3D morphometric evaluation of the dental arches in children with cleft lip and palate submitted to different surgical techniques.

OBJECTIVES: This study aimed to compare dimensional alterations of dental arches in children with unilateral complete cleft lip and palate before and after different techniques of primary plastic surgeries. MATERIALS AND METHODS: The sample was divided into two groups: group 1-cheiloplasty by Millard's technique and one-stage palatoplasty by von Langenbeck's technique; group 2-cheiloplasty by Millard's technique and two-stage palatoplasty: anterior palatoplasty by Hans Pichler's technique and posterior palatoplasty by Sommerlad's technique. Dental arches were evaluated before (T1), after the first phase (T2), and 1 year after the second phase (T3) of primary surgeries. Linear measurements and palatal area were assessed. To analyze the method's error, interclass correlation coefficient was applied. ANOVA (followed by Tukey test), dependent, and independent t-test were used (p < 0.05). RESULTS: At T1, the intertuberosity distance was statistically greater in G2 (p = 0.004). At T2, the anterior length of the dental arch was statistically greater in G2 (p = 0.025), while the area of the smaller palatal segment (p = 0.001), cleft area (p = 0.014), and total area (p = 0.002) were statistically smaller in G2. At T3, the intertuberosity distance was statistically greater in G2 (p = 0.017). CONCLUSION: This study suggests that cheiloplasty and one-stage palatoplasty resulted in smaller growth of maxilla than cheiloplasty and two-stage palatoplasty in the linear measurements (T-T' and I-CC') and total area of the dental arches. CLINICAL RELEVANCE: Surgical protocols need to be evaluated to verify their effects aiming at improving the clinical practice of the interdisciplinary team, determining new parameters for the rehabilitation of individuals with cleft lip and palate.

Prevalence, cause, and location of palatal fistula in operated complete unilateral cleft lip and palate: retrospective study.

OBJECTIVE: To evaluate the prevalence of fistulas after palate repair and analyze their location and association with possible causal factors. DESIGN: Retrospective analysis of patient records and evaluation of preoperative initial photographs. SETTING: Tertiary craniofacial center. PARTICIPANTS: Five hundred eighty-nine individuals with complete unilateral cleft lip and palate that underwent palate repair at the age of 12 to 36 months by the von Langenbeck technique, in a single stage, by the plastic surgery team of the hospital, from January 2003 to July 2007. INTERVENTIONS: The cleft width was visually classified by a single examiner as narrow, regular, or wide. The following regions of the palate were considered for the location: anterior, medium, transition (between hard and soft palate), and soft palate. MAIN OUTCOME MEASURES: Descriptive statistics and analysis of association between the occurrence of fistula and the different parameters were evaluated. RESULTS: Palatal fistulas were observed in 27% of the sample, with a greater proportion at the anterior region (37.11%). The chi-square statistical test revealed statistically significant association (P ≤ .05) between the fistulas and initial cleft width (P = .0003), intraoperative problems (P = .0037), and postoperative problems (P = .00002). CONCLUSIONS: The prevalence of palatal fistula was similar to mean values reported in the literature. Analysis of causal factors showed a positive association between palatal fistulas with wide and regular initial cleft width and intraoperative and postoperative problems. The anterior region presented the greatest occurrence of fistulas.

Dental anomalies of number in the permanent dentition of patients with bilateral cleft lip: radiographic study.

OBJECTIVE: To radiographically evaluate the prevalence of dental anomalies in patients with complete and incomplete bilateral cleft lip, comparing the prevalence of anomalies between genders and cleft types. SETTING: Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Bauru, São Paulo, Brazil. PARTICIPANTS: 150 randomly selected panoramic radiographs of individuals with complete or incomplete bilateral cleft lip; patient age 12 to 25 years (mean age 13.8 years). RESULTS: Data were statistically analyzed to compare the possible association between presence of hypodontia and supernumerary teeth, according to gender and cleft type. Among the 150 patients evaluated, 80 (53.3%) were male and 70 (46.6%) were female. Since no statistically significant difference was found in hypodontia between genders, data were grouped for analysis, revealing prevalence of 31.6% for complete clefts and 26.8% for incomplete clefts. Concerning supernumerary teeth, the prevalence for the male patients was 28.2% for complete cleft lip and 29.2% for incomplete cleft lip. For female patients, the prevalence was significantly (p = .006) lower for complete cleft lip (17.5%) than for incomplete cleft lip (46.6%). CONCLUSIONS: The present results suggest that the prevalence of hypodontia was higher in patients with complete cleft lip, and the prevalence of supernumerary teeth was higher in patients with incomplete cleft lip, in agreement with previous studies.

Evaluation of oral health knowledge and oral health status in mothers and their children with cleft lip and palate.

OBJECTIVE: To assess the oral health knowledge of mothers of children with cleft lip and/or palate, analyzing the practical application of this information on the basis of the oral hygiene of the children and caries prevalence of mothers and children. DESIGN: Cross-sectional. SETTING: Pediatric Dentistry sector of the Hospital for Rehabilitation of Craniofacial Anomalies. PATIENTS: Mothers (n = 300) and their children with cleft lip and/or palate, ages 3 years to 5 years 6 months. MATERIALS AND METHODS: An interview with questions related to dietary habits and oral health knowledge and habits was conducted. Children and their mothers also were evaluated by intraoral clinical examination. RESULTS: Of the mothers, 47.3% displayed poor oral health status (Group A) and 52.7% had a satisfactory oral health status (Group B). Children in Group A presented a mean dmft of 6.0, whereas children in Group B had a mean dmft of 5.6. No significant differences were observed between groups. Mothers demonstrated a reasonable knowledge on prevention of dental caries and oral hygiene. CONCLUSION: Even though the mothers interviewed had some knowledge on the causes and prevention of dental caries, other factors should be regarded as relevant in the caries process.

Prevalence of enamel hypoplasia in deciduous canines of patients with complete cleft lip and palate.

OBJECTIVE: To evaluate the prevalence and type of enamel hypoplasia in deciduous canines of patients with complete unilateral and bilateral cleft lip and palate, as well as its distribution according to gender, dental arch, and side of cleft. DESIGN: Cross sectional. SETTING: Hospital for Rehabilitation of Craniofacial Anomalies, Bauru, São Paulo, Brazil. MATERIAL AND METHODS: Three-hundred twelve Caucasian children (193 boys, 119 girls), aged 3 to 10 years, presenting complete unilateral and bilateral cleft lip and palate were included in this study. A single examiner carried out clinical examination under natural light with a dental probe and dental mirror and, after drying of the tooth, by means of a simplified hypoplasia index. RESULTS: A prevalence of 43.8% was observed for unilateral and 39% for bilateral clefts. Both groups revealed similar distributions regarding the maxillary and mandibular dental arches and gender. Similar distribution was also observed on the cleft and noncleft sides for the unilateral cleft group. The most frequent type and severity was obvious hypoplasia, followed by minimal hypoplasia, both roughly round. CONCLUSION: The results suggest that the cleft does not influence the occurrence of hypoplasia in deciduous canines.

Chronology and sequence of eruption of the permanent teeth in patients with complete unilateral cleft lip and palate.

OBJECTIVE: To establish the chronology and sequence of eruption of the permanent teeth in subjects with complete unilateral cleft lip and palate. DESIGN: Cross-sectional. Data on children presenting complete cleft lip and palate were evaluated. SETTING: The study was carried out at the Hospital for Rehabilitation of Craniofacial Anomalies, Bauru, São Paulo, Brazil. SAMPLE: The sample comprised 477 patients with complete unilateral cleft lip and palate, aged 5 to 14 years. Of these patients, 166 were girls and 311 were boys. RESULTS: The girls presented, for all maxillary and mandibular teeth, a smaller mean age of eruption than the boys. The maxillary lateral incisor and cuspid adjacent to the cleft presented significantly higher mean ages of eruption than their homologous teeth on the noncleft side.

Prevalence of palatal and alveolar cysts in babies with cleft lip and palate.

OBJECTIVE: To evaluate the prevalence of palatal and alveolar cysts in babies with cleft lip and/or palate. DESIGN: Cross-sectional. SETTING: Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC-USP), Bauru, São Paulo, Brazil. PARTICIPANTS: Two hundred ninety-one Caucasian babies divided into four groups according to the type of cleft: cleft lip with or without cleft alveolus (70), complete unilateral cleft lip and palate (112), complete bilateral cleft lip and palate (56), and cleft palate (53). RESULTS: A low prevalence of palatal and alveolar cysts was observed among patients with the four different types of clefts, with no statistically significant difference between genders. The maxilla and the anterior area of the mouth were more affected than the mandible and the posterior area. CONCLUSIONS: The low prevalence of palatal and alveolar cysts in the four groups of babies with clefts included in this study may have been due to the high mean age of the sample.