Evaluating SWAG and Its Validity When Compared to 3D Imagery of Secondarily Grafted Cleft Sites.

OBJECTIVE: To test validity of 2D Standardized Way to Assess Grafts (SWAG) ratings to assess 3D outcomes of bone grafting (ABG). PATIENTS: 43 patients (34 UCLP, 9 BCLP) with non-syndromic complete clefts, bone-grafted at mean age 9yrs/3mos, with available post-graft occlusal radiographs and cone beam computed tomography (CBCT) (taken mean 4yrs/9mos post-ABG). MAIN OUTCOME MEASURES: 2D occlusal radiographs rated twice using SWAG by 6 calibrated raters. 12 scores were averaged and converted to a percentage reflecting bone-fill. Weighted Kappas were assessed for SWAG reliability. 3D cleft-site bone volume was calculated by 1 rater using ITK-SNAP. 13 cleft sites were re-measured by the 'one rater' for 3D reliability using Intraclass Correlation Coefficient (ICC). 2D versus 3D ratings were compared using paired t-test, independent samples t-test, Bland-Altman and Linear Regression. Significance level was P = .5. RESULTS: 2D reliability was 0.724 (intra-rater) and 0.546 (inter-rater). 3D reliability was 0.986. Bland-Altman plot comparing 2D vs 3D showed for 45 of 47 graft-sites were within 2 SD's. Mean % bone-fill was 64.11% with 2D and 69.06% with 3D (mean difference = 4.95%) that was a non-significant difference in both t-tests. Regression showed a statistically significant relation between the two methods (r2 = 0.46; P = .0001). CONCLUSION: 2D SWAG systematically and non-significantly underestimated bone-fill. There was a significant correlation between 2D/3D methods. Bland-Altman analysis illustrated the similarity of the two methods. For comparisons of group (cleft treatment Centers') bone grafting outcomes, the 2D method may suffice as a proxy for the 3D method. However, with individual variation up to 40% in 2D estimates of actual 3D volume, 2D SWAG method cannot be used in place of 3D images.

Association between incisor irregularity and coronal caries: A population-based study.

INTRODUCTION: The objective of this study was to investigate the association between incisor irregularity and anterior coronal caries by means of an arch-specific analysis among the U.S. population in the National Health and Nutritional Examination Survey (NHANES III) 1988-1994. METHODS: This study analyzed data from 9049 participants who were surveyed from 1988 to 1994 as a part of the NHANES III. Participants with a complete set of fully erupted permanent anterior teeth in the maxillary and mandibular segments (ie, canine to canine), who completed an examination of occlusal characteristics and anterior dental caries, and who reported no previous orthodontic treatment were included in the study. Incisor irregularity per arch was determined with the use of the Little irregularity index. Anterior coronal caries per arch was defined as ≥1 surface with decayed or filled surface (CDFS ≥1). Analyses were conducted with the use of chi-square test and logistic regression modeling taking into account the complex sampling design of the survey. RESULTS: In the maxillary arch, 25.1% of the study population had maxillary anterior coronal caries experience (CDFS ≥1), whereas only 5.5% of the study population had mandibular anterior coronal caries experience (CDFS ≥1). In both arches, no statistically significant association between incisor irregularity and anterior coronal caries experience was found. CONCLUSIONS: Maxillary and mandibular incisor irregularity is not associated with anterior dental caries prevalence in a subset of NHANES III data that included mostly highly educated adult participants who were white, of medium socioeconomic status, and with high oral health compliance and oral self-care. Future well designed prospective cohort studies are needed to confirm these results. Clinicians are still encouraged to continue providing oral health education to their patients about the well established effect of incisor irregularity on plaque retention.

Palatal and Alveolar Tissue Deficiency in Infants With Complete Unilateral Cleft Lip and Palate.

OBJECTIVE: To investigate intrinsic palatal and alveolar tissue deficiency in patients with unilateral cleft lip and palate (UCLP) as compared to age-matched individuals without UCLP using surface area measurements on 3D scans of plaster casts. METHODS: 22 maxillary casts of infants with UCLP from the Wyss Department of Plastic Surgery of NYU Langone Medical Center and 37 maxillary casts from infants without clefts from Sillman's longitudinal study were scanned by Ortho Insight 3D by Motion View Software, LLC (Chattanooga, TN) and measured using Checkpoint software (Stratovan, Davis, CA). The palatal and alveolar surface areas of each cast were measured. The most superior point of the alveolar ridge in front of the incisive papilla and the most superior point of each maxillary tuberosity were connected by a line that ran along the highest part of the alveolar ridge. This line was used to set boundaries for the palatal surface area measurements. The surface areas of greater and lesser segments were measured independently on UCLP casts. A total palatal surface area for the UCLP sample including width of the cleft gap was also measured. RESULTS: There was a statistically significant difference in surface area (P > .001) when we compared the UCLP area of the cleft segments alone with the non-cleft sample. There was a positive correlation (determine the statistical significance) between the surface area of the cleft segments and cleft gap. In addition, there was a statistically significant difference between UCLP plus cleft area and the non-cleft samples in surface area (P < .0001). CONCLUSION: An intrinsic palatal and alveolar tissue deficiency exists in patients born with UCLP. The amount of tissue deficiency for a patient with UCLP should be considered when developing and executing a patient-specific treatment plan.