Elastic Chain Premaxillary Retraction Appliance Does Not Increase Inter-Canthal Dimension in Patients with Bilateral Cleft Lip and Palate.

OBJECTIVE: To determine if the elastic chain premaxillary retraction (ECPR) appliance increases inter-medial and inter-lateral canthal dimension in patients with bilateral complete cleft lip and palate (BCLP). DESIGN: Retrospective cohort study. SETTING: Specialized tertiary care facility. PATIENTS, PARTICIPANTS: 126 patients with BCLP; 75 had ECPR, 51 had no pre-surgical manipulation. INTERVENTIONS: Three-dimensional facial photographs were obtained prior to insertion of appliance (T0), post-appliance therapy prior to appliance removal/labial repair (T1), and several months after labial repair (T2) for a longitudinal ECPR group, and were obtained after age 4 years (T3) for a non-longitudinal ECPR group and for the non-ECPR group. MAIN OUTCOME MEASURES: Inter-medial and inter-lateral canthal dimension (en-en, ex-ex) was determined for all groups/time-points. Measurements were compared between groups and to norms. RESULTS: The mean en-en and ex-ex was 32.6 ± 3.2 mm and 84.4 ± 6.3 mm for the ECPR group and 33.5 ± 3.1 mm and 86.7 ± 7.2 mm for the non-ECPR group at T3. Inter-medial and inter-lateral canthal dimensions were significantly greater than normal (P < .05) in both groups; there was no significant difference between groups (P > .05). The mean en-en and ex-ex for the Longitudinal ECPR group was 27.5 ± 2.4 mm and 66.7 ± 3.7 mm at T0, 29.6 ± 2.4 mm and 70.4 ± 2.9 mm at T1, and 29.2 ± 2.3 mm and 72.3 ± 3.8 mm at T2. en-en and ex-ex increased significantly from T0-T1 (P < .05), decreased at T2 (P > .05) and was significantly larger than normal at all time-points (P < .05). CONCLUSIONS: Inter-medial and inter-lateral canthal dimension increased after ECPR but returned to baseline growth trajectory. These dimensions were above normal at all time-points. There was no difference between those that did and did not have dentofacial orthopedic manipulation.

Craniofacial Anthropometry: Normative Data for Caucasian Infants.

PURPOSE: Craniofacial anthropometry is a valuable tool for characterization of facial dysmorphology and evaluation of treatment outcomes. Databases of normal anthropometric ranges are limited for infants. The aim of this study is to establish normative data for craniofacial anthropometric measurements in Caucasian infants. METHODS: This is a prospective cross-sectional study including Caucasian infants (≤12 months old) that were recruited from a pediatric medicine practice and Boston Children's Hospital. Infants with craniofacial deformities, trauma or operations were excluded. The sample was stratified by age (in months) into 4 groups: 0 to 3, 3.1 to 6, 6.1 to 9, and 9.1 to 12. Three dimensional (3D) photographs were obtained for all subjects. Forty-five standard anthropometric points were plotted, and 37 measurements were made on the 3D photographs. Two evaluators independently performed all measurements. One examiner repeated the measurements on 25% of the subjects. Intraclass correlation coefficients (ICC) were calculated to assess inter-rater and intra-rater agreement. RESULTS: Thirty-three subjects were enrolled in the study. The mean age for the entire sample was 6.3 ±â€Š3.0 months, and 17 subjects (52%) were female. The mean ages (months) for each group were: 1.9 ±â€Š0.7 for group 1 (n = 6); 4.4 ±â€Š0.7 for group 2 (n = 8); 7.5 ±â€Š1.1 for group 3 (n = 11); and 9.9 ±â€Š1.0 for group 4 (n = 8). Descriptive statistics are presented for each group. Inter- and intra-rater agreements were acceptable (ICC >0.6) for 21 anthropometric measurements. CONCLUSIONS: This study generated normative craniofacial anthropometric measurements for Caucasian infants. These data can be used in the interpretation of measurements for research studies evaluating craniofacial anomalies in this population.

Changes in the Vertical Dimension After Orthodontic Treatment in Response to Different Premolar Extraction Patterns.

INTRODUCTION: Premolar extractions in orthodontics can relieve dental crowding and affect incisor inclination. The aim of this retrospective study was to compare changes to the facial vertical dimension after orthodontic treatment with different premolar extraction patterns and non-extraction treatment. METHODS: This was a retrospective cohort study. The pre-and post-treatment records of patients with at least 5.0mm of dental arch crowding were accessed. Patients were divided into three groups: Group A, patients who had four first premolars extracted during their orthodontic treatment; Group B, patients who had four second premolars extracted during their orthodontic treatment; and Group C, patients with no extractions during orthodontic treatment. The pre-and post-treatment skeletal vertical dimension measured through the mandibular plane angle, as well as the incisor angulations/positions, were measured on lateral cephalograms and compared between groups. Descriptive statistics were computed and statistical significance was set at p<0.05. A one-way ANOVA test was conducted between groups to assess for statistically significant differences in changes to the mandibular plane angle and incisor positions/angulations. Post-hoc statistical analyses were performed between groups for parameters showing significant differences. RESULTS: One-hundred twenty-one patients were included (47 males and 74 females) with ages ranging from 9 years old to 26 years old. Mean upper dental crowding ranged from 6.0 to 7.3mm and mean lower crowding ranged from 5.9-7.4mm across groups. There were no significant differences in mean age, mean treatment length, or mean dental arch crowding in each arch across groups. There were no significant differences in changes to the mandibular plane angle across all three groups regardless of the extraction pattern or non-extraction during orthodontic treatment. The upper and lower incisors were significantly retracted in groups A and B and significantly protracted in group C post-treatment. The upper incisors retroclined significantly more in Group A than Group B and proclined significantly in Group C. CONCLUSION: No differences in the vertical dimension and the mandibular plane angle were observed when extracting first versus second premolars and in non-extraction treatment. Significant changes to the incisor inclinations/position were observed depending on the extraction/non-extraction pattern executed. Different premolar extraction patterns during orthodontic treatment do not influence changes to the vertical dimension. Clinicians should make extraction decisions based on desired outcomes for incisors rather than controlling the vertical dimension.

The efficacy of anterior open bite closure when using Invisalign's optimized extrusion versus conventional attachments.

BACKGROUND: Clear aligners are reported to control anterior open bites. Despite this, anterior extrusion remains difficult with aligners. Optimized extrusion attachments on incisors may facilitate anterior extrusion to correct open bite with Invisalign. The aim of this retrospective study was to compare the efficacy of anterior open bite correction with Invisalign when using optimized extrusion versus conventional attachments. METHODS: This was a retrospective cohort study. The pre- and post-treatment intraoral scans of patients with anterior open bite treated with Invisalign aligners were assessed. Patients were divided into two groups: group A, patients with horizontal conventional attachments and group B, patients with optimized extrusion attachments on incisors. The pre and post-treatment overbite and the planned overbite change were measured and compared between the groups. Descriptive statistics were computed and statistical significance was set at P < 0.05. RESULTS: A total of 86 patients were included. Both groups showed significant increases in overbite, but there was no difference in the open bite correction efficacy in patients with conventional versus optimized attachments. Shorter treatment times for open bite closure were reported for patients with optimized attachments. CONCLUSIONS: Anterior open bite can be corrected regardless of the attachment type. Optimized attachments are no more effective than using conventional attachments in incisor extrusion to correct open bite. Patients with anterior open bite with optimized attachments observed shorter treatment times for overbite correction. When correcting anterior open bite with Invisalign, the attachment type does not improve the success rate. Optimized extrusion attachments on incisors may shorten the treatment time compared to conventional attachments.

Quantifying the efficacy of overbite reduction in patients treated with clear aligners using optimized versus conventional attachments.

BACKGROUND: Deep overbite has been shown to be difficult to correct with clear aligners. Optimized deep bite attachments are reported to facilitate deep bite correction with aligners. The aim of this retrospective study was to quantify the efficacy of deep bite correction with aligners when using optimized versus conventional attachments. METHODS: This was a retrospective cohort study. The pretreatment and post-treatment intraoral scans of patients with deep overbite treated with Invisalign clear aligners were accessed. Patients were divided into two groups: group A, patients treated with conventional attachments, and group B, patients treated with optimized attachments. Pre and post-treatment overbite and the planned overbite reduction were measured and compared between groups. Descriptive statistics were computed, and statistical significance was set at P < 0.05. RESULTS: Seventy-eight patients were included. There was no statistically significant difference in overbite reduction between patients who had conventional versus optimized attachments. The amount of overbite reduction observed post-treatment was found to be no more than 33-40% of the planned amount of overbite reduction across all patients and groups. CONCLUSIONS: Deep overbite correction with aligners remains difficult regardless of the type of attachment used. Optimized attachments are no more effective than using conventional attachments in reducing deep overbite. The amount of overbite reduction expected with clear aligners is significantly lower than the planned overbite reduction. PRACTICAL IMPLICATIONS: When correcting deep bite with clear aligners, the attachment type does not improve the success rate. Clinicians should plan to overcorrect deep bite reduction to expect only 33% to 40% of their planned final overbite to be actually expressed.

Augmentation of the Median Tubercle with Dermis-Fat Graft in Children with Repaired Cleft Lip.

BACKGROUND: Deficiency of the median tubercle is a common residual deformity after repair of cleft lip. The purpose of this study was to analyze the change in labial contour after insertion of a dermis-fat graft. METHODS: Patients with repaired cleft lip who underwent secondary dermis-fat grafting of the median tubercle between 2012 and 2015, along with preoperative and greater than or equal to 3-month postoperative three-dimensional photographs, were included. The photographs were registered to one another and measurements made before and after grafting using anthropometric landmarks. Outcome variables included the following: labial surface area, midline labial height (ls-sto), and lateral labial height (cphi-sto'). RESULTS: Twenty-five patients were included: 14 with unilateral and 11 with bilateral repaired cleft lip. Mean age at graft placement was 10.9 ± 3.2 years. Preoperative and postoperative three-dimensional images were taken at 13.6 ± 21.6 weeks before and 34.8 ± 25.1 weeks after the procedure, respectively. There were significant increases in labial surface area (11.5 percent; p = 0.019) and labial height (14.1 to 18.5 percent; p = 0.002) after grafting. Augmentation was greater in bilateral clefts (25.5 percent at midline and 16.8 percent laterally) compared with unilateral clefts (11.6 percent at midline and 12.5 percent on the grafted noncleft side). Intrarater and interrater reliability was excellent for all measurements. CONCLUSION: Dermis-fat grafting significantly increases contour of the median tubercle in patients with repaired cleft lip. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.