Assessing the Recordkeeping Quality at the School of Dental Sciences, Universiti Sains Malaysia.

INTRODUCTION:  Dental records are an essential part of dental practice. The quality of dental recordkeeping is paramount in ensuring the delivery of high-quality dental care and is also important for medico-legal reasons. Should there be any dispute or need for review, detailed and well-maintained records can provide evidence of the care provided and the decision-making process. OBJECTIVE: The study aimed to assess the quality of dental recordkeeping and dental charting practice at the dental clinic School of Dental Sciences. METHODS: The study was conducted in a retrospective manner reviewing dental records of patients treated by specialists, dental officers, and postgraduate and undergraduate students at the Hospital Universiti Sains Malaysia over a five-year period. Eight key components of clinical dental records i.e. date of charting, legibility on the odontogram, no blank on the odontogram, whether any mistakes have been strikethrough and initials, medical history, dental history, investigation, and treatment plan were assessed. A modified CRABEL scoring system was used to assess the quality of data retrieved from dental records. RESULTS: The study involved the analysis of 324 case files. Among these, 90 files obtained scores ranging from 60% to 80%, with 7.7% attributed to undergraduates, 9.6% to dental officers, 6.8% to postgraduates, and 3.7% to specialists. The remaining 234 files achieved scores between 80% and 100%, with a breakdown of 17% from undergraduates, 15.4% from dental officers, 18.2% from postgraduates, and 21.3% from specialists. CONCLUSION:  Even though the overall quality of recordkeeping in this study is good, with most records achieving a CRABEL score of 80% and above, it's important to acknowledge that ideally, each component assessed should achieve a perfect score of 100%, as it will reflect the practitioners's work.

Potential use of the cusp and crown areas of the maxillary posterior teeth measured with a two-dimensional stereomicroscope for sex determination.

In this study, we aimed to compare the cusp and crown areas of the maxillary first premolar (PM1), second premolar (PM2), and first molar (M1) in males and females in the Malay population and to formulate sex prediction models. For this purpose, the maxillary posterior teeth of 176 dental cast samples (from 88 males and 88 females) were selected and transformed to two-dimensional digital models using 2D-Hirox KH-7700. Cusp and crown area measurements were obtained using Hirox software by tracing the outermost circumference of the tooth cusps. Statistical analysis included independent t-tests, logistic regression analysis, and receiver-operating characteristic (ROC) curves as well as determination of sensitivity and specificity; analysis was performed with SPSS version 26.0. The significance threshold was set at 0.05. All crown and cusp area measurements were significantly larger in males than in females (p < 0.001). The most sexually dimorphic tooth was the first maxillary molar (mean difference, 10.27 mm2), and the most sexually dimorphic cusp was the mesiopalatal cusp (mean difference, 3.67 mm2) of M1. The sex prediction model had a good accuracy, with 80% of selected cases correctly predicted. Hence, we conclude that the maxillary posterior teeth in the Malay population exhibit significant sexual dimorphism, and this information may be used for sex determination as adjuvants along with other procedures.

Application of two systems to classify the root and canal morphology in the human dentition: A national survey in India.

PURPOSE: To assess the application and accuracy of two systems (Vertucci et al. 1974 and Ahmed et al. 2017) in classifying the root and canal morphology of human dentition among final-year undergraduates, interns, and postgraduate dental students in India. METHODS: The survey was conducted using physical and online presentation modes in two phases. Phase 1; PowerPoint presentation (PPT), describing the most used classification system (Vertucci et al. 1974) and its supplementary types and Ahmed et al. (2017) classification. A single presenter delivered the PPT to participants, using either a projector in an auditorium/seminar hall (face-to-face) or an online platform (zoom meeting software). Phase 2 involved determining the students' responses. A questionnaire was distributed amongst the participants after the lecture and collected for analysis. Fisher's exact test was used to analyze the data statistically, and the significance level was set at 0.05 (p < 0.05). RESULTS: A total of 1082 participants were involved in this survey. Overall, 93% of study participants found that Ahmed et al. classification system was more practical and accurate than Vertucci et al. system and its supplemental configurations (p < 0.001). About 97% agreed that Ahmed et al. classification system aided in understanding root and canal morphology better than Vertucci's and its additional configurations, and they recommended to include in their curriculum (p < 0.001). CONCLUSIONS: In comparison to Vertucci's classification system and supplementary types, the undergraduate and postgraduate dental students, and interns in India agreed that Ahmed et al. classification system is more practical and accurate for classifying the root and canal morphology.

Effects of Low-Level Laser Therapy and Bracket Systems on Root Resorption during Orthodontic Treatment: A Randomized Clinical Trial.

This study aimed to assess the outcomes of low-level laser therapy (LLLT) with the conventional bracket (CB) and self-ligating (SL) bracket systems on root resorption (RR) during orthodontic treatment. A total of 32 patients were included in this randomized clinical trial. All the patients were randomly divided into four individual groups (SLL: self-ligating laser, CBL: conventional bracket laser, SLNL: self-ligating non-laser, CBNL: conventional bracket non-laser). RR was measured from the cone-beam computed tomography (CBCT) radiographs which were taken at two stages of the orthodontic treatment: pre-treatment (T1) and after leveling and alignment stage (T2). Wilcoxon rank test for the comparison was conducted to compare the RR at T1 and T2 stages within each group and showed a significant difference (p < 0.05) for various variables. Mann Whitney test compared the RR in laser and non-laser groups irrespective of the bracket systems and exhibited no significant differences except the left lateral incisor. Moreover, CB and SL groups showed no significant difference in RR among any tooth. Kruskal Wallis test was performed to compare the RR among all groups which presented no significant differences. LLLT and bracket systems have no consequences on RR until the leveling and alignment stage of orthodontic treatment.

Validity and reliability of palatal rugae morphometric assessment with 3D laser scanned models

Aim: To assess the reliability and validity of morphometric features on 3D digital models produced by scanning maxillary dental casts of Malaysian Malay subjects. Methods: Dental casts of 20 subjects were scanned using a 3D laser scanner (Next Engine Inc., Santa Monica, California, USA). The palatal rugae morphometric features were assessed on the resulting 3D models using 3-Matic Research 9.0 software (Materialise NV, Heverlee, Belgium). The assessments were repeated by the first and second authors to assess the intra- and interexaminer reliability, respectively. Rugae morphometric features were also evaluated on the conventional plaster models to assess the validity of the 3D method. Results: Kappa values of the validity ranged from 0.807 to 0.922 for rugae shape, size category and direction. The intraclass correlation coefficient (ICC) for rugae number validity was 0.979. For intra-examiner reliability, kappa values ranged from 0.716-1.000 for rugae shape, size category and direction. The ICC for rugae number intra-examiner reliability was 0.949. Kappa values of interexaminer reliability for rugae shape, size category and direction were 0.723-885, while the ICC of rugae number was 0.896. Conclusion: Palatal rugae analyses on 3D digital models scanned by the 3D Next Engine laser scanner using 3-Matic Research 9.0 software are valid and reliable

The Assessment of 3D Digital Models Using GOSLON Yardstick Index: Exploring Confounding Factors Responsible for Unfavourable Treatment Outcome in Multi-Population Children With UCLP.

To evaluate dental arch relationship (DAR) using GOSLON Yardstick and also to explore the association between multiple factors (age, gender, UCLP types, UCLP side, Family history of cleft, family history of Class III malocclusion, techniques of cheiloplasty, techniques of palatoplasty) and DAR in children unilateral cleft lip and palate (UCLP) in different populations. Two hundred fifty-five laser scanned 3D digital models (LS3DM) of UCLP children (5-12 years) from Malaysia, Bangladesh, and Pakistan were included. The intra- and inter-examiner agreements were evaluated by kappa statistics, to compare the GOSLON mean score between the populations and to explore the responsible factors that affect DAR, one way ANOVA, and crude logistic regression analysis was used, respectively. The mean GOSLON score was 2.97; 3.40 and 3.09 in Malaysia, Bangladesh, and Pakistan, respectively. Twenty seven, 40, and 30 subjects were in unfavourable (category rating 4 and 5) groups in Malaysia, Bangladesh, and Pakistan, respectively. A significant association was found between techniques of palatoplasty (p = 0.03; p = 0.04 and p = 0.04 in Malaysia, Bangladesh, and Pakistan, respectively) and unfavourable DAR. Different cheiloplasty techniques (p = 0.04) and gender (p = 0.03) also exhibited noteworthy associations with unfavourable DAR in the Bangladeshi population. Bardach techniques of palatoplasty were significantly associated with unfavourable DAR in all three populations. Moreover, male UCLP and modified Millard techniques of cheiloplasty were also associated with unfavourable DAR in the Bangladeshi population.

Photobiostimulatory Effect of a Single Dose of Low-Level Laser on Orthodontic Tooth Movement and Pain.

Objective: To assess the effect of low-level laser applied at 3 weeks intervals on orthodontic tooth movement (OTM) and pain using conventional brackets (CB). Materials and Methods: Twenty patients with Angle's class II div 1 (10 males and 10 females; aged 20.25 ± 3.88 years) needing bilateral extractions of maxillary first bicuspids were recruited. Conventional brackets MBT of 0.022 in slot (McLaughlin Bennett Trevisi) prescription braces (Ortho Organizers, Carlsbad, Calif) were bonded. After alignment and levelling phase, cuspid retraction began with nitinol closed coil spring on 19 × 25 stainless steel archwire, wielding 150 gram force. 7.5 J/cm2 energy was applied on 10 points (5 buccal and 5 palatal) on the canine roots on the investigational side using gallium-aluminum-arsenic diode laser (940 nm wavelength, iLase™ Biolase, Irvine, USA) in a continuous mode. Target tissues were irradiated once in three weeks for 9 weeks at a stretch (T0, T1, and T2). Patients were given a feedback form based on the numeric rating scale (NRS) to record the pain intensity for a week. Silicon impressions preceded the coil activation at each visit (T0, T1, T2, and T3), and the casts obtained were scanned with the Planmeca CAD/CAM™ (Helsinki, Finland) scanner. Results: The regimen effectively accelerated (1.55 ± 0.25 mm) tooth movement with a significant reduction in distress on the investigational side as compared to the placebo side (94 ± 0.25 mm) (p < 0.05). Conclusions: This study reveals that the thrice-weekly LLLT application can accelerate OTM and reduce the associated pain.

Biostimulatory Effects of Low-Intensity Pulsed Ultrasound on Rate of Orthodontic Tooth Movement and Associated Pain, Applied at 3-Week Intervals: A Split-Mouth Study.

Objective: Low-intensity pulsed ultrasound (LIPUS) is a noninvasive modality to stimulate bone remodeling (BR) and the healing of hard and soft tissues. This research evaluates the biostimulatory effect of LIPUS on the rate of orthodontic tooth movement (OTM) and associated pain, when applied at 3-week intervals. Methods: Twenty-two patients (11 males and 11 females; mean age 19.18 ± 2.00 years) having Angle's Class II division 1 malocclusion needing bilateral extractions of maxillary first bicuspids were recruited for this split-mouth randomized clinical trial. After the initial stage of alignment and leveling with contemporary edgewise MBT (McLaughlin-Bennett-Trevisi) prescription brackets (Ortho Organizers, Carlsbad, Calif) of 22 mil, followed by extractions of premolars bilaterally, 6 mm nickel-titanium spring was used to retract the canines separately by applying 150 g force on 0.019 × 0.025-in stainless steel working archwires. LIPUS (1.1 MHz frequency and 30 mW/cm2 intensity output) was applied for 20 minutes extraorally and reapplied after 3 weeks for 2 more successive visits over the root of maxillary canine on the experimental side whereas the other side was placebo. A numerical rating scale- (NRS-) based questionnaire was given to the patients on each visit to record their weekly pain experience. Impressions were also made at each visit before the application of LIPUS (T1, T2, and T3). Models were scanned with a CAD/CAM scanner (Planmeca, Helsinki, Finland). Mann-Whitney U test was applied for comparison of canine movement and pain intensity between both the groups. Results: No significant difference in the rate of canine movement was found among the experimental (0.90 mm ± 0.33 mm) and placebo groups (0.81 mm ± 0.32 mm). There was no difference in pain reduction between experimental and placebo groups (p > 0.05). Conclusion: Single-dose application of LIPUS at 3-week intervals is ineffective in stimulating the OTM and reducing associated treatment pain.

Comparison of Soft Tissue Changes Produced by Two Different Appliances on Mixed Dentition Children.

OBJECTIVE: This study was focused on comparing and analyzing the soft tissue changes induced by Reverse Twin-Block (RTB) and Reverse Pull Face Mask (RPFM) in early and late mixed dentition Malay children having Class III malocclusion. METHODS: This cross-sectional study includes a total sample of 95 Malay children of both early (8-9 years) and late (10-11 years) mixed dentition stages. The comparison was between 49 samples treated by RTB and 46 samples treated by RPFM. Both pre- and posttreatment changes were assessed with Holdaway's analysis using the CASSOS software. In each cephalogram, 71 anatomic landmarks were traced. Descriptive and multiple regression analyses were performed for statistical evaluation. RESULTS: Statistically significant changes were noticed in soft tissue facial angle, subnasale to H-line, skeletal profile convexity, upper lip strain, H-line angle, lower lip to H-line, and inferior sulcus to H-line measurements. Gender disparity was noticed in upper lip strain. Other significant changes were influenced by the type of appliance. However, the mean differences were minute to notice clinically. Age difference did not have any effect on the treatment changes. CONCLUSIONS: RPFM revealed treatment outcome with more protruded upper lip than RTB.

An Investigation of Three-Dimensional Maxillary Arch Morphometry of Children With Unilateral Cleft Lip and Palate.

ABSTRACT: The aim of this study was to evaluate the effects of multiple factors (congenital and postnatal treatment factors) on the treatment outcome by assessing the maxillary arch dimension of children with unilateral cleft lip and palate (UCLP). Eighty-five Pakistani children with UCLP were taken who received cheiloplasty and palatoplasty. Laser scanned 3D digital models of UCLP subjects were prepared before any orthodontic treatment and bone grafting at 7.69 ±â€Š2.46 (mean ±â€Šstandard deviation) years of age. Inter-canine width (ICW), inter-molar width (IMW), and arch depth (AD) measurements of maxillary arch were measured with Mimics software. Multiple linear regression analyses were used to evaluate the association between congenital factors (age, gender, UCLP side, family history of cleft) and postnatal treatment factors (techniques of cheiloplasty and techniques of palatoplasty) with maxillary arch dimensions (ICW, IMW, and AD). P value was set at 5%. The mean (standard deviation) dimensions of ICW, IMW, and AD are 26.7 (5.70) mm, 43.3 (4.66) mm, and 27.1 (5.26) mm, respectively. There is no significant association found between multiple factors and maxillary arch dimensions. This regression analysis shows no significant association between multiple factors and MAD in this sample.

Effects of Multiple Factors on Treatment Outcome in the Three-Dimensional Maxillary Arch Morphometry of Children With Unilateral Cleft Lip and Palate.

Studies have claimed that the maxillary arch dimension of unilateral cleft lip and palate (UCLP) patient is significantly smaller than normal patient. Multiple factors (both congenital and post natal treatment factors) are believed to have an impact on the treatment outcome (maxillary arch retardation) of UCLP patient. The aim of this study was to evaluate the effects of multiple factors on the treatment outcome by assessing the maxillary arch dimension of UCLP Children. Eighty-five Malaysian UCLP children were taken who received cheiloplasty and palatoplasty. Laser scanned 3D digital models of UCLP subjects were prepared before any orthodontic treatment and bone grafting at 7.69 ±â€Š2.46 (mean± SD) years of age. Intercanine width (ICW), intermolar width (IMW), and arch depth (AD) measurements of maxillary arch were measured with Mimics software. Multiple linear regression analyses were used to evaluate the association between multiple factors (gender, UCLP type, UCLP side, family history of cleft, family history of class III malocclusion, techniques of cheiloplasty, and techniques of palatoplasty) and maxillary arch dimensions (ICW, IMW, and AD). P value was set at 5%. Significant association was found between 2 techniques of cheiloplasty and ICW (P = 0.001) and also between 2 techniques of palatoplasty and ICW (P = 0.046) of maxilla. No significant association observed in IMW and AD in relation to all other factors. Modified Millard techniques of Cheiloplasty and Bardach technique of palatoplasty had unfavorable effect on the treatment outcome by assessing the maxillary arch dimension (ICW) using laser scanned 3D digital models in Malaysian UCLP children.

Self-perceived preparedness of undergraduate dental students in dental public universities in Malaysia: A national study.

AIMS: To evaluate the self-perceived preparedness of final-year dental undergraduate students in dental public universities in Malaysia. METHODS: Final-year dental undergraduate students from six dental public universities in Malaysia were invited to participate in an online study using a validated Dental Undergraduates Preparedness Assessment Scale DU-PAS. RESULTS: In total, about 245 students responded to the online questionnaire yielding a response rate of 83.05%. The age range of the respondents was 23-29 years with a mean age of 24.36 (SD 0.797). The total score obtained by the respondents was ranged from 48 to 100 with a mean score of 79.56 (SD 13.495). Weaknesses were reported in several clinical skills, cognitive and behavioural attributes. CONCLUSIONS: The preparedness of undergraduate students at six dental institutions in Malaysia was comparable to students from developed countries. The dental undergraduate preparedness assessment scale is a useful tool, and dental institutions may be used for self-assessment as well as to obtain feedback from the supervisors.

Treatment effects of two different appliances on pharyngeal airway space in mixed dentition Malay children.

BACKGROUND: Treatment of Class III malocclusion is related to redirecting the growth of mandible, which may have an impact on the pharyngeal airway. OBJECTIVE: To evaluate and compare the treatment effect of Reverse Twin-Block (RTB) and Reverse Pull Face Mask (RPFM) on Pharyngeal Airway Space (PAS) in early and late mixed dentition Class III samples. METHODS: Ninety-five mixed dentition Malay children with Class III malocclusion were included in this study. Data consists of 190 pre- and post-treatment lateral cephalograms of early (8-9 years) and late (10-11 years) mixed dentition Class III samples. forty-nine samples were under RTB and forty-six samples were under RPFM. Treatment changes were evaluated by McNamara airway analysis and changes in tongue and hyoid bone position. RESULTS: Both upper and lower pharyngeal airway width were increased after treatment with RTB and RPFM ruling out the chance of airway constriction. There was also posterior positioning of the tongue and hyoid bone indicating mandibular retrusion. No significant treatment changes were found on the Pharyngeal Airway Space by the factor age, gender or type of appliance. CONCLUSIONS: Both RTB and RPFM increased the Pharyngeal Airway Space and produced similar treatment effect. As age does not affect the treatment outcome significantly, treatment can be delayed until late mixed dentition stage.

Treatment Outcome Based on GOSLON Score of Multiple Factors in Unilateral Cleft Lip and Palate Children of Four Different Ethnic

Objective: To evaluate and compare the effect of each congenital and postnatal treatment factors in treatment outcome based on dental arch relationship (DAR) of four different populations at a time using GOSLON yardstick. Material and Methods: 432 unilateral cleft lip and palate subjects (Japanese, Malay ethnic group, Bangladeshi and Pakistani populations) age 5 to 12 years were taken before orthodontic treatment and alveolar bone grafting. The DAR was assessed by GOSLON Yardstick. Independent t-test was performed to compare the GOSLON score for each factors. A multiple comparison (Anova) was also conducted between the GOSLON score of four different populations. The significance level was set at p<0.05. Results: Statistically no significant different was found among the congenital factors. However, the family history of Class III malocclusion showed most likely to associate with, though there was no significant difference (p=0.069). Significant difference revealed between two techniques of cheiloplasty in both Malay ethnic group and Pakistani population (p=0.038 and p=0.000, respectively). Gender and Techniques of palatoplasty also showed significant difference in Pakistani population (p=0.026 and p=0.000, respectively). Japanese and Bangladeshi population showed no significant differences. Also no significant differences found between the GOSLON score and different countries. Conclusion: The treatment outcome based on DAR significantly varies in individual population [Malay ethnic group (cheiloplasty); Pakistan (gender, cheiloplasty and palatoplasty)].

The Reliability and Validity of the Measurements in Unilateral Cleft Lip and Palate Laser Scanned 3D Dental Casts

Abstract Objective: To evaluate the reliability and validity of the Next Engine 3D Laser scanner. Material and Methods: A total of 30 dental casts of unilateral cleft lip and palate (UCLP) children with 90 linear variables were measured using digital caliper while the laser-scanned 3D dental casts (LS3DM) were measured using Mimics Software. All scanned data coordinates (in x, y, z) were transferred into Mimics software in STL format to be measured. All the variables were measured using a computer mouse accurate to 0.5 mm. The intra-class correlation coefficient (ICC) was used to evaluate the intra- and inter-examiner reliabilities and also for the validity of two methods Results: Intra-examiner reliabilities of digital caliper and LS3DM were found excellent (ICC 0.916-0.995) and inter-examiner reliabilities of LS3DM were good to excellent (ICC 0.816-0.990). The validity of LS3DM measurements was confirmed based on the ICC values were in the range of 0.913-0.996. The overall time frame for conducting measurements was shorter using a laser-scanned model (10 min.) than using a digital caliper (5 hours) Conclusion: The LS3DM is a valid reliable tool for future high impact research in our institution.

Treatment Outcome of Bangladeshi UCLP Patients Based on Both Phenotype and Postnatal Treatment Factors using Modified Huddart Bodenham (mHB) Index.

OBJECTIVE: To evaluate the dental arch relationship (DAR) of nonsyndromic unilateral cleft lip and palate (UCLP) and to explore the various phenotype and postnatal treatment factors that are responsible for poor DAR. DESIGN: Retrospective study. SETTING: School of Dental Science, Universiti Sains Malaysia. SUBJECTS: Eighty-four Bangladeshi children with nonsyndromic UCLP who received cheiloplasty and palatoplasty. MAIN OUTCOME MEASURES: Dental models were taken at 5 to 12 years of age (man: 7.69), and dental arch relationships were assessed using modified Huddart/Bodenham index (mHB) by two raters. Kappa statistics was used to evaluate the intra- and interexaminer agreements, chi-square was used to assess the associations, and logistic regression analysis was used to explore the responsible factors that affect DAR. RESULTS: The total mHB score (mean [SD]) was -8.261 (7.115). Intra- and interagreement was very good. Using crude and stepwise backward regression analysis, significant association was found between positive history of class III (P = .025, P = .030, respectively) and unfavorable DAR. Complete UCLP (P = .003) was also significantly correlated with unfavorable DAR. CONCLUSION: This multivariate study suggested complete type of UCLP and positive history of class III had a significantly unfavorable effect on the DAR.

Effects of low-level laser irradiation on the rate of orthodontic tooth movement and associated pain with self-ligating brackets.

INTRODUCTION: The aim of this study was to evaluate the effect of low-level laser irradiation applied at 3-week intervals on orthodontic tooth movement and pain associated with orthodontic tooth movement using self-ligating brackets. METHODS: Twenty-two patients (11 male, 11 female; mean age, 19.8 ± 3.1 years) with Angle Class II Division 1 malocclusion were recruited for this split-mouth clinical trial; they required extraction of maxillary first premolars bilaterally. After leveling and alignment with self-ligating brackets (SmartClip SL3; 3M Unitek, St Paul, Minn), a 150-g force was applied to retract the canines bilaterally using 6-mm nickel-titanium closed-coil springs on 0.019 x 0.025-in stainless steel archwires. A gallium-aluminum-arsenic diode laser (iLas; Biolase, Irvine, Calif) with a wavelength of 940 nm in a continuous mode (energy density, 7.5 J/cm2/point; diameter of optical fiber tip, 0.04 cm2) was applied at 5 points buccally and palatally around the canine roots on the experimental side; the other side was designated as the placebo. Laser irradiation was applied at baseline and then repeated after 3 weeks for 2 more consecutive follow-up visits. Questionnaires based on the numeric rating scale were given to the patients to record their pain intensity for 1 week. Impressions were made at each visit before the application of irradiation at baseline and the 3 visits. Models were scanned with a CAD/CAM scanner (Planmeca, Helsinki, Finland). RESULTS: Canine retraction was significantly greater (1.60 ± 0.38 mm) on the experimental side compared with the placebo side (0.79 ± 0.35 mm) (P <0.05). Pain was significantly less on the experimental side only on the first day after application of LLLI and at the second visit (1.4 ± 0.82 and 1.4 ± 0.64) compared with the placebo sides (2.2 ± 0.41 and 2.4 ± 1.53). CONCLUSIONS: Low-level laser irradiation applied at 3-week intervals can accelerate orthodontic tooth movement and reduce the pain associated with it.

Assessment of complete unilateral cleft lip and palate treatment outcome using EUROCRAN index and associated factors.

OBJECTIVES: Assessment of treatment outcome is the only non-invasive approach to identify the effects of cleft lip and palate repair and modify management accordingly. Here the aim is to assess the outcome of complete unilateral cleft lip and palate (CUCLP) patients using EUROCRAN index and to check whether there are any factors associated with the treatment outcome. MATERIALS AND METHODS: It is a retrospective cross sectional study. Dental models were collected from archives of two cleft referral centers in Pakistan. Five blinded examiners scored 101 models twice at two week interval. The primary outcome was mean EUROCRAN scores based on dental arch relationships and palatal surface morphology. RESULTS: A mean(SD) score of 2.72 (0.76) and 2.20 (0.73) was determined based on dental arch relationships and palatal surface morphology, respectively. According to the final logistic regression model, modified Millard technique (cheiloplasty) and Veau-Wardill-Kilners' method (palatoplasty) had higher odds of producing unfavorable treatment outcome. CONCLUSIONS: Present study determined a fair and a fair to poor treatment outcome based on dental arch relationships and palatal surface morphology, respectively. Our study suggests a significant association between treatment outcome and primary surgical techniques for lip and palate. These findings could warrant a modification of management protocols to ensure improvement in future cleft outcomes.

The effect of various factors on the dental arch relationship in non-syndromic unilateral cleft lip and palate children assessed by new approach: a retrospective study.

BACKGROUND: Cleft lip and palate (CLP) is one of the most common birth defects. Multiple factors are believed to be responsible for an unfavorable dental arch relationship in CLP. Facial growth (maxillary) retardation, which results in class III malocclusion, is the primary challenge that CLP patients face. Phenotype factors and postnatal treatment factors influence treatment outcomes in unilateral cleft lip and palate (UCLP) children, which has led to a great diversity in protocols and surgical techniques by various cleft groups worldwide. The aim of this study was to illustrate the dental arch relationship (DAR) and palatal morphology (PM) of UCLP in Bangladeshi children and to explore the various factors that are responsible for poor DAR and PM. METHODS: Dental models of 84 subjects were taken before orthodontic treatment and alveolar bone grafting. The mean age was 7.69 (SD 2.46) years. The DAR and PM were assessed blindly by five raters using the EUROCRAN index (EI). Kappa statistics was used to evaluate the intra- and inter-examiner agreement, chi square was used to assess the associations, and logistic regression analysis was used to explore the responsible factors that affect DAR and PM. RESULTS: The mean EUROCRAN scores were 2.44 and 1.93 for DAR and PM, respectively. Intra- and inter-examiner agreement was moderate to very good. Using crude and stepwise backward regression analyses, significant associations were found between the modified Millard technique (P = 0.047, P = 0.034 respectively) of cheiloplasty and unfavorable DAR. Complete UCLP (P = 0.017) was also significantly correlated with unfavorable DAR. The PM showed a significant association with the type of cleft, type of cheiloplasty and type of palatoplasty. CONCLUSION: This multivariate study determined that the complete type of UCLP and the modified Millard technique of cheiloplasty had significantly unfavorable effects on both the DAR and PM.