A retrospective cohort study on dental implant survival in patients with grafted alveolar clefts.

OBJECTIVES: The aim of this study was to assess the survival rate of dental implants inserted in an alveolar cleft area where one or more bone graft procedures were performed and to identify possible factors that affect the survival rate. MATERIALS AND METHODS: The available data from 78 implants placed in 64 patients with grafted alveolar clefts were retrospectively analysed. Statistical analyses were performed using Kaplan-Meier survival analysis, log-rank tests and univariable Cox proportional hazard models. RESULTS: The median follow-up period from insertion to the last follow-up appointment was 46 months (IQR: 29-79.3). In five patients, a single implant failed. This resulted in a cumulative survival rate of 95.0% at median follow-up. The factors investigated in this study did not have a significant effect on implant survival. CONCLUSIONS: Dental implants placed in patients with alveolar clefts are a reliable treatment option for dental rehabilitation.

Customized Tray for Impression Taking in Children With Cleft Lip and Palate.

The assessment of rehabilitation outcomes requires a patient documentation protocol, including records obtained at standardized ages, to compare different types of surgeries, their effects, as well as between different rehabilitation centers. The aim of this paper was to present proper trays for babies with different types of cleft lip and palate, which are used in the outpatient routine at Hospital of Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP). The customized trays are made with self-curing acrylic resin. The tray must have suitable depth to copy the buccal sulcus, and wax is usually applied to contour the tray edge, and the adjustment of the tray to the fornix, making the tray specific for each child. The impression precludes the utilization of dental casts for diagnosis, treatment plan, and research measurements. In the clinical practice at HRAC-USP, it was observed that customized trays increased the quality of impression, accurately reproducing anatomical features of dental arches of babies with oral clefts.

Implant placement for patients with cleft lip and palate: A clinical report and guidelines for treatment.

The multidisciplinary teams involved in the treatment of individuals with cleft lip and palate are challenged when implants are indicated in the cleft area. Difficulties include obtaining a healthy peri-implant area and, especially, obtaining the natural-looking papilla essential for esthetic success. The area affected by the cleft has a bone deficiency, which is typically augmented with an alveolar bone graft at adolescence. Guidelines for the 3-dimensional placement of implants at the cleft area are presented based on clinical reports. The patients were followed up for at least 1 year. Adoption of the proposed guidelines enables satisfactory esthetic and functional outcomes in patients with cleft lip and palate.

Assessment of Orthodontic Burden of Care in Patients With Unilateral Complete Cleft Lip and Palate.

OBJECTIVE: To assess the orthodontic burden of care of patients from a Brazilian rehabilitation center (Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo [HRAC-USP]). DESIGN: Retrospective. SETTING: Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo. INTERVENTIONS: One hundred files of unilateral complete cleft lip and palate patients who had consecutively finished orthodontic rehabilitation at HRAC-USP were evaluated from January 2011 to January 2013. The duration of orthodontic treatment, number of visits, kilometers traveled, number of appliances and surgical procedures performed were recorded. The sample was divided into 2 subgroups according to severity the interarch relation (Goslon Yardstick score) at the beginning of orthodontic treatment. Mann-Whitney test was applied for intergroup comparison ( P < .05). RESULTS: For the total sample (n = 100), the mean time of orthodontic treatment was 140.2 months, the mean number of orthodontic appointments was 61.8, the mean number of appliances was 10, the mean number of surgical procedures was 6.2, and the mean distance traveled to attend the center for orthodontic appointments was 38,978.5 km. The subgroup with the most severe malocclusion (Goslon yardsticks scores 4 and 5) showed a longer orthodontic treatment length, greater number of surgical procedures, and longer distance traveled than those presenting Goslon yardstick scores 1, 2, and 3. CONCLUSION: Patients with greater severity of the initial malocclusion experienced a higher burden of care than patients with less severity of the initial malocclusion. To reduce the burden of care, research and efforts should focus on minimizing maxillary growth deficiency related to primary surgery.

Early Reading Abilities of Bilingual Children With Nonsyndromic Orofacial Clefts.

OBJECTIVE: To investigate the early reading abilities, and related cognitive-linguistic processes, in bilingual children with nonsyndromic cleft lip and/or palate (CL/P), and to identify deficits that might be amenable to intervention. DESIGN AND PARTICIPANTS: Bilingual participants with CL/P aged 5 to 6 years who were English-dominant ( n=17) or Mandarin-dominant ( n=18) were recruited using consecutive sampling from a national cleft treatment center and matched pairwise to a sample of typically developing (TD) children on language dominance, age, and socioeconomic status. All participants were assessed in English on single-word reading accuracy using the Wide Range Achievement Test (4th Ed), and key cognitive-linguistic factors associated with reading development: phonological awareness, rapid automatized naming (RAN), receptive and expressive vocabulary, and verbal short-term and working memory. RESULTS: CL/P and TD groups were compared within language dominance group (Mandarin or English) for all measures. The Mandarin-dominant CL/P group had significantly poorer reading accuracy and phonological awareness than their TD peers. Additionally, regardless of language dominance, faster RAN correlated significantly with better reading accuracy in both the CL/P groups but not the TD groups. CONCLUSIONS: Children with CL/P who are learning English as a second language are at greater risk of reading difficulties. Furthermore, the cognitive-linguistic processes underlying early reading in bilingual children with CL/P differ from those of their TD peers. Routine screening and tailored intervention is advisable.

[Complex rehabilitation of children with congenital cleft lip and palate at stomatological treatment stages]. / Kompleksnaia reabilitatsiia detei s vrozhdennymi rasshchelinami guby i neba na étapakh stomatologicheskogo lecheniia.

Congenital malformations of the maxillofacial area - congenital cleft lip and palate (CCLP) due to their frequency, the severity of anatomical and functional disorders, the difficulty of social adaptation of patients, economic aspects are one of the most important problems of medicine. It is established that for timely stage surgical treatment of children with IAPC the emphasis is on the somatic status of the child, anti-infective resistance, the ability to safely tolerate surgery, which is important for the restoration of anatomical defects, communication functions and psychosomatic health. Children with CCLP are at risk for increased occurrence of postoperative complications, since upper respiratory tract infection and exacerbation of chronic respiratory tract diseases and ENT organs is a contraindication to surgical intervention. The study of immune status revealed deep violations of antiviral and antibacterial immunity in children with CCPC aged from 6 to 12 years. A program of combine interferon- and immunotherapy has been created. Positive clinical and immunological efficacy of combine interferon-(gel Viferon - recombinant IFNα2b in combination with antioxidant) and immunotherapy in the rehabilitation of children with CCPC aged 6 to 12 years was demonstrated.

Development of a Valid and Reliable Instrument for the Assessment of Quality of Life in Adolescents with Clefts - Detection of Potential Mental Health Issues.

BACKGROUND: The rehabilitation of patients with cleft deformities is very complex and unique, and managed by a team of professionals. Quality of life depends on the health, and represents an instrument that examines the disease impact and treatment modalities on the health, integrating an objective assessment of the health status and its subjective experience. Children with clefts are often teased by their peers, and that is the reason why they experience different kinds of psychological distress. Patients with non-syndromic clefts may develop depression and anxiety, hyperactivity, elevated risk of suicide and increased drug abuse in adolescence. SUBJECTS AND METHODS: Experienced members of a cleft palate team developed a specific questionnaire divided into 2 parts: the first contains the clinical profile of adolescents, and the second part contains questions regarding quality of life. This questionnaire was administered to 73 patients between June 2015 and June 2016, who matched these criteria during their control examinations at the University Hospital Dubrava. RESULTS: In general, the patient group showed significantly worse scores on majority of answers, specifying that their quality of life is worse compared to the control group. The principal component analysis revealed the presence of three components (factors). The interpretation of the three components was consistent with loadings indicating the component names: Component 1: The relationship with parents, success, society; Component 2: Appearance, and Component 3: Function. CONCLUSION: According to our results, we created a specific instrument - The Quality of Life in Adolescents with Cleft Assessment to assess aesthetic and functional results of treatment and quality of life of the operated adolescents with clefts. The adolescents in this study have no psychiatric disorders diagnosed in their medical charts, but results indicate that some of them need help in dealing with future life. Regarding these findings, it will be possible to intervene in the process of treatment and improve the overall outcome of therapy.

Evaluation of Stress Distribution of Mini Dental Implant-Supported Overdentures in Complete Cleft Palate Models: A Three-Dimensional Finite Element Analysis Study.

OBJECTIVE: Mini dental implants could be an alternative treatment method for prosthetic treatment of edentulous cleft palate. The aim of this study was to analyze stress distribution around the cortical bone and different plans using a varied number of mini dental implants in edentulous unilateral complete cleft palates. MATERIALS AND METHODS: Three edentulous maxillary models were modified to create unilateral complete cleft palates. Mini dental implants (2.4 × 15 mm) were located as two mini implants at the premolar region, four mini implants at the premolar and molar region, and six mini implants at the first premolar, second premolar, and first molar regions in the models, respectively. Mucosa, o-ring/ball attachments, and overdentures were simulated. Vertical and horizontal loads of 100 N were applied on both the right and left molar teeth of the overdenture for each model. Maximum and minimum principal stress values and the distribution at cortical bone around the implants and cleft palates were evaluated by finite element analysis. RESULTS: Stress values under vertical loads were lower than values under horizontal loadings for all models. Stress values were found to be lower in the first model than in the second and third models. The highest stress values were found around implants in the second model. The unilateral feature of a complete cleft pattern affected the stress distribution. CONCLUSION: Stresses occured mostly around implants when the overdenture was supported by six implants; however, the stress distribution around implants was low with two implants because of tissue support.

The Anterior Double-Tilt Precision Attachment Case for Cleft Palate Patients and Accident Victims. Case Reports.

Passively retained precision attachment removable partial dentures have been used successfully since the 1920s. Adult cleft palate patients and accident victims often have endured a lifetime of wearing awkward appliances to replace the missing structures that never formed intraorally or were lost in a traumatic accident. These patients tend to be poor candidates for dental implants, even with repeated grafting surgeries. The anterior double-tilt precision attachment case is a great treatment option for adults to restore the missing dental structures. Anterior precision partial dentures are stable appliances in the mouth that are worn 24 hours a day and only removed for hygiene. They can be custom designed for maximum esthetics. They do not require denture paste, and they extend minimally onto the palate. As a result, they do not interfere with musculature, tongue movements, speech and taste. Cleft palate patients and accident victims with poor or non-existent edentulous ridges will have difficulty retaining a denture, so preservation of the existing dentition is essential for comfort and function. Because these prostheses do not apply destructive forces to the abutment teeth, they can last decades with minimal maintenance.

[Prosthodontic care of orofacial clefts in adulthood: About a clinical case]. / Prise en charge prothétique des fentes oro-faciales à l'âge adulte: A propos d'un cas Clinique.

This paper relates, through a clinical case, the different steps of the prosthodontic rehabilitation of a palate-pharyngeal cleft, sequelae to surgery, by performing a Suersen's Velar obturator since the soft Palate is divided but toned. A functional reeducation in conjunction with a prosthodontic care improves the quality of life's patients and help for their resocialization. This therapeutic is non-invasive, quick, efficient and evolutive method.

[IMPACT OF URANOSTAPHILOPLASTY ON QUALITY OF LIFE OF THE PATIENTS].

Abstract Retrospective analysis was conducted in 78 patients of various age, who suffered the inborn lip and palate fissura, for estimation of the patients quality of life after uranostaphiloplasty. The operations were performed on clinical base of The Oral Cavity Surgery and The Jaw-Facial Surgery Cathedra in Department of The Jaw-Facial Surgery of Clinical Medical Center (Baku). There was established, that application of uranostaphiloplasty procedure, as well as timely initiated rehabilitation, influences a further establishment of the patient personality. A timely refer to a speech therapeutist and the treatment began also have great significance for further establishment of the patient personality. Disorders of speech, incorrect bite hampers obtaining of education, working, interferes with a family creation, hampers the employment and worsens a quality of life.

Alternatives for rehabilitation of cleft patients with severe maxillomandibular discrepancy.

Rehabilitation of cleft patients is a process that occurs from birth to adult life and involves a team of many professionals. Reconstructive plastic surgery, despite its functional and aesthetic benefits to the patient, can restrict the normal anterior displacement that occurs in the growth of the maxilla, which, in turn, can lead to a concave profile that requires correction. This study aimed to demonstrate an alternative rehabilitation treatment for cleft patients who have severe maxillomandibular discrepancy and choose not to undergo orthognathic surgery. A retrospective review and case reports of rehabilitation treatment of cleft patients were performed, with an emphasis on prosthetic rehabilitation without orthognathic surgical procedures. Prosthetic rehabilitation is a fast and reversible option for cleft patients that provides facial harmony and facilitates the reintegration of these patients into society.

Functional and aesthetic rehabilitation of a geriatric patient with cleft palate: a case report.

Cleft palate defect with complete edentulism in elderly patients presents a prosthodontic challenge for complete denture fabrication. Such large defects are very difficult to restore by surgical intervention and have direct consequence on such functions as mastication and speech, on aesthetics, and on the patient's mental attitude. This article describes a case report in which a 76-year-old female patient underwent restoration with a closed hollow bulb obturator for a large cleft palate defect.

Empowering Volunteers at Tawanchai Centre for Patients with Cleft Lip and Palate.

BACKGROUND: Cleft lip and palate (CLP) congenital anomalies have a high prevalence in the Northeast of Thailand. A care team's understand of treatment plan would help to guide the family of patients with CLP to achieve the treatment. OBJECTIVE: To examine the impact of the empowering volunteer project, established in the northeast Thailand. MATERIAL AND METHOD: The Empowering Volunteer project was conducted in 2008 under the Tawanchai Royal Granted project. The patients and family's general information, treatment, the group brainstorming, and satisfaction with the project were analysed. RESULTS: Participants were 12 children with CLP their families and five volunteers with CLP; the participating patients were predominantly females and the mean age was 12.2 years. The treatment comprised of speech training, dental hygiene care, bone graft and orthodontic treatment. Four issues were addressed including: problems in taking care of breast feeding, instructions' needs for care at birth, difficulty in access information and society impact, and needs in having a network of volunteers. CONCLUSIONS: Empowering volunteer is important for holistic care of patients with CLP which provides easy access and multiple channels for patients and their families. It should be developed as part of the self-help and family support group, the development of community based team and comprehensive CLP care program.

Speech Therapy for Children with Cleft Lip and Palate Using a Community-Based Speech Therapy Model with Speech Assistants.

OBJECTIVE: Evaluate the speech services using a Community-Based Speech Therapy model by trained speech assistants (SAs) on the improvement of articulation in cleft palate children. MATERIAL AND METHOD: Seventeen children with repaired cleft palates who lived in Chiang Rai and Phayao provinces were registered to the camp. They received speech therapy with a 4-day intensive camp and five follow-up camps at Chiang Rai's The Young Men's Christian Association (YMCA). Eight speech assistants (SAs) were trained to correct articulation errors with specific modeling by the speech-language pathologists (SLPs). SAs encouraged family members to stimulate their children every day with speech exercise at home. Each camp was covered with a main speech therapy and others supported by the multidisciplinary team, as well as, discussion among SLPs, SAs and the care givers for feedback or difficulties. RESULTS: Results showed a sufficient method for treating persistent speech disorders associated with cleft palate. Perceptual analyses presented significant improvement of misarticulation sounds both word and sentence levels after speech camp (mean difference = 1.5, 95% confidence interval = 0.5-2.5, p-value <0.01; mean difference = 2.5, 95% confidence interval = 1-3, p-value <0.001, respectively). CONCLUSION: The Community-Based Speech Therapy model is a valid and efficient method for providing speech therapy in cleft palate children.

A Networking of Community-Based Speech Therapy: Borabue District, Maha Sarakham.

BACKGROUND: Most children with cleft lip and palate have articulation problems because of compensatory articulation disorders from velopharyngeal insufficiency. Theoretically, children should receive speech therapy from a speech and language pathologist (SLP) 1-2 sessions per week. For developing countries, particularly Thailand, most of them cannot reach standard speech services because of limitation of speech services and SLP Networking of a Community-Based Speech Model might be an appropriate way to solve this problem. OBJECTIVE: To study the effectiveness of a networking of Khon Kaen University (KKU) Community-Based Speech Model, Non Thong Tambon Health Promotion Hospital, Borabue, Maha Sarakham, in decreasing the number of articulation errors for children with CLP. MATERIAL AND METHOD: Six children with cleft lip and palate (CLP) who lived in Borabue and the surrounding district, Maha Sarakham, and had medical records in Srinagarind Hospital. They were assessed for pre- and post-articulation errors and provided speech therapy by SLP via teaching on service for speech assistant (SA). Then, children with CLP received speech correction (SC) by SA based on assignment and caregivers practiced home program for a year. RESULTS: Networking of Non Thong Tambon Health Promotion Hospital, Borabue, Maha Sarakham significantly reduce the number of post-articulation errors for 3 children with CLP. There were factors affecting the results in treatment of other children as follows: delayed speech and language development, hypernaslaity, and consistency of SC at local hospital and home. CONCLUSION: A networking of KKU Community-Based Speech Model, Non Thong Tambon Health Promotion Hospital, Borabue, and Maha Sarakham was a good way to enhance speech therapy in Thailand or other developing countries, where have limitation of speech services or lack of professionals.

Speech Correction for Children with Cleft Lip and Palate by Networking of Community-Based Care.

BACKGROUND: Prevalence of cleft lip and palate (CLP) is high in Northeast Thailand. Most children with CLP face many problems, particularly compensatory articulation disorders (CAD) beyond surgery while speech services and the number of speech and language pathologists (SLPs) are limited. OBJECTIVE: To determine the effectiveness of networking of Khon Kaen University (KKU) Community-Based Speech Therapy Model: Kosumphisai Hospital, Kosumphisai District and Maha Sarakham Hospital, Mueang District, Maha Sarakham Province for reduction of the number of articulations errors for children with CLP. MATERIAL AND METHOD: Eleven children with CLP were recruited in 3 1-year projects of KKU Community-Based Speech Therapy Model. Articulation tests were formally assessed by qualified language pathologists (SLPs) for baseline and post treatment outcomes. Teachings on services for speech assistants (SAs) were conducted by SLPs. Assigned speech correction (SC) was performed by SAs at home and at local hospitals. Caregivers also gave SC at home 3-4 days a week. RESULTS: Networking of Community-Based Speech Therapy Model signficantly reduced the number of articulation errors for children with CLP in both word and sentence levels (mean difference = 6.91, 95% confidence interval = 4.15-9.67; mean difference = 5.36, 95% confidence interval = 2.99-7.73, respectively). CONCLUSION: Networking by Kosumphisai and Maha Sarakham of KKU Community-Based Speech Therapy Model was a valid and efficient method for providing speech services for children with cleft palate and could be extended to any area in Thailand and other developing countries, where have similar contexts.

Phonology in Swedish-speaking 3-year-olds born with cleft lip and palate and the relationship with consonant production at 18 months.

BACKGROUND: Approximately 50% of children born with cleft palate present speech difficulties around 3 years of age, and several studies report on persisting phonological problems after palatal closure. However, studies on early phonology related to cleft palate are few and have so far mainly been carried out on English-speaking children. Studies on phonology related to cleft palate in languages other than English are also warranted. AIMS: To assess phonology in Swedish-speaking children born with and without unilateral cleft lip and palate (UCLP) at 3 years of age, and to identify variables at 18 months that are associated with restricted phonology at age 3 years. METHODS & PROCEDURES: Eighteen consecutive children born with UCLP and 20 children without cleft lip and palate were included. Transcriptions of audio recordings at 18 months and 3 years were used. Per cent correct consonants adjusted for age (PCC-A), the number of established phonemes, and phonological simplification processes at 3 years were assessed and compared with different aspects of consonant inventory at 18 months. OUTCOMES & RESULTS: PCC-A, the number of established phonemes, and the total number of phonological processes differed significantly at 3 years between the two groups. Total number of oral consonants, oral stops, dental/alveolar oral stops and number of different oral stops at 18 months correlated significantly with PCC-A at 3 years in the UCLP group. CONCLUSIONS & IMPLICATIONS: As a group, children born with UCLP displayed deviant phonology at 3 years compared with peers without cleft lip and palate. Measures of oral consonant and stop production at 18 months might be possible predictors for phonology at 3 years in children born with cleft palate.

Conventional prosthodontic management of partial edentulism with a resilient attachment-retained overdenture in a patient with a cleft lip and palate: a clinical report.

Recent advances in surgery and orthodontics have resulted in improvements in the management of patients with a cleft lip or palate. Early surgical intervention and bone-grafting procedures have frequently been used to ensure closure of the cleft and continuity of the alveolar bone. However, a need for the prosthodontic management of patients with a cleft palate still exists. Most frequently, the indication is to restore the edentulous spaces located anteriorly in the vicinity of the residual cleft defect. In addition to improving the esthetic outcome, prosthodontic management also is required to restore function, especially occlusion and speech. This clinical report illustrates the management of an adult patient with a unilateral cleft of the lip and palate who required prosthodontic rehabilitation after surgery. The patient had previously undergone multiple surgeries and did not want to consider implant therapy as a treatment option. Thus, the patient was managed with fixed and removable prosthodontics with a maxillary overdenture prosthesis retained by microextracoronal resilient attachments, which were laser welded onto crowns on abutment teeth to obtain a functionally and esthetically acceptable result.

Late maxillary protraction in patients with unilateral cleft lip and palate: a retrospective study.

OBJECTIVES: This retrospective study assessed the dentoskeletal effect of late maxillary protraction (LMP; reverse-pull headgear, Class III elastics, and maxillary sutural loosening) in unilateral cleft lip and palate (UCLP) patients versus a control group of untreated UCLP patients. MATERIALS AND METHODS: Cephalograms taken at age 13 to 14 years (T1) and 17 to 18 years (T2) were used for this study. The study group comprised 18 patients (10 male and 8 female, mean age at start of LMP therapy = 13.4 [0.45] years). A control groups of 17 patients (8 male and 9 female, mean age = 13.5 [0.44] years) was used for comparison. RESULTS: The repeated-measures analysis of variance showed statistically significant changes across time between groups for the following variables (mean difference [T2-T1] in the study group, 95% confidence interval): SNA (°) (1.95, 0.75 to 3.15), A ⊥ Na Perp (mm) (1.82, 0.86 to 2.77), CoA (mm) (2.92, 1.53 to 4.31), ANB (°) (3.13, 2.02 to 4.24), Wits (mm) (7.82, 5.01 to 10.54), Mx-Md Diff (mm) (0.62, -1.58 to 2.83), Occl P-SN (°) (-3.98, -5.99 to -1.98), overjet (mm) (8.82, 5.90 to 11.74), FMIA (°) (4.05, -0.05 to 8.15), and IMPA (°) (-5.77, -9.74 to -1.80). Late maxillary protraction created a slight open bite (0.66 mm). Trends for overeruption of mandibular incisors and an increase in lower face height (P = .07 for both) were noted in the study group. CONCLUSIONS: Late maxillary protraction produced a combination of skeletal changes (protraction of maxilla, improvement in the maxillo-mandibular skeletal relationship) and dental compensations (counterclockwise rotation of occlusal plane, retroclination of mandibular incisors) in patients with UCLP. Late maxillary protraction was also associated with some unwanted tooth movements (open bite tendency, mandibular incisors overeruption).