The Impact of Fan-Type Rapid Palatal Expanders on Speech in Patients With Unilateral Cleft Lip and Palate.

Rapid palatal expanders (RPEs) are commonly used in patients with cleft lip and palate (CLP) prior to secondary alveolar bone grafting (SABG). Their position and size can impede tongue movement and affect speech. This study assessed changes in perception and production of speech over the course of RPE treatment.Prospective longitudinal.Tertiary university-affiliated hospital.Twenty-five patients with unilateral CLP treated with Fan-type RPEs, and their parents.Patient and parent speech questionnaires and patient speech recordings were collected at baseline before RPE insertion (T1), directly after RPE insertion (T2), during RPE expansion (T3), during RPE retention (T4), directly after RPE removal but before SABG (T5), and at short-term follow-up after RPE removal and SABG (T6).Ratings for patient and parent questionnaires, first (F1) and second (F2) formants for vowels /a/, /i/, and /u/, and nasalance scores for non-nasal and nasal sentences, were obtained and analyzed using mixed model analyses of variance.Ratings worsened at T2. For the vowel /a/, F1 and F2 were unchanged at T2. For the vowel /i/, F1 increased and F2 decreased at T2. For the vowel /u/, F1 was unchanged and F2 decreased at T2. Nasalance was unchanged at T2. All outcome measures returned to T1 levels by T4.RPE insertion resulted in initial adverse effects on speech perception and production, which decreased to baseline prior to removal. Information regarding transient speech dysfunction and distress may help prepare patients for treatment.

A Retrospective Longitudinal Treatment Review of Multidisciplinary Interventions in Nonsyndromic Robin Sequence With Cleft Palate.

OBJECTIVE: To document and analyze the overall longitudinal institutional treatment experience of children with nonsyndromic Robin sequence (RS) from infancy to early adulthood. DESIGN: Retrospective longitudinal treatment review. SETTING: A tertiary-care, referral, teaching hospital. PATIENTS: Children with nonsyndromic RS and cleft palate (N = 117) born between December, 1985, and January, 2012. INTERVENTIONS: Data regarding airway management, nutritional management, audiological interventions, orthodontic treatment, and surgical interventions were documented and analyzed in different growth/developmental stages. Comparative data from other international centers were collected from the literature. RESULTS: Airway management during infancy involved prone positioning (92%), nasopharyngeal airway (6%), tracheostomy (2%), and mandibular distraction osteogenesis (1%). Feeding with nasogastric, gastrostomy, and/or gastrojejunostomy tubes was used in 44%, Haberman feeders in 53%, and Mead Johnson feeders in 3%. Gastroesophageal reflux disease was documented in 6% of the sample. During childhood and early adolescent years, pharyngeal flap surgery was carried out in 22% of the children, while 11% had secondary palatal surgery. Audiological management included the use of tympanostomy tubes in 62%, with several children needing multiple tube replacements. At least 18% were diagnosed with obstructive sleep apnea. Adenoidectomy or adenotonsillectomy was undertaken in 4%. Analysis of data pertaining to middle childhood and adolescent years showed that orthodontic treatment was conducted for most children for crowding, tooth agenesis, and skeletal and/or dental dysplasia. Orthognathic surgery frequency (<18%) was low. CONCLUSIONS: Institutional treatment experience of children with nonsyndromic RS involves multidisciplinary care at different ages and stages of their development.

Eruption path of permanent maxillary canines after secondary alveolar bone graft in patients with nonsyndromic complete unilateral cleft lip and palate.

INTRODUCTION: Successful eruption of the maxillary canine after secondary alveolar bone grafting (SABG) improves dentoalveolar outcomes in the final occlusal rehabilitation of patients with cleft lip and palate (CLP). We aimed to study eruptive positions of the maxillary canine in CLP post-SABG. METHODS: This retrospective longitudinal study included 27 patients with complete unilateral CLP who received standardized SABG from the same surgeon. Rigorous selection criteria enabled a relatively homogeneous sample. Using panoramic radiographs, angulation, horizontal and vertical positions of the maxillary canines were recorded 3 times. Linear proportions along with sectorial methods were used. Linear regression and t tests were performed to assess and compare the position of the canine on the cleft side (CS) and noncleft side from pre-SABG (T1) to a minimum 2 years post-SABG (T3); to evaluate its displacement and identify predictors for its impaction, and to analyze the characteristics of the impacted canines vs the nonimpacted canines at T3. RESULTS: The CS maxillary canine was more acutely angulated and more apically positioned than the noncleft side canine at all times. It was relatively more distally positioned at T1 and exhibited significantly greater mesial movement from T1 to T3 (P <0.0001). Canine impaction on the CS was associated with a more apical position at 1-year post-SABG (P = 0.022) and a more acute angulation of this tooth. CONCLUSION: More acute angulation and more apical position of the CS maxillary canine before SABG may be associated with an increased risk of its impaction after SABG.

Efficacy and safety of different interventions to accelerate maxillary canine retraction following premolar extraction: A systematic review and network meta-analysis.

Decreasing orthodontic treatment duration is at the forefront of innovation for clinical orthodontics. This network meta-analysis aimed to determine the relative efficacy and safety of treatments for accelerated orthodontic tooth movement (OTM) in patients undergoing extraction of maxillary first premolars followed by canine retraction in any orthodontic setting. MEDLINE, EMBASE, Cochrane CENTRAL, CINAHL and SCOPUS were searched (from inception to 20 April 2020). Study selection and data extraction were performed in duplicate. Eligible randomized controlled trials (RCTs) were meta-analysed to estimate the rate of tooth movement, 95% credible interval and surface under the cumulative ranking curve (SUCRA) in the first 3 months following the application of the adjunctive accelerative method. Eligible RCTs were assessed by Cochrane risk of bias tool, and quality of evidence was assessed by GRADE approach, obtained from CINeMA web application. Interventions were ranked for efficacy and reviewed for safety. Nineteen studies pertaining to eight interventions, with data from 415 patients were included. Quality of evidence was very low to moderate. Very low-to low-quality evidence suggests that corticotomy is an efficacious and safe adjunctive treatment to accelerate OTM in comparison with conventional treatment in the first 2 months of treatment. Low-quality evidence suggests that piezocision and micro-osteoperforations (MOP) are efficacious and safe adjunctive treatments only in the first month of treatment. Frequent MOP in conjunction with low-level laser therapy appeared to be an efficacious and safe adjunctive treatment only in the first month following its initial application but not thereafter.

Infective endocarditis and orthodontic implications in children: A review of the literature.

INTRODUCTION: Owing to access to high-quality medical care, more medically compromised patients are seeking orthodontic therapy, including those at risk of developing infective endocarditis (IE). The current guidelines for orthodontic therapy and IE are few. The objective of this review is to provide an evidence-based update on the relationship between orthodontic procedures and IE in children. METHODS: A comprehensive review of the English language literature available through PubMed, Ovid Medline, and Google Scholar without any limits of years of publication was conducted to analyze the evidence regarding IE and orthodontics. LITERATURE REVIEW: A necessary prerequisite for IE is bacteremia. Although the only orthodontic procedure included in the current American Heart Association guidelines is the placement of bands, placement of separators has also been found to lead to significant bacteremia. Procedures with possible clinical significance include removal of expanders, placement of separators, and placement of bands. Because of the unavailability of high-quality evidence, elective invasive procedures prone to causing bacteremia should be avoided. CONCLUSIONS: Evidence regarding orthodontic treatment and IE is limited because of ethical considerations of conducting trials in patients who are at risk for IE. Clinical interpretation based on a comprehensive review of the available literature is therefore essential. CLINICAL IMPLICATIONS: Before initiating orthodontic therapy in cardiac patients, the patient's IE risk is best determined by referring to the current American Heart Association guidelines and through consultation with the patient's cardiologist. Procedures that can lead to tissue injury or bacteremia should be avoided. Oral hygiene must be reinforced because inflammation influences bacteremia.

Comparison of dental outcomes in patients with nonsyndromic complete unilateral cleft lip and palate who receive secondary alveolar bone grafting before or after emergence of the permanent maxillary canine.

INTRODUCTION: For patients with complete unilateral cleft lip and palate (CUCLP), secondary alveolar bone grafting (SABG) can be performed before or after the emergence of the cleft side permanent canine (pre-CE and post-CE, respectively). The controversy regarding dental outcomes related to the timing of SABG remains unsettled. The objective of this study was to evaluate dental survival and specific dental outcomes of cleft-adjacent teeth in children with CUCLP who received either pre-CE or post-CE SABG. METHODS: The permanent maxillary canines and the central and lateral incisors of 21 pre-CE and 23 post-CE SABG subjects with nonsyndromic CUCLP and all cleft-related surgeries performed by the same surgeon were analyzed retrospectively. Intraoral radiographs and clinical chart notes were collected at age 7 years, at the time of the SABG, and approximately 4 years after the grafting. Dental survival, spontaneous canine eruption, planned prosthetic replacement, root development, and root resorption were analyzed. RESULTS: Dental outcomes on the noncleft side were better than those on the cleft side. On the cleft side, dental survival of the cleft-adjacent teeth was not significantly different between the pre-CE and post-CE SABG groups (P >0.05). Most teeth completed root development after grafting, and the cleft side canine root development in the pre-CE SABG group appeared to accelerate after SABG. Trends showed that the pre-CE SABG group suffered less root resorption (16.28%; post-CE: 22.73%; P >0.05) and received fewer planned prosthetic replacements (14.29%; post-CE: 26.01%; P >0.05) but required a greater number of canine exposures (33.33%; post-CE: 4.55%; P = 0.02). CONCLUSIONS: Pre-CE SABG showed better dental outcomes in patients with CUCLP, with fewer adverse dental outcomes than post-CE SABG.

Impacts of oligodontia on oral health-related quality of life reported by affected children and their parents.

BACKGROUND: Oligodontia (agenesis of six or more permanent teeth) affects functional, emotional, and social aspects of an individual's life. Few published studies have evaluated oral health-related quality of life (OHRQoL) in children with oligodontia and very limited have compared the child and parental perceptions. METHODS: Thirty-five 8- to 18-year-old patients with oligodontia (10 M, 25 F; mean age: 12.4 ± 2.9 years; mean number of permanent teeth missing due to agenesis: 8.9 ± 3.2) recruited from The Hospital for Sick Children, Toronto, and Holland Bloorview Kids Rehabilitation Hospital, Toronto, and their parents completed the short format of Child Perception Questionnaire (CPQ11-14) and the Parent Child Perception Questionnaire, respectively. RESULTS: Children reported significantly worse overall CPQ score than their parents. Correlations between children's and parents' overall CPQ score, oral symptoms and functional limitations, and social well-being were not statistically significant. However, as children's emotional well-being score increased, parents' score also increased. There was no association between child CPQ score and age, gender, number, and location of permanent tooth agenesis in this sample. There was a significant correlation between overall CPQ score and Site-Specific Tooth Absences. CONCLUSION: Children's overall CPQ score and domain scores were significantly worse than their parents indicating that children with oligodontia had poorer OHRQoL compared to what was perceived by their parents.

Anterior open bite due to idiopathic condylar resorption during orthodontic retention of a Class II Division 1 malocclusion.

A common dilemma when treating anterior open bite is understanding its etiology. Idiopathic condylar resorption (ICR) can cause open bite in affected individuals. Although it is prudent to not treat patients with ICR until active resorption has ceased, orthodontists may begin treating them because anterior open bite from ICR may not appear before or during their orthodontic treatment. This article reports a 12-year-old female who was diagnosed with ICR 10 months after completion of her orthodontic treatment for a Class II Division 1 malocclusion. When a young patient with a high mandibular angle and previous skeletal or dental Class II malocclusion returns with an open bite during the retention phase, the patient's condyles must be carefully examined to determine whether any temporomandibular joint disorder, such as ICR, is present. Currently, the controversy over the cause and the cure for ICR is continuing to challenge orthodontists in diagnoses and treatments. Orthodontists should closely monitor and offer informed treatment options to patients with risk factors for ICR or signs of its pathology that might develop at any stage of orthodontic treatment, including the retention period.

Effects of orthodontic appliances on the diagnostic quality of magnetic resonance images of the head.

INTRODUCTION: The influence of 4 commonly used fixed orthodontic appliances on artifact formation and diagnostic quality of magnetic resonance (MR) images of the head produced by a 3-T MR scanner was studied. METHODS: Stainless steel brackets, ceramic brackets, combination of ceramic brackets and steel molar tubes, and multistranded steel mandibular lingual retainers were embedded into custom-made trays for each of 10 adult subjects. Head MR scans of 9 regions were acquired for each subject wearing these trays. Sagittal T1-weighted, axial T2-weighted, axial gradient-recalled, axial diffusion-weighted, noncontrast axial MR angiography, and axial fluid-attenuated inversion recovery MR sequences were included. Two neuroradiologists evaluated image distortions and diagnostic qualities of the 1314 acquired images (13860 image slices). RESULTS: The images were affected by appliance, head region, and MR sequence. Stainless steel brackets and molar tubes affected the images the most, and ceramic brackets caused minimal image distortion. CONCLUSIONS: Head MR images are differentially affected by orthodontic appliances. The appliance, region imaged, and MR sequence should be considered before imaging patients wearing fixed orthodontic appliances.

Increase in sagittal depth of the bony nasopharynx following maxillary protraction in patients with unilateral cleft lip and palate.

Objective : To study the change in the sagittal depth of the bony nasopharynx in patients with unilateral cleft lip and palate (UCLP), following maxillary protraction using reverse headgear. Methods : Nineteen patients (14 male, five female; aged 9.36 ± 2.89 years) with repaired complete UCLP underwent maxillary protraction with a Delaire type reverse headgear at a tertiary-care referral teaching hospital. Control data were taken from five patients (four male, one female; aged 8.25 ± 2.25 years) who did not receive any orthopedic/orthodontic treatment for a similar duration of time as the treated patients. Average treatment/observation period was 11.71 ± 3.39 months for the treated patients and 12.40 ± 2.60 months for the untreated subjects. Changes in the sagittal bony nasopharynx depth were measured by comparing pretreatment (T1) and posttreatment (T2) lateral cephalograms. Correlations between the changes in the bony nasopharynx depth and in other variables measured in the treated patients were analyzed. An exploratory analysis of differences in the changes from T1 to T2 between the treated patients and untreated subjects was also conducted. Results : The favorable skeletal changes seen in SNA and ANB following maxillary protraction were accompanied by a significant increase in the sagittal depth of bony nasopharynx (1.74 ± 1.10 mm; P < .001). This change was significant when compared with the data from the untreated subjects (P = .004). Correlations between the increase in bony nasopharynx depth and changes in other variables studied in the treated patients were weak and not statistically significant. Conclusion : Sagittal depth of the bony nasopharynx in patients with repaired UCLP increased following maxillary protraction therapy using reverse headgear.