Rating dental arch relationships and palatal morphology with the EUROCRAN index on three different formats of dental casts in children with unilateral cleft lip and palate.

BACKGROUND: The EUROCRAN index has been used in inter-center studies to assess dental arch relationship (DAR) and palatal morphology (PM) in children with unilateral cleft lip and palate (UCLP). For this type of inter-center research, a scoring method that could be performed over the internet would be the most effective. Therefore, the aim of this study was to investigate the reliability of application of the EUROCRAN index on 3D digital models or photographs of plaster models instead of using plaster models. METHODS: The EUROCRAN reference models were presented in three formats: plaster models, 2D photographs of plaster models, and 3D digital models. Plaster models of children with UCLP (n = 45) were rated. Of each case, all three formats were rated by six calibrated observers in random order. The strength of agreement of the ratings was assessed with kappa statistics. Concordance among observers was evaluated with the intra-class correlation coefficient (ICC). RESULTS: The ICC showed a good inter-observer agreement for the DAR and poor inter-observer agreement for the PM. Intra-observer agreement for the DAR was moderate to very good, yet for the PM poor to moderate. Comparison between the three formats per observer for the DAR was good or very good and for the PM moderate to poor. CONCLUSIONS: The overall results show that the EUROCRAN index is an acceptable and reliable scoring method for the DAR on plaster models, 2D photographs of plaster models, and 3D digital models. However, due to the small range of deviations in palatal morphology between the cases in our study, the PM component of the index was difficult to assess. CLINICAL RELEVANCE: In clinical audits and inter-center studies, plaster models can be substituted by 2D photographs of plaster casts or 3D digital models when grading treatment outcome with the EUROCRAN index.

Does powdering of the dentition increase the accuracy of fusing 3D stereophotographs and digital dental casts.

OBJECTIVES: The shiny vestibular surfaces of teeth make it difficult to match digital dental casts to 3D stereophotogrammetric images of patient teeth. This study tested whether reducing this shininess by coating the teeth with titanium-oxide powder might improve the accuracy of the matching procedure. METHODS: Twenty patients participated in the study. For each patient, 3D stereophotogrammetric images were taken without and with a powder coating. Separately, digital dental casts were created. Next, the digital dental casts were fused with the 3D stereophotogrammetric images of either non-powdered or powdered dentition. Distance maps were created to evaluate the inter-surface distance between the digital dental cast and the 3D images. The matching accuracy was compared for dentition with and without powdering. RESULTS: Of all recorded distances between corresponding points, 95% was smaller than 0.84mm for the powdered dentition and smaller than 0.90mm for the non-powdered dentition. Although powdered dentition showed significantly better matching than non-powdered dentition, the difference was less than 0.1mm. Intra-observer statistics showed that five out of 24 repetitions gave significantly different results, but only for dentition that was not powdered. LIMITATIONS: The patients did not have any major malocclusions. Severe malocclusions might cause greater difficulty in matching the dentition without powder. Only one type of powder was used, but it effectively reduced shininess. CONCLUSION: Powdering the dentition had a small, but significant, positive effect on matching. However, this effect was of minor clinical importance. Therefore, we do not recommend powdering the dentition for 3D stereophotogrammetric images used for matching procedures.

Is cleft severity related to maxillary growth in patients with unilateral cleft lip and palate?

OBJECTIVE: To study the relationship of cleft severity and maxillary growth in patients with unilateral cleft lip and palate. DESIGN: A systematic literature review. METHODS: A literature survey from the PubMed database from January 1966 to December 2008 used the Medical Subject Headings terms facial growth, unilateral cleft lip palate, cephalometry, and cleft severity or cleft width. The Cleft Palate-Craniofacial Journal from 1964 to November 2008 was hand searched. Studies published as full-length articles reporting quantitative data on the relationship of cleft severity and written in English were selected. Two reviewers selected and extracted the data independently and also assessed the quality of the studies. RESULTS: Four studies met the selection criteria and were included in the review. All were retrospective and longitudinal. Quality analysis revealed medium to low level of the included studies. Heterogeneity of the studies prevented major conclusions about the relationship of a severe cleft and unfavorable maxillary forward growth. CONCLUSIONS: The review has highlighted the importance of further research. Further well-designed controlled studies and long-term studies are needed, and researchers have to consider combined assessment of cleft size and palate size. Further studies should also focus on the cleft severity at birth and at the time of palate repair.

Initial cleft severity and maxillary growth in patients with complete unilateral cleft lip and palate.

INTRODUCTION: Initial cleft severity in patients with complete unilateral cleft lip and palate (UCLP) varies. This is reflected in the sizes of the cleft and the palate. The purpose of this retrospective study was to establish whether there is a relationship between cleft severity at birth and growth of the maxilla. METHODS: Maxillary dental casts of 29 infants with nonsyndromic complete UCLP were used to measure the sizes of the cleft and the palate. The later growth of the maxilla was determined by using cephalometric radiographs taken at age 9. Statistical analyses were performed with multiple linear regression. RESULTS: The results showed a relationship between cleft area and maxillary protrusion (SNA, P <0.05). Also, there was a relationship between palate area and maxillary width (P <0.05). CONCLUSIONS: These data suggest that in patients with complete UCLP there is a significant relationship between initial cleft severity and maxillary growth. Patients with a small cleft area have a more protruded maxilla than do those with a large cleft area. Patients with a large palate area have a wider maxilla than those with a small palate area.

Difference in the Surgical Outcome of Unilateral Cleft Lip and Palate Patients with and without Pre-Alveolar Bone Graft Orthodontic Treatment.

Presurgical orthodontic treatment before secondary alveolar bone grafting (SABG) is widely performed for cleft lip/palate patients. However, no randomized controlled trial has been published comparing SABG outcomes in patients with, and without, presurgical orthodontic treatment. This randomized, prospective, single-blinded trial was conducted between January 2012 and April 2015 to compare ABG volumes 6 months postoperatively between patients with and without presurgical orthodontic treatment. Twenty-four patients were enrolled and randomized and 22 patients completed follow-up. Patients who had presurgical orthodontics before SABG had significantly improved inclination (p < 0.001) and rotation (p < 0.001) of the central incisor adjacent to the defect, significantly improved ABG fill volume (0.81 ± 0.26 cm(3) at 6 months compared to 0.59 ± 0.22 cm(3); p < 0.05) and less residual alveolar bone defect (0.31 ± 0.08 cm(3) at 6 months compared to s 0.55 ± 0.14 cm(3); p < 0.001) compared to patients who did not have presurgical orthodontic treatment. In conclusion, orthodontic treatment combined with SABG results in superior bone volume when compared with conventional SABG alone.

Three-dimensional imaging methods for quantitative analysis of facial soft tissues and skeletal morphology in patients with orofacial clefts: a systematic review.

BACKGROUND: Current guidelines for evaluating cleft palate treatments are mostly based on two-dimensional (2D) evaluation, but three-dimensional (3D) imaging methods to assess treatment outcome are steadily rising. OBJECTIVE: To identify 3D imaging methods for quantitative assessment of soft tissue and skeletal morphology in patients with cleft lip and palate. DATA SOURCES: Literature was searched using PubMed (1948-2012), EMBASE (1980-2012), Scopus (2004-2012), Web of Science (1945-2012), and the Cochrane Library. The last search was performed September 30, 2012. Reference lists were hand searched for potentially eligible studies. There was no language restriction. STUDY SELECTION: We included publications using 3D imaging techniques to assess facial soft tissue or skeletal morphology in patients older than 5 years with a cleft lip with/or without cleft palate. We reviewed studies involving the facial region when at least 10 subjects in the sample size had at least one cleft type. Only primary publications were included. DATA EXTRACTION: Independent extraction of data and quality assessments were performed by two observers. RESULTS: Five hundred full text publications were retrieved, 144 met the inclusion criteria, with 63 high quality studies. There were differences in study designs, topics studied, patient characteristics, and success measurements; therefore, only a systematic review could be conducted. Main 3D-techniques that are used in cleft lip and palate patients are CT, CBCT, MRI, stereophotogrammetry, and laser surface scanning. These techniques are mainly used for soft tissue analysis, evaluation of bone grafting, and changes in the craniofacial skeleton. Digital dental casts are used to evaluate treatment and changes over time. CONCLUSION: Available evidence implies that 3D imaging methods can be used for documentation of CLP patients. No data are available yet showing that 3D methods are more informative than conventional 2D methods. Further research is warranted to elucidate it.

Comparison of two nasoalveolar molding techniques in unilateral complete cleft lip patients: a randomized, prospective, single-blind trial to compare nasal outcomes.

BACKGROUND: Nasoalveolar molding became increasingly popular in the 1990s as a means of easing surgery and improving nasal outcomes for cleft lip repairs. In the late 1990s, three orthodontists from our center underwent nasoalveolar molding training: two at the Rush Craniofacial Center, in Chicago; and one at New York University Craniofacial Center. They brought two different nasoalveolar molding techniques back to Chang Gung Craniofacial Center: the modified Figueroa and the modified Grayson techniques. Outcomes following use of these techniques have not previously been compared prospectively. METHODS: Between May of 2010 and March of 2013, a randomized, prospective, single-blind trial was conducted to compare the number of clinical visits, total costs, complications, and nasal symmetry between the two nasoalveolar molding techniques in 30 patients with unilateral complete cleft lip. RESULTS: There were no differences between nasoalveolar molding techniques in the number of clinical visits, total costs, nostril height, or nostril area ratio. Preoperatively but after nasoalveolar molding, the nostril width ratio was wider for the Figueroa group than for the Grayson group. Six months after surgical correction, there were no differences in nostril height, nostril width, nasal sill height, or nostril area ratio between nasoalveolar molding methods. Alveolar ulceration occurred more frequently in the Grayson group. CONCLUSIONS: The modified Grayson technique reduced nostril width more efficiently, but alveolar ulceration was more frequent and no differences in nostril width were found following surgery. Overall, the two nasoalveolar molding techniques produced similar nasal outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Presurgical orthodontics versus no presurgical orthodontics: treatment outcome of surgical-orthodontic correction for skeletal class III open bite.

BACKGROUND: It has long been claimed that presurgical orthodontics is crucial to the outcome of surgical-orthodontic treatment for dentofacial deformity. However, in the literature, the effect of presurgical orthodontics on the treatment outcome remains controversial. The purpose of the study was therefore to investigate the effect of presurgical orthodontics on the treatment outcome in terms of facial aesthetics, occlusion, stability, and efficiency. METHODS: Thirty-three adult patients with skeletal class III open bite corrected by Le Fort I posterior impaction and bilateral sagittal split osteotomy were included. The patients were divided into two groups: 13 received presurgical orthodontics, and 20 did not. Cephalometric radiographs and study models were used to evaluate the treatment outcome. RESULTS: There were no between-group differences in facial aesthetics, overbite, or Peer Assessment Rating score. Overjet was larger in the no-presurgical orthodontics group than in the presurgical orthodontics group, but both were within normal limits. Both groups had similar maxillary and horizontal mandibular stability. Although the vertical mandibular stability was worse in the no-presurgical orthodontics group than in the presurgical orthodontics group, the direction of instability was favorable for open bite correction. Finally, longer treatment time was required in the presurgical orthodontics group compared with the no-presurgical orthodontics group (512±103 days versus 342±127 days; p<0.001). CONCLUSIONS: The results suggest that in surgical-orthodontic correction of skeletal class III open bite, presurgical orthodontics has no clinically significant effects on facial aesthetics, occlusion, or stability. However, presurgical orthodontics has a significant adverse effect on efficiency. Patients receiving presurgical orthodontics undergo longer treatment time than those receiving no presurgical orthodontics.