Interdisciplinary approach for a patient with unilateral cleft lip and palate.

The oral rehabilitation of patients with cleft lip and palate is a challenge. The aim of this case report was to underline the importance of a sequential interdisciplinary approach to correct functional problems and improve facial esthetics for a patient with unilateral cleft lip and palate. Few clinical reports have described this treatment in a teenager. The patient, a girl, age 12.6 years, had a complete right cleft lip and palate with a Class II molar tendency and a full Class II canine relationship on the right side, and a full Class II molar relationship with a canine Class I on the left side. Transposed, impacted, and anomalously shaped teeth and crowding added to the patient's problems. Treatment included maxillary expansion and maxillary and mandibular extractions. An interdisciplinary approach was necessary to achieve proper occlusion and better esthetics.

Alignment efficiency and esthetic performance of 4 coated nickel-titanium archwires in orthodontic patients over 8 weeks: A multicenter randomized clinical trial.

INTRODUCTION: The objective of this 4-arm parallel study was to evaluate the alignment efficiency and esthetic performance of 4 coated nickel-titanium archwires over an 8-week period. METHODS: Patients in the permanent dentition requiring maxillary and mandibular fixed orthodontic treatment with a preadjusted edgewise appliance were eligible for inclusion. Patients attending 4 hospital departments (United Kingdom and Italy) were randomly allocated to 1 of 4 treatment interventions: (1) BioCosmetic (Forestadent, Pforzheim, Germany), 0.017 in; (2) Titanol (Forestadent), 0.016 in; (3) TP Aesthetic (TP Orthodontics, La Porte, Ind), 0.014 in; and (4) Tooth Tone (Ortho Organizers, Calsbad, Calif) 0.016 in. Block randomization with block sizes of 4 and 8 was used to ensure an allocation ratio of 1:1:1:1. The primary outcome was alignment efficiency determined by the reduction in Little's irregularity index (mm). Secondary outcomes were color change using the Commission Internationale de L'Eclairage L*a*b* system and percentage of coating loss. Blinding was only applicable to outcome assessment of alignment efficiency. Regression models with Sidak's multiple comparison of means were used to analyze the data. RESULTS: One hundred fifty patients (300 dental arches) were allocated to the treatment interventions, including 61 male and 89 female subjects with a mean age of 16.60 years. The average duration of follow-up was 63.65 days. Baseline characteristics for the archwire groups were similar. One patient was lost to follow-up. Five percent (n = 15) of the archwires fractured: BioCosmetic, 5.3% (n = 4); Titanol, 6.8% (n = 5); TP Aesthetic, 5.3% (n = 4); and Tooth Tone, 2.7% (n = 2). We analyzed 283 dental arches for alignment efficiency. There was no statistically significant difference for mean reduction in irregularity between the archwire groups (P = 0.627): BioCosmetic (n = 71), 3.86 mm (95% CI, 3.31-4.41); Titanol (n = 69), 4.51 mm (95% CI, 4.00-5.02); TP Aesthetic (n = 71), 4.13 mm (95% CI, 3.49-4.78); and Tooth Tone (n = 72), 4.21 mm (95% CI, 3.89-4.46). There was a statistically significant difference between archwire groups for color change (P = 0.001) and percentage of coating loss (P = 0.001), with BioCosmetic performing best in both parameters. CONCLUSIONS: There was no difference between the archwires for alignment efficiency. BioCosmetic performed statistically significantly better than did the other groups for both color change and coating loss. REGISTRATION: This trial was registered with the East Midlands NHS Research Ethics Committee (12/EM/0190). PROTOCOL: The protocol was not published before trial commencement.

Comparisons of two protocols for early treatment of anterior open bite.

Aim: The purpose of this study was to compare the outcomes of the treatment with the quad-helix/crib (Q-H/C) appliance with those of a combination of transpalatal arch, high-pull headgear, and lip bumper (TPA/HG/LB) in growing patients with anterior open bite malocclusion. Methods: The TPA/HG/LB sample consisted of 22 subjects, 16 girls and 6 boys (mean age 7.5±1.4 years at the start of treatment, T1, and 8.7±1.5 years at the end of active treatment, T2). The Q-H/C sample consisted of 28 subjects, 17 girls and 11 boys (mean age 8.2±1.3 years at T1, and 8.7±1.6 years at T2). Both treated groups were compared with a control group of 20 untreated subjects matched for dentoskeletal disharmony and observation interval. The changes from T2 to T1 between the three groups were compared with the analysis of variance. Results: Both TPA/HG/LB and Q-H/C groups exhibited greater reduction of the palatal plane to mandibular plane angle (-1.7° and -1.9°, respectively) and a significantly greater increase in overbite (2.2 and 2.3mm, respectively) with respect to controls. Conclusions: Q-H/C and TPA/HG/LB protocols were equally effective in correcting the anterior open bite.

Comparisons of two protocols for the early treatment of Class III dentoskeletal disharmony.

OBJECTIVE: To assess the short-term outcomes of splints, Class III elastics, and chincup (SEC III) and rapid maxillary expansion and facial mask (RME/FM) protocols. MATERIALS AND METHODS: 25 patients with Class III dentoskeletal disharmony (10 males, 15 females) treated with the SEC III protocol were evaluated at the beginning (T1, mean age 7.5±1.4 years) and at the end of treatment (T2, mean age 8.7±1.4 years). The SEC III group was compared to a matched sample of 32 Class III patients (16 males, 16 females) treated with the RME/FM protocol and to a matched control group (CG) consisting of 23 subjects (12 males, 11 females) with untreated Class III dentoskeletal disharmony. The statistical comparisons between the three groups were performed with analysis of variance with Tukey's post hoc tests. RESULTS: With respect to the CG the SEC III and the RME/FM groups showed significantly favourable effects in terms of maxillary advancement (SNA +1.2 and +1.4 degrees, respectively), control of mandibular projection (SNB -1.3 and -1.4 degrees, respectively), and intermaxillary relationships (ANB +2.6 and +2.9 degrees, respectively; WITS +3.7 and +2.6mm, respectively). The RME/FM group showed a significantly greater increase in the intermaxillary divergency than the SEC III group (+1.8 degrees) and the CG (+2.0 degrees). LIMITATIONS: A limitation of this study is its short-term nature. CONCLUSIONS: Both SEC III and RME/FM protocols are efficient treatments for Class III dentoskeletal disharmony. The SEC III protocol produces more favourable control in intermaxillary vertical relationships than the RME/FM therapy.