentes inicia-se depois de formada a face, com ou sem fissuras. Discussão: A hipótese mais plausível para compreender a presença dos dentes extranumerários em um ou nos dois lados da fissura labiopalatina é a hiperatividade da lâmina dentária em suas paredes. Essa hiperatividade, com formação de mais germes dentários, deve ser atribuída aos mediadores e genes relacionados à formação dos dentes, sob forte influência de fatores epigenéticos locais, cujo ambiente de desenvolvimento foi afetado pela presença da fissura. Conclusão: Os conceitos atuais da embriologia não fundamentam mais a fusão de processos embrionários para a formação da face, e sim o nivelamento dos sulcos entre eles. Todos os dentes humanos têm uma dupla origem embrionária, pois se compõem de ectoderma e mesênquima/ectomesênquima, mas isso não facilita sua duplicação para formar dentes extranumerários.

Fissuras orofaciais: uma análise bibliométrica dos trabalhos apresentados em um congresso brasileiro / Orofacial fissures: a bibliometric analysis of the works presented at a Brazilian congress

Objetivo: Investigar a produção científica sobre fendas orofaciais em um congresso brasileiro, entre os anos de 2009 a 2019. Métodos:Realizou-se um estudo bibliométrico, observacional, pela análise de resumos publicados em anais das Reuniões Anuais da Sociedade Brasileira de Pesquisa Odontológica (SBPqO), que envolviam o tema de fissuras orofaciais.Os dados referentes aos resumos (ano de publicação, local do estudo ­ unidade federativa, tipo de fissura, grande área de conhecimento, desenho, tipo de instituição,recebimento de fomento) foram coletados e analisados através de uma estatística descritiva e analítica. Foi aplicado o teste não paramétrico de Mann-Whitney (p < 0,05). Resultados: Dentre 28.578 resumos, 194 (0,67%) eram sobre fissuras orofaciais. A maioria deles envolvia mais de um tipo de fissura (n = 180; 93,3%) e foram realizados,principalmente, em instituições públicas (n = 128; 66%) das regiões Sudeste (n = 121;62,3%), e Sul (n = 23; 11,8%), sem recebimento de fomento (60,8%). A área de conhecimento mais comum foi Epidemiologia/Saúde Coletiva (n = 60; 30,9%), com predominância dos desenhos de estudos transversais (n = 85; 43,8%). Houve associação estatisticamente significativa entre recebimento de financiamento e maior tamanho amostral. Conclusão: Poucos estudos investigaram as fissuras orofaciais na SBPqO.Uma investigação mais aprofundada nesse campo de pesquisa permite identificar problemáticas que possibilitam a organização, planejamento e monitoramento da atenção especializada para os portadores dessas anomalias, assim como criar condições para uma descentralização do cuidado pela ampliação da rede de serviços para outras localidades no Brasil.

Aim: To investigate the scientific production concerning orofacial clefts presented at a Brazilian congress, between 2009 and 2019. Methods: A bibliometric and observational study was conducted, though the analysis of abstracts published in the annals of the Annual Meetings of the Brazilian Society of Dental Research (SBPqO), concerning orofacial clefts. Data referring to the abstracts (year of publication, place of study - federative unit, type of fissure, broad area of knowledge, design, type of institution, receipt of funding) were collected and organized through descriptive and analytical statistics. The Mann-Whitney non-parametric test was applied (p < 0.05). Results: Among 28,578 abstracts, 194 (0.67%) concerned orofacial clefts. Most of them dealt with more than one type of cleft (n = 180; 93.3%) and were mainly conducted in public institutions (n = 128; 66%), in the Southeast (n = 121; 62.3%) and South (n = 23; 11.8%) regions, and without funding (60.8%). The most common field of knowledge was Epidemiology/Public Health (n = 60; 30.9%), with a predominance of cross-sectional studies (n = 185; 43.8%). There was a statistically significant association between funding and higher sample size. Conclusion:Few studies have investigated orofacial clefts in SBPqO. An in-depth investigation in this field of research allows for the identification of problems that make it possible to organize, plan, and monitor specialized care for people with these anomalies, as well as create conditions for the decentralization of care by expanding the service network to other locations in Brazil.

Association of a Polymorphism in the Gene Encoding Methylenetetrahydrofolate Dehydrogenase 1 (MTHFD1) 1958G> A with Orofacial Cleft

ABSTRACT Objective: To evaluate the possible association of a polymorphism in the gene encoding methylenetetrahydrofolate dehydrogenase 1 (MTHFD1), 1958G>A, with the susceptibility to orofacial cleft in an Indonesian population. Material and Methods: A total of 200 stored secondary biological samples from 30 cases of orofacial cleft and 170 unaffected controls were analyzed to determine the polymorphism status at base 1958. The analysis was conducted using the PCR-restriction fragment length polymorphism technique after digestion with the Msp1 restriction enzyme. The samples were then subjected to agarose gel electrophoresis to investigate the presence or absence of the following fragments: genotype GG, 196, 86 and 40 base pairs (bp); genotype AA, 282 and 28 bp and genotype AG, 282, 196, 86, 40 and 28 bp. The test groups were compared using the Chi-square test. Results: The wild-type allele containing 1958G, as well as the genotype GG, were significantly more common in the control group than in the orofacial cleft group. Conclusion: The MTHFD1 1958G>A polymorphism was significantly associated with orofacial cleft susceptibility in the tested Indonesian population.

Prevalence of cleft lip and palate and associated factors in Brazil's Midwest: a single-center study

Abstract: The aim of this study was to evaluate the prevalence of cleft lip and/or palate (CL/P) and associated factors in patients treated at a referral service in Brazil's Midwest. Data were obtained from medical records on file between 2010 and 2017 for this epidemiologic and associational study. A descriptive analysis of the sociodemographic and clinical data was carried out, after which the data were analyzed using the chi-square test and Poisson regression with robust variance. A total of 1,696 medical records were eligible. The requests for rehabilitation were mainly for children in the early years of life, and were mostly for patients from low-income families in the state of Goiás. CL/P was more prevalent in its most severe morphological representation (cleft lip and palate), and the most frequently affected side was the left. Syndromic cleft was present in 4.1% of the cases, and the Pierre Robin sequence and Apert syndrome appeared more frequently. Adjusted multivariate Poisson regression showed an association between cleft palate and the presence of syndromes, since the prevalence was 2.33 times higher in this case than that of no syndrome. Cleft lip and palate were associated with males, whereas cleft palate was associated with females. This study highlights the importance of collecting and analyzing epidemiological data, managing health service planning, and allocating funds to assist cleft patients.

Prevalence of cleft lip and palate in Bauru, SP ­ concordance among registries of HRAC/USP, DNV and SINASC / Prevalência da fissura labiopalatina em Bauru, SP ­ concordância entre os registros do HRAC/USP, DNV e SINASC

Objective: Congenital defects, including cleft lip and palate, increase the morbidity and mortality in the affected population. This study aimed to determine the prevalence of cleft lip and palate in the city of Bauru, Brazil, by evaluation of registry in the Brazilian Livebirth Certificate (DNV) and the Information System on Livebirths (SINASC), and analyzed the concordance of diagnosis compared with registries of the Hospital for Rehabilitation of Craniofacial Anomalies (HRAC/USP), located in the same city. Material and Methods: This retrospective observational study comprised analysis of all DNVs and identification of individuals with clefts born and living in Bauru, comparing with data from HRAC/USP. The prevalence was calculated by dividing the number of children born with clefts in the study period by the total number of livebirths registered. The reporting of different types of clefts was compared by the chi-square test. Results: Overall, 50,898 DNV were evaluated, among which there were 25 reported cases of cleft lip and/or palate. In the same period, HRAC/USP registered 77 cases born in Bauru, representing 67.5% of underreporting of the occurrence of clefts. Cleft palate was the most prevalent (34.9%), followed by cleft lip and palate (31.7%) and cleft lip (30.2%), mostly affecting males (58.5%). The reporting of cleft palate (16.12%) was lower compared to cleft lip (43.75%) and cleft lip and palate (54.54%). Conclusion: The study revealed predominance of cleft palate, with significant underreporting of clefts in the public health system, especially for cleft palate as compared to cleft lip and cleft lip and palate (AU)

Objetivo: Os defeitos congênitos, incluindo fenda labial e palatina, aumentam a morbidade e mortalidade na população afetada. Este estudo teve como objetivo determinar a prevalência de fissura labiopalatina na cidade de Bauru, Brasil, por meio da avaliação do registro na Certidão de Nascimento de Vivos (DNV) e no Sistema de Informação de Nascidos Vivos (SINASC), e analisar a concordância do diagnóstico em comparação com registros do Hospital de Reabilitação de Anomalias Craniofaciais (HRAC / USP), localizado na mesma cidade. Material e Métodos: Este estudo observacional retrospectivo compreendeu a análise de todas as DNVs e a identificação dos indivíduos com fissuras nascidos e residentes em Bauru, comparando com os dados do HRAC / USP. A prevalência foi calculada dividindo-se o número de filhos nascidos com fissura no período do estudo pelo total de nascidos vivos registrados. O relato de diferentes tipos de fissuras foi comparado pelo teste do qui-quadrado. Resultados: No geral, foram avaliadas 50.898 DNV, entre as quais houve 25 casos notificados de fenda labial e / ou palatina. No mesmo período, o HRAC / USP registrou 77 casos nascidos em Bauru, representando 67,5% de subnotificação da ocorrência de fissuras. A fenda palatina foi a mais prevalente (34,9%), seguida da fenda labiopalatina (31,7%) e fenda labial (30,2%), ocorrendo principalmente no sexo masculino (58,5%). O relato de fissura palatina (16,12%) foi menor em comparação com fissura labial (43,75%) e fissura labiopalatina (54,54%). Conclusão: O estudo revelou predomínio de fissura palatina, com subnotificação significativa de fissuras no sistema público de saúde, principalmente para fenda palatina em relação à fenda labial e labiopalatina. (AU)

Parents' Emotional and Social Experiences of Caring a Child with Cleft Lip and/or Palate

ABSTRACT Objective: To evaluate the emotional and social experiences of parents or caregivers of children with cleft lip and/or palate (CL/P) in a city in the Northeastern of Brazil. Material and Methods: A quantitative and cross-sectional study was conducted among parents or caregivers of children with CL/P by interviews based on a questionnaire. Interviews were conducted during the First Smile Project in Sobral, Ceará, Brazil. All participants (n=41) agreed to participate in the interview and signed an informed consent. The data was analyzed in SPSS software version 22.0. Results: The majority of participants were female (87.2%), with a mean age of 37 years, with a low level of education and low family income. The great majority (90.2%) of the parents were not prenatally diagnosed to have CL/P babies. Of those interviewed, 56.1% mentioned that the first diagnosis of cleft lip and palate was not presented by the professionals in a clarifying way to the family. Fear (36.6%) and sadness (19.5%) were the main feelings experienced when the child was diagnosed with fissure. Feeding (48.8%) was pointed out as the main concern in caring for a child with CL/P. Conclusion: The parents and caregivers interviewed faced important emotional and social problems that must be addressed by the professional team that assists the child with CL/P.

Alinhadores NAM com elevador nasal: um estudo clínico em pacientes com fissura labiopalatal / Nasoalveolar molding clear aligner technique with a nasal retractor: a clinical study

A fissura de lábio e palato é a deformidade congênita da face mais comum em humanos e acomete cerca de 1:650 nascimentos no Brasil. O tratamento para esses pacientes tem sido amplamente discutido durante décadas e ainda não existe um consenso ou um protocolo de atendimento padronizado. Com o passar dos anos e a evolução da tecnologia, novas formas de tratamento foram surgindo e hoje é possível realizarmos o tratamento desses pacientes através do planejamento digital (CAD/CAM ­ Projeto e fabricação assistida por computador). A partir do conceito dos alinhadores ortodônticos introduzido por Kesling em 1946 e hoje com toda tecnologia disponível para fabricação digital desses dispositivos é que realizamos o tratamento de 25 bebês fissurados no projeto de extensão denominado NAM ­ Naso-Alveolar Modelador do Departamento de Odontologia Restauradora na Faculdade de Odontologia da Universidade Federal de Minas Gerais, avaliando a eficácia da utilização dos alinhadores NAM no fechamento das fissuras do rebordo alveolar. O tratamento com os alinhadores NAM se mostrou eficiente com a diminuição de pouco mais de 50% do tamanho da fenda anterior e com os pacientes realizando o tratamento à distância reduzindo o número de consultas presenciais. A tecnologia CAD/CAM com os alinhadores NAM tornará acessível a pacientes que residem longe dos centros de deformidades, particularmente em áreas rurais, além da possibilidade de padronização do tratamento no mundo global. Embora ainda em estágios iniciais, os alinhadores NAM representam um tratamento promissor para pacientes portadores de fissuras lábio palatinas.

Cleft lip and palate is the most common facial deformity in humans, afflicting 1:650 births in Brazil. Optimal treatment protocols have been debated over the last several years but no consensus has yet been reached. Recently several technological advancements have made possible to develop new ways to treat cleft lip and palate patients using 3D treatment planning softwares to produce customized appliances for pre-surgical orthopaedic treatment of newborns. This new technique is based on well established Clear Aligners introduced by Kesling in 1946. The current manuscript aims to evaluate the outcomes of 25 babies (15 to 30 days-old) treated with clear aligners to reduce the cleft and the gap between the alveolar segments prior to lip and palate repair surgery. Treatment with NAM aligners proved to be efficient with a reduction of just over 50% in the size of the anterior cleft and with patients undergoing treatment at a distance, reducing the number of face-to-face consultations. CAD/CAM technology with NAM aligners will make it accessible to patients residing far from deformity centers, particularly in rural areas, in addition to the possibility of standardizing treatment in the global world. Although still in early stages, NAM aligners represent a promising treatment for patients with cleft lip and palate.