Function of Nasoalveolar Molding Devices in Bilateral Complete Cleft Lip and Palate: A 3-Dimensional Maxillary Arch Analysis.

OBJECTIVE: This study aimed to observe and analyze the effects of nasoalveolar molding (NAM) on maxillary arch dimensions in patients with bilateral complete cleft lip and palate (BCLP) using 3-dimensional analyses. DESIGN: Retrospective case series. MATERIALS AND METHODS: Seventeen infants were treated using modified Khon Kaen University presurgical nasoalveolar molding devices (KKU-NAM). Dental casts were evaluated 3 dimensionally at 3 time points: pretreatment (T1), after using modified KKU-NAM for 2 weeks (T2), and before cheiloplasty (T3). Repeated-measures analysis of variance and Friedman test were used to compare the maxillary arch dimensions between time points. RESULTS: Both sides of the cleft width, premaxilla deviation, and premaxilla protrusion had significantly reduced with the use of KKU-NAM. Premaxillary rotation had significantly improved, whereas the arch depth did not change significantly. Premaxilla width, posterior arch width, alveolar length, and height had significantly increased. The anterior arch width, intercanine width, and lateral sulcus width showed no significant changes. The intraclass correlation coefficient used to test the measurements indicated substantial reliability. CONCLUSION: The modified KKU-NAM is an effective device for reducing the severity of bilateral cleft deformities, especially in the premaxilla area.

Evaluation of Postorthodontic Changes in the Treatment of Cleft Lip and Palate Patients Using the PAR Index.

OBJECTIVE: To evaluate dental changes in cleft patients after undergoing orthodontic treatment for at least 2 years. HYPOTHESIS: The dental change would decline significantly after 2 years of completing orthodontic treatment. DESIGN: This is a retrospective study. PATIENT: Eighteen repaired cleft lip and palate patients from the Faculty of Dentistry, KhonKaen University, Thailand, participated in this study. MEAN OUTCOME MEASURES: A dental model with before treatment (T0), completed treatment (T1), and retention period (T2) data was analyzed using the peer assessment rating (PAR) index. RESULT: The results showed that the PAR score improved enormously after treatment; from T0 to T1, it was 34.00 ± 10.01 to 4.67 ± 2.47, and there was a reversion in the retention period. There was statistical significance between T0, T1, and T2, with P values <.001, .005, and <.001 when comparing T0 with T1, T1 with T2, and T0 with T2, respectively. CONCLUSION: Occlusion in cleft lip and palate patients changed from the time of completing treatment to the final results after the retention period. To sustain satisfactory results, orthodontists should plan carefully for the retention period before performing the treatment.

Evaluation of the Effects of Cheiloplasty on Maxillary Arch in UCLP Infants Using Three-Dimensional Digital Models.

OBJECTIVE: To analyze and identify changes in the maxillary dental arch before and after cheiloplasty in a group of unilateral complete cleft lip and palate (UCLP) infants. DESIGN: This is a cohort study. MATERIAL AND METHOD: Study models from 16 infants with nonsyndromic UCLP, who were treated at Khon Kaen University, were taken before (T1) and after cheiloplasty (T2). The dental models underwent a process of scanning through a 3D scanner, from which 9 linear and 2 angular landmarks were evaluated. Paired t test was used to compare the measurement statistically between T1 and T2. RESULTS: Alveolar cleft gap (G-L), anterior basal angle (∠GC-CC'), and anterior arch curvature angle on greater segment (∠GIC) were significantly decreased (P < .05). Contrarily, anterior ridge length of greater segment (C-I), anterior ridge length of lesser segment (L-C'), and posterior arch width (T-T') were significantly increased (P < .05) after cheiloplasty. While, anterior portion of greater segment (I-G), anterior arch width (C-C'), anterior arch depth (I⊥CC'), arch length (G⊥TT'), and arch circumference (T-C-I-G-L-C'-T') showed no significant difference. The measurements were tested using the Intraclass correlation coefficient. The coefficients indicated high reliability. CONCLUSION: Cleft gap significantly decreased after lip repair, and the anterior part of maxillary dental arch was also bent palatally after cheiloplasty without any other intervention except cheiloplasty. More studies are needed to assess the amount of lip pressure. If any convincing force is presented, an appliance to prevent undesirable pressure is indicated.

Xylitol-containing Chewing Gum for Caries Prevention in Students with Disabilities: A Randomised Trial.

PURPOSE: This cluster randomised controlled trial evaluated the effectiveness of a school-based xylitol chewing-gum programme on caries prevention among students with visual or hearing impairment. MATERIALS AND METHODS: The study compared xylitol gum plus oral health education (intervention group, n = 93) with oral health education alone (control group, n = 81) among students aged 7-18 years in special needs schools in Khon Kaen, Thailand. The primary outcome was caries onset rate measured as the change in caries onset on tooth surfaces. The secondary outcome was plaque index. Between-group differences were determined using generalised estimated equations and a general linear model under the intention-to-treat approach. RESULTS: After 1 year, there was a significantly lower caries rate in the primary dentition among the intervention group compared to the control group (0.08 vs 0.12 surfaces per surface-year, respectively; adjusted relative risk = 0.64, 95% confidence interval 0.44-0.96; p = 0.03), but there was no significant difference in the caries rates for the permanent dentition. Remineralisation also occurred more in the intervention vs the control group in the primary dentition only. Oral hygiene was significantly improved in the intervention but not in the control group (p = 0.001). CONCLUSION: This programme reduced the caries rate and enhanced remineralisation in primary dentition, and improved oral hygiene in students with disabilities.

Oral Health-Related Quality of Life in Children and Young Adolescent Orthodontic Cleft Patients.

OBJECTIVE: To evaluate and compare the oral health-related quality of life (OHRQoL) in Thai patients with cleft lip and palate and to evaluate parents' and their children perceptions. MATERIAL AND METHOD: Child Oral Health Impact Profile (COHIP) questionnaire was used to evaluate OHRQoL of the patients and parents' perceptions of patients' OHRQoL. The subjects consisted of 140 cleft patients (aged 8-15 years) and their parents who visited the Department of Orthodontics, Khon Kaen University. RESULTS: COHIP scores in cleft patients were relatively high. No statistically significant differences were found for overall and subscales COHIP scores between gender and age groups (aged 8-11 and 12-15 years) of patients. Comparison among cleft types, overall COHIP and functional well-being subscales scores showed statistically significant differences (p = 0.01 and p = 0.002, respectively). Cleft lip with or without alveolus (CL/A) had higher overall and functional well-being subscale scores than unilateral and bilateral cleft lip and palate patients (CLP). Only self-image subscale scores were statistically significant differences between patients and parents at p<0.001. CONCLUSION: Young and adolescent patients with cleft lip and palate had generally positive oral health-related quality of life. Impacts of gender and age of patients on OHRQoL were similar CL/A patients had more positive in overall oral health-related quality of life and functional well-being domains than CLP patients did. Parents had higher perceptions of self-image shown by their children than the children themselves.

Correlations between Cervical Vertebral Maturation (CVM) and Dental Development in Thai Cleft Patients.

OBJECTIVE: To examine correlations between cervical vertebral maturation stages (CVMs) and dental development stages, and cervical vertebral maturation (CVM) stage 6 and completion of root formation of mandibular third molar in Thai cleft patients. MATERIAL AND METHOD: Lateral cephalograms of 366 cleft subjects aged 7-9 years were assessed for CVMs using Baccetti method. Calcication stages of all left mandibular teeth within each CVMs were assessed from panoramic films using Demirjian method. RESULTS: Spearman rank correlation coefficients comparing CVMs and teeth were 0.51-0.79 (p<0.001). Second molar had the highest and central incisor had the lowest correlations. In CVMs 6, 2.9% of third molars had completed root formation. However, only CVMs 6 could be predicted from third molar stage G that had a high likelihood ratio (30.94). CONCLUSION: Dental development was highly correlated with CVM in clefts. Third molar stage G could predict completed growth of mandible in individual patients, but it should be combined with other maturation indicators.

Oral health status and oral impacts on quality of life in early adolescent cleft patients.

OBJECTIVE: To determine the levels of dental caries, periodontal disease and oral health-related quality of life in children with cleft lip and/or cleft palate compared to non-cleft controls. MATERIAL AND METHOD: This cross-sectional study was conducted in Khon Kaen, Thailand. Subjects included 68 oral cleft and 118 non-cleft individuals aged 10-14 years, who were interviewed using the Child-Oral Impacts on Daily Pemformance (Child-OIDP) index and received oral examinations. RESULTS: Decayed, missing and filled teeth (DMFT) index in permanent teeth, plaque index (PI), and gingival index (GI) scores were significantly higher in the children with cleft than in the controls. However, there was no significant difference in caries prevalence and decayed, missing and filled teeth (dmnft) index inprimaly teeth between comparison groups. The prevalence of oral impacts on Speaking and Smiling was significantly higher in the cleft children than non-cleft controls. The mean impact score between both groups were not significantly different, but the cleft children with impacts had a significantly higher mean impact score (11.9) than did the controls (8.6). The impact score in the cleft children was high for speaking (4.5), emotion control (4.2), eating (3.4) and relaxing (3.4) activities. The main causes of these impacts included having oro-nasalftstula, having orthodontics appliance, position of teeth and deformity of mouth or face. CONCLUSION: The cleft children had higher levels ofdental caries and gingivitis, and poorer oral hygiene than the controls. They also had lower quality of life than the controls in most pelformances with different perceived causes.

In vitro resorbability and granular characteristics of 3D-printed hydroxyapatite granules versus allograft, xenograft, and alloplast for alveolar cleft surgery applications.

Three-dimensionally printed hydroxyapatite (3DP HA) was investigated in regards to its functional properties supporting bone regeneration and tooth movement in alveolar cleft applications. Commercially available bovine xenograft (BXG), biphasic calcium phosphate alloplast (BCP), and two types of freeze-dried bone allograft granules (FDBA and FDBA-CMC) were employed as control samples. Degradability was studied by submerging the samples in pH 7.4 buffered solution at 37°C for 28 days and determining subsequent weight loss percentage. The wicking property and granular agglomeration were evaluated by putting the granules in contact with deionized water, blood, and phosphate-buffered saline (PBS). Both of FDBA and FDBA-CMC showed the greatest weight loss at 28 days followed by 3DP HA. In contrast, 3DP HA showed significantly greater wicking ability than other samples for all liquid types. FDBA-CMC exhibited the greatest granular agglomeration for all liquid types followed by 3DP HA. 3DP HA was found to be a favorable candidate for bone grafting in alveolar cleft treatment.