Radiographic Study of the Prevalence and Distribution of Hypodontia Associated with Unilateral and Bilateral Clef Lip and Palate in a Hungarian Population.

BACKGROUND Cleft defects are one of the most frequent birth-deformities of the orofacial region and they are commonly associated with anomalies of the tooth structure, size, shape, formation, eruption, and tooth number. The aim of our study was to evaluate the prevalence, distribution, and potential association of combined hypodontia in cleft-affected patients with regard to all types of teeth in both jaws in the permanent dentition. MATERIAL AND METHODS This retrospective radiographic analysis included patients with various types of clefts treated orthodontically in the Department of Orofacial Orthopedics and Orthodontics at Heim Pàl Children's Hospital, Budapest. There were 150 patients (84 males, 66 females) with non-syndromic unilateral (UCLP; n=120 patients) or bilateral (BCLP; n=30 patients) cleft formation (lip, alveolus and palate) who met the inclusion criteria. Statistical analysis was performed using the chi-square test and Fisher's exact test (significance level p<0.05). RESULTS Hypodontia was significantly more frequent in patients with cleft-sided lateral incisor (104 patients, 69%), with a total of 235 missing teeth, followed by the second premolars of the upper and lower jaw. A significant correlation of congenital missing teeth was observed in left-sided clefts between the upper and lower second premolar in the cleft area CONCLUSIONS Hypodontia inside and outside the cleft area was frequently observed. This should affect the therapy plans, especially if the cleft-sided premolar is also absent. Further comprehensive research including numerous random samples is necessary for better estimating other possible associations.

Three-Dimensional Upper Lip and Nostril Sill Changes After Cleft Alveolus Reconstruction Using Autologous Bone Grafting Versus Recombinant Human Bone Morphogenetic Protein-2.

Cleft alveolus in patients with unilateral complete cleft lip and palate has been alternatively reconstructed with recombinant human bone morphogenetic protein (rhBMP)-2. However, its effects on upper lip and nostril sill anatomy are not known. Thus, the objective of this investigation was to assess and compare upper lip and nostril sill changes after cleft alveolus reconstruction with autologous bone from the iliac crest region and rhBMP-2. Patients were randomly allocated into 2 groups. In group 1, autologous bone from the iliac crest region was used to fill the cleft alveolus (n = 4), and in group 2, rhBMP-2 was used to fill the cleft alveolus (n = 8). Preoperatively and at one after the surgery, computerized tomography (CT) was performed. Reformatted CT imaging was used to perform cephalometric linear measurements of the upper lip and nostril sill regions. Inter- and intragroup data of the pre and postoperative reformatted CT measurements of the upper lip and nostril sill regions did not show differences (P >0.05) in cutaneous upper lip height and projection, nostril sill elevation, and subnasale projection. There were no significant upper lip and nostril sill anatomical changes after cleft alveolus reconstruction using autologous bone grafting and rhBMP-2.

Uso do ácido hialurônico como uma estratégia terapêutica para o reparo ósseo de alvéolos dentais humanos: um ensaio clínico randomizado, triplo-cego, boca dividida / Use of hyaluronic acid as a therapeutic strategy for bone repair in human dental sockets: a split-mouth randomized triple-blind clinical trial

O ácido hialurônico (AH), nas últimas décadas, tem sido amplamente estudado como um potente biomaterial na engenharia de tecidos, devido a sua biocompatibilidade, biodegradabilidade e participação em diversos processos biológicos relacionados à morfogênese e regeneração tecidual. O objetivo do presente estudo foi avaliar os efeitos do AH no reparo ósseo de alvéolos dentais humanos. Trinta e dois primeiros pré-molares inferiores foram extraídos de 16 pacientes com média de 18,67 (DP = 7,95) anos de idade com indicação de exodontia bilateral. Imediatamente após as exodontias, um dos alvéolos foi preenchido aleatoriamente com gel contendo AH a 1%, enquanto o contralateral foi preenchido naturalmente com coágulo. Durante os intervalos pós-operatórios de 30 e 90 dias, os pacientes realizaram exames de tomografia computadorizada cone beam (TCCB). Foram capturadas imagens dos cinco cortes ortorradiais mais centrais de cada alvéolo. A intensidade de cinza foi mensurada para cada imagem e os resultados foram expressos como porcentagem média de formação de osso. A espessura vestíbulo-lingual do processo alveolar foi mensurada e comparada entre os intervalos pós-operatórios para avaliar possíveis alterações dimensionais do alvéolo. Também foi avaliado o padrão do trabeculado ósseo alveolar através da dimensão fractal. A análise estatística envolveu análise descritiva e Testes T pareado e Wilcoxon (p<0,05). Os alvéolos tratados apresentaram maior porcentagem de formação óssea e valores de dimensão fractal (58,17% e 1,098, respectivamente) em comparação com os controles (48,97% e 1,074, respectivamente) no período de 30 dias pós-operatório (p<0,05). Com relação ao período de 90 dias, não foi observada diferença significativa entre os grupos. Além disso, não foram observadas diferenças estatisticamente significativas nas dimensões dos alvéolos entre os grupos (p>0,05). Assim, estes dados indicam que o AH acelerou o reparo ósseo em alvéolos dentais humanos

Hyaluronic Acid (HA), in the last decades, has become widely studied as a powerful biomaterial for tissue engineering, since its biocompatibility, biodegradability, and participation in several biological processes related to morphogenesis and tissue healing. The aim of this study was to evaluate the effects of HA on bone repair in human dental sockets. Thirty-two premolars were extracted from 16 patients with a mean age of 18.67 (SD = 7.95) years old with indication of bilateral extraction of lower first premolars. Immediately after the extractions, one socket was randomly filled with 1% HA gel, while the other side was naturally filled with blood clot. During the postoperative intervals of 30 and 90 days, the patients underwent cone beam computed tomography (CBCT). Five central parasagittal scan images were captured from each socket. The gray intensity was measured in each image and the results were expressed as mean percentage of bone formation. The buccolingual alveolar ridge width was also measured and dimensional changes were compared between the postoperative intervals. The pattern of the alveolar trabecular bone was evaluated through the fractal dimension. Statistical analyses included descriptive analysis and Wilcoxon and paired-t tests (p<0.05). The treated sockets showed a higher percentage of bone formation and fractal dimension values (58.17% and 1.098, respectively) compared with controls (48.97% and 1.074, respectively) in the 30-day postoperative period (p<0.05). After 90 days, there were no significant differences between the groups. Additionally, no significant differences were found between the groups regarding the alveolar dimensions (p>0.05). Thus, these data indicate that HA accelerate the bone repair in human dental socket

Prevalence of second premolar hypodontia in the Polish cleft lip and palate population.

BACKGROUND: Cleft lip and/or palate is the most frequent congenital abnormality occurring in the craniofacial region and is often associated with numerous dental defects such as tooth agenesis, supernumerary teeth, microdontia, taurodontism, crown malformations, or delay in eruption. The prevalence of hypodontia in cleft-affected patients is much higher in comparison with a healthy population. The aim of this study was to evaluate the prevalence of second premolar hypodontia in patients with cleft lip and/or palate. MATERIAL AND METHODS: We performed a retrospective, evaluation of panoramic radiographs and dental casts in the Department of Dentofacial Orthopeadics and Orthodontics, Wroclaw Medical University. Two independent observers evaluated the records of 469 patients with various types of clefts and analyzed dental casts and panoramic radiographs. RESULTS: 202 individuals met inclusion criteria. The sample comprised 120 UCLP patients, 38 BCLP patients, 28 CP patients, and 17 CLA patients. Hypodontia in the premolar region was observed in 39 individuals (19.3%). A total number of 58 second premolars were missing, of which 35 were maxillary second premolars (U5) and 23 were mandibular second premolars (L5). CONCLUSIONS: Estimated hypodontia in the Polish CL/P sample was considerably higher than the hypodontia in permanent dentition reported for a European healthy population. The number of congenitally missing second premolars was higher in the maxillary arch than in the mandibular.

Simplifying cleft surgery by presurgical nasoalveolar molding (PNAM) for infant born with unilateral cleft lip, alveolus, and palate: a clinical report.

PATIENT: A 2-day-old female infant with complete unilateral cleft lip, alveolus, and palate (left side) was presented to the Department of Prosthodontics, Government Dental College and Hospital, Nagpur for evaluation and treatment with presurgical nasoalveolar molding (PNAM) prior to surgical intervention. DISCUSSION: The alignment of the alveolar segments creates the foundation upon which excellent results of primary lip and nasal surgery are dependent in the repair of the cleft lip, alveolus, and palate patient. Presurgical infant orthopedics has been employed since the 1950s as an adjunctive neonatal therapy for the correction of cleft lip and palate. One of the problems that the traditional approach failed to address was the deformity of the nasal cartilages and the deficiency of columella tissue in infants with unilateral and bilateral cleft lip and palate. The purpose of this article is to illustrate the step-by-step fabrication process of the PNAM prosthesis used to direct growth of the alveolar segments, lips, and nose in the presurgical treatment of cleft lip and palate. CONCLUSION: As a result, the primary surgical repair of the lip and nose heals under minimal tension, thereby reducing scar formation and improving the esthetic result. Frequent surgical intervention to achieve the desired esthetic results can be avoided by PNAM.

El consentimiento informado en el tratamiento integral del niño con fisura labio-alveolo-palatina / Informed consent in the comprehensive treatment of children with labial-alveolar-palatal clefts

Introducción: el Servicio de Cirugía Maxilofacial del Hospital Pediátrico Universitario Juan Manuel Márquez de La Habana adoleció de un proceso estandarizado de consentimiento informado. Se tuvo además como propósito el analizar los criterios de los representantes válidos sobre la información que le brindaría el consentimiento informado. Métodos: se estudió a los 32 integrantes del equipo multidisciplinario y a 9 representantes válidos de los pacientes para así constatar el grado de conocimiento sobre los principios de Ética Médica y Bioética. Resultados: se mostró que la mayoría tuvo un nivel bajo en cuanto a Ética Médica y niveles medio o alto en la Bioética. Los representantes válidos presentaron un nivel bajo. Se confirmó el reconocimiento de la necesidad e importancia del consentimiento informado aunque el equipo de salud refirió que no lo utiliza adecuadamente. Se elaboró una propuesta metodológica del proceso de consentimiento informado. Conclusiones: el nivel de conocimiento sobre los principios de la Ética Médica y la Bioética de los profesionales no se correspondió con la percepción que ellos tuvieron ni con la expresión práctica de dichos elementos(AU)

Introduction: the Maxillofacial Surgery Service at Juan Manuel Marquez Children's University Hospital in Havana did not have a standardized informed consent procedure. Another purpose was to analyze the opinions of valid representatives about the information to be provided by such informed consent. Methods: a study was conducted of the 32 members of the multidisciplinary team and 9 valid representatives of the patients to verify their awareness of the principles of medical ethics and bioethics. Results: most showed low awareness of medical ethics, and medium to high awareness of bioethics. Valid representatives showed a low level of awareness. Acknowledgement of the importance of and need for informed consent was confirmed, but the medical team admitted that they do not use it appropriately. A methodological proposal was developed for the process of informed consent. Conclusions: awareness of the principles of medical ethics and bioethics by professionals was not consistent with their perception of such principles or their implementation(AU)

Tratamento de defeitos alveolares verticais pela técnica de distração osteogênica / Treatment of vertical alveolar defects by means of osteogenic distraction technique

Introdução: a reconstrução alveolar de defeitos ósseos verticais ainda constitui um desafio dentro da Implantodontia. Dentre as diversas técnicas empregadas para a correção de tais defeitos, está a distração osteogênica, a qual tem sido descrita como uma técnica empregada para ganho de tecido ósseo e tecidos moles, sobretudo em cirurgias para reconstrução de rebordos alveolares mandibulares e maxilares, com a finalidade de permitir a instalação de implantes osseointegrados bem posicionados e com maior previsibilidade de sucesso quando submetidos a cargas funcionais. Objetivo: o propósito desse estudo foi avaliar a efetividade do procedimento em dois pacientes tratados pela técnica de distração osteogênica alveolar Relato de caso: os casos clínicos foram avaliados quanto ao ganho ósseo através de exame clínico e radiográfico, pré e pós-distração. Resultados: em ambos os casos, constatou-se, ao final do tratamento, ganho ósseo suficiente para posterior reabilitação com implantes. Conclusão: o sucesso relatado na literatura e nos casos apresentados comprova a eficiência da técnica e sua viabilidade clínica.

Introduction: Alveolar reconstruction of vertical bone defects remains a daunting challenge in implant dentistry. Among the various techniques used to correct such defects is distraction osteogenesis (DO), which has been described as a technique used to gain bone and soft tissues, especially in surgeries for reconstruction of mandibular and maxillary alveolar ridges to allow the placement of dental implants in a favorable position and with greater success predictability when subjected to functional loads. Objective: The purpose of this studywas to evaluate the effectiveness of DO in two patients treated with the technique of alveolar distraction osteogenesis. Case report: The clinical cases were evaluated for bone gain through clinical and radiographic examination, pre- and post-distraction. Results: At the end of treatment, both cases had gained sufficient bone as to enable subsequent rehabilitation with implants. Conclusions: The success rate reported in the literature and in the cases presented here prove the efficiency of the technique and its clinical feasibility.

Induction and prevention of cleft lip, alveolus and palate and neural tube defects with special consideration of B vitamins and the methylation cycle.

Previous studies on the development of cleft lip, alveolus, palate, and velum and neural tube defects have revealed several shared multifactorial causes. Both anomalies emerge at different times during embryonic development and are not associated with each other unless there is a genetic component to the etiology. Vitamin deficiency disorders are one of several factors contributing to the etiology of these anomalies.Vitamins B6, folic acid and B12 play an essential role in the methylation cycle. A lack of or deficiency in these vitamins thus has severe consequences for the organism, especially the unborn child. Due to its short half-life, vitamin B6 is particularly important for undisturbed embryogenesis and should be taken along with folic acid as a periconceptional supplement to prevent embryonic deformities. This paper is intended to provide the orthodontist (as a member of the interdisciplinary cleft team) with an overview of the issues and etiological significance of vitamin B deficiencies as possible inducers of these embryopathies. This may encourage comprehensive counselling, particularly of parents of children born with deformities who wish to have more children.

Morphofunctional changes of orofacial muscles in patients with unilateral or bilateral cleft lip, alveolus and palate.

The facial musculature is part of a biocybernetic feedback system within the stomatognathic system, the continuity of which is disturbed by clefts of the lip, jaw, and palate (cheilognathopalatoschisis). This results in topographic, fine-structural and functional alterations of the facial musculature. In two heads with unilateral clefts and two heads with bilateral clefts, the facial musculature was dissected and the M. orbicularis oris macroscopically and topographically examined. We found changes in the attachment of the M. orbicularis oris. The modiolus, which is coresponsible for the proper topographic relation of the M. obicularis oris to the other facial muscles, was unchanged. Further, we examined the vascular system of the muscle, which likewise adapts to the altered situation. Lip/jaw/palatal clefts result in anatomically functional and fine-structural alterations of the M. orbicularis oris, while the rest of the facial musculature remains unchanged.

Bone grafting with platelet-rich plasma in alveolar cleft. Case report.

Bone grafting of the alveolus has become an essential part of the contemporary surgical management of oral clefts. The benefits of this procedure are the stabilization of the maxillary arch, elimination of oronasal fistulae, the reconstruction of the soft tissue nasal base support, creation of bony support for subsequent tooth eruption or, when they are not present or not preserved, for implants application. The authors show a case of bone grafting with the aid of platelet-rich plasma (PRP). Because of the difficulties due to the oral cleft and to its surgical reparation (big size of bone defect, hard scars and sclerotic soft tissue) the authors decided to add PRP to a bone graft taken from the chin. PRP contains a high concentration of growth factors and is able to stimulate both wound and bone regeneration. Infact, the authors have observed very good results both in bone integration and in soft tissue reparation.

Management of alveolar clefts.

Treatment philosophies in the management of alveolar clefts have changed greatly over the years. Currently. the most widely accepted protocol is for repair using autologous cancellous bone from the iliac crest during the stage of mixed dentition. Preliminary data suggest that the appropriate age for surgical repair during the secondary phase can be decreased without evidence of limitation of facial growth. Further long-term studies are necessary to support this protocol, however. With a multidisciplinary approach between the various medical and dental specialties, it is now commonplace to achieve normal dentofacial aesthetics and function. The continued advances in medical and dental technology have further contributed to the excellent outcomes that are now achieved.

Vertical changes in patients with complete unilateral and bilateral cleft lip, alveolus and palate.

AIMS AND METHODS: Twelve UCLP and eleven BCLP patients who had been treated according to the Hanover treatment protocol were evaluated by means of cephalometric analysis and cast measurements. The aim of this investigation was to demonstrate changes in the vertical plane and in incisor position in the course of craniofacial growth compared to age-matched non-cleft controls. Lateral cephalograms and casts were analyzed for each cleft patient at age 10 and 15 and compared with corresponding data of a non-cleft control group (n = 20). RESULTS: A vertical growth impairment of the maxilla was registered in patients with cleft lip, alveolus and palate. The maxilla of the cleft patients showed a significant clockwise rotation while the inclination of the mandible remained virtually unchanged. Both upper and lower incisors, which were significantly retruded at the beginning of the late mixed dentition, could be protruded in the course of craniofacial growth, development of the dentition and treatment, but remained retruded in comparison with the non-cleft controls. The posterior midfacial height was highly significantly shorter in both UCLP and BCLP patients at both evaluation timepoints, whereas the anterior lower jaw height was greater than in the control group

[Positioning of the premaxilla in cases of bilateral cleft lip, alveolus and palate using Latham's appliance]. / Positionierung der Oberkieferelemente mit der Latham-Appartur bei Patienten mit Lippen-Kiefer-Gaumen-Spalten.

UNLABELLED: SUBJECT MATTER: In cases of bilateral cleft lip, alveolus and palate, preoperative positioning of the premaxilla using Latham's appliance has been described. This method is controversial, since it may cause growth defects. PATIENTS AND METHODS: From 1992 to 2000, Latham's appliance was inserted preoperatively into 20 patients with bilateral lip, alveolus and palate clefts with extreme premaxillary protrusion. Pin fixation ensued at the age of 3 months. After adjustment of the premaxilla, the soft palate was closed and bilateral lip adhesion as well as bilateral gingivoperiosteoplasty were performed directly after the removal of the appliance. Final lip closure took place 4-6 weeks later. At the age of 2 years, the hard palate was closed. Evaluation was based on combined face-maxilla models, standard photographs and, when available, lateral skull x-rays showing the relative position of the segments, the influence of Latham's appliance on the nasal septum and the relation of the upper jaw to the skull base and mandibula. RESULTS: In all cases, a satisfactory alveolar alignment was achieved; thickening and curvature of the nasal septum occurred but receded. Neither growth disturbances nor dental germ damage were seen. In two cases, complications arose from suture dehiscence of the lip adhesion: in one patient, a screw defect caused a loosening of the appliance and there was also a transmigration of the postpremaxillary pin. CONCLUSIONS: On the basis of our experience, the use of Latham's appliance, combined with consistent orthodontic supervision and, if necessary, treatment, represents a practical option for the treatment of bilateral cleft lip, alveolus and palate, especially in cases with extreme protrusion of the premaxilla.