Analysis of Dental Arch in Children With Oral Cleft Before and After the Primary Surgeries.

This study aimed to evaluate longitudinally the alteration of the dental arch dimensions of children with different oral cleft types, before and after the primary surgeries. Three-dimensional images of the maxillary dental casts of children with unilateral complete cleft lip (G1), unilateral complete cleft lip and palate (G2), and cleft palate (G3). The children were evaluated at pre-cheiloplasty (T1), pre-palatoplasty (T2), and 1 year after palatoplasty (T3). The measurements obtained: intercanine (C-C') and intertuberosity (T-T') distances, anterior (I-CC') and total (I-TT') arch lengths. To analyze the intraexaminer error, paired t-test was applied and Dahlbergh formula. The intragroups comparisons were applied: paired t-test, ANOVA followed by Tukey, Wilcoxon test, and Kruskal-Wallis test followed by Dunn test. The intergroup comparisons were performed by independent t-test and Mann-Whitney test. In G1, the C-C', T-T', and the I-TT' distances revealed a significant increase of the maxilla. In G2, the C-C' distance statistically decreased from T1 to T3, T-T' distance showed statistical increase from T1 to T3. The I-TT' length increased with statistically significant differences between T1 and T3, T2 and T3. In G3, the C-C', T-T', and I-TT' distance increased was statistically significant. The longitudinal evaluation of the changes occurred in the dental arches with different oral cleft types showed that cheiloplasty and palatoplasty caused the most alterations in the development of the maxillary dimensions of children with complete cleft lip and palate.

Three-dimensional evaluation of surgical techniques in neonates with orofacial cleft.

BACKGROUND: Individuals with cleft lip and palate have many anatomic and functional alterations compromising esthetics, hearing, speech, occlusion, and development/craniofacial growth. The rehabilitative treatment of these patients is very challenging and starts at birth aiming at the best treatment for all functional demands. This study aimed to evaluate the dimensional alterations of the dental arches of neonates with cleft lip and palate after two different primary surgical techniques. MATERIALS AND METHODS: The sample comprised 114 digital models of children aged from 3 to 36 months, with unilateral complete cleft lip and palate divided into two groups. Two different phases were evaluated: precheiloplasty and 1 year after palatoplasty. The evaluation was performed through the digital models of each child obtained by scanning digitalization (3D Scanner). Dental arches measurements were accomplished through Appliance Designer software. The following measurements were assessed: dental arch area, anterior amplitude of the cleft, total length of dental arch, intercanine distance, and intertuberosity distance. t-test was applied to compare differences between groups. RESULTS: No statistically significant differences were observed between groups at precheiloplasty phase. At 1 year after palatoplasty, the groups differed in the total length of dental arch (P = 0.002), with greater values for Group I. CONCLUSION: This study suggests that the results of the different surgical techniques may alter the growth and development of the dental arches of neonates with cleft lip and palate.

General anesthesia for dental care management of a patient with epidermolysis bullosa: 24-month follow-up.

Epidermolysis bullosa comprises a group of uncommon skin-related diseases, characterized by the formation of blisters on mucocutaneous regions occurring spontaneously, following a trauma, exposure to heat, or as a result of minimal mechanical trauma. The dental treatment of the patient with epidermolysis bullosa raises many questions and discussions, due to the difficulty of carrying out the procedures. This report aimed to detail the clinical considerations of the treatment under general anesthesia of a patient with epidermolysis bullosa. The extraction of all deciduous teeth under general anesthesia was recommended based on the clinical and radiographic examinations. At 24-month follow-up, the patient had great improvement in oral hygiene without new caries lesions. The patient has been followed-up at every month for caries lesion prevention and permanent tooth development. The treatment under general anesthesia provided the ideal safe conditions and was beneficial for the patient.

Mini-implants: alternative for oral rehabilitation of a child with ectodermal dysplasia.

Ectodermal dysplasia is a rare congenital disease that affects several structures of ectodermal origin. The most commonly related oral characteristics are hypodontia, malformed teeth and underdeveloped alveolar ridges. New alternative treatments are needed due to the failure of the conventional prosthesis retention. This case report outlines the oral rehabilitation treatment of a 9-year-old girl with ectodermal dysplasia. The treatment was performed with conventional prosthesis upon mini-implants. The mini-implants provided prosthetic retention. The patient reported a good adaptation of the dental prosthesis and satisfaction with the treatment. The increased self-esteem improved the socialization skills of the girl. In this case report, use of prosthesis with mini-implants was satisfactory for prosthetic retention. However, clinical studies with long-term follow-up are needed to test the mini-implants as an alternative for oral rehabilitation of children with ectodermal dysplasia.

Evaluation of the intercanine distance in newborns with cleft lip and palate using 3D digital casts.

OBJECTIVE: The purpose of this present study was to compare, by means of 3D digital casts, the anterior transverse dimension of the dental arch of newborns with and without cleft lip and palate. MATERIAL AND METHODS: The sample was composed of ninety-four children aged from 3 to 9 months divided into three study groups: Group I - children without craniofacial deformities (control group); Group II - children with unilateral cleft lip and palate; Group III - children with bilateral cleft lip and palate. Impressions were executed before lip and palate repair in patients with clefts. Dental casts were digitized using a 3D scanner linked to a computer. Measurements of the intercanine distance were measured on the digital casts. Intergroup comparisons were performed using ANOVA (p<0.05). RESULTS: The results showed a mean of 36.5 mm for unilateral cleft lip and palate group, 34.8 mm for bilateral cleft lip and palate group and 27.52 mm for the control group. There was a statistically significant difference between the control group and both groups of patients with cleft lip and palate. There was no statistically significant difference between complete unilateral and bilateral cleft lip and palate groups. CONCLUSIONS: Patients with complete cleft lip and palate were born with an increased anterior dimension of the maxillary dental arch compared to non cleft patients.

Mini-implants: Alternative for Oral Rehabilitation of a Child with Ectodermal Dysplasia

Ectodermal dysplasia is a rare congenital disease that affects several structures of ectodermal origin. The most commonly related oral characteristics are hypodontia, malformed teeth and underdeveloped alveolar ridges. New alternative treatments are needed due to the failure of the conventional prosthesis retention. This case report outlines the oral rehabilitation treatment of a 9-year-old girl with ectodermal dysplasia. The treatment was performed with conventional prosthesis upon mini-implants. The mini-implants provided prosthetic retention. The patient reported a good adaptation of the dental prosthesis and satisfaction with the treatment. The increased self-esteem improved the socialization skills of the girl. In this case report, use of prosthesis with mini-implants was satisfactory for prosthetic retention. However, clinical studies with long-term follow-up are needed to test the mini-implants as an alternative for oral rehabilitation of children with ectodermal dysplasia.

A displasia ectodérmica é uma doença congênita rara, que afeta várias estruturas de origem ectodérmica. As principais características na cavidade oral são hipodontia, má formação dentária e subdesenvolvimento do rebordo alveolar. Devido às falhas de retenção das próteses convencionais, novas alternativas de tratamento são necessárias. Este relato de caso descreve o tratamento de reabilitação oral em uma menina de 9 anos de idade com displasia ectodérmica. O tratamento foi realizado com próteses dentárias convencionais sobre mini-implantes. Os mini-implantes promoveram a retenção da prótese. A paciente relatou uma boa adaptação das próteses e satisfação com o tratamento. O aumento da autoestima melhorou as atividades de socialização da criança. Neste estudo de caso, o uso de prótese com mini-implantes foi satisfatória para a retenção da prótese. No entanto, estudos clínicos longitudinais são necessários para testar os mini-implantes como uma alternativa para a reabilitação oral de crianças com displasia ectodérmica.

Evaluation of the intercanine distance in newborns with cleft lip and palate using 3D digital casts

OBJECTIVE: The purpose of this present study was to compare, by means of 3D digital casts, the anterior transverse dimension of the dental arch of newborns with and without cleft lip and palate. MATERIAL AND METHODS: The sample was composed of ninety-four children aged from 3 to 9 months divided into three study groups: Group I - children without craniofacial deformities (control group); Group II - children with unilateral cleft lip and palate; Group III - children with bilateral cleft lip and palate. Impressions were executed before lip and palate repair in patients with clefts. Dental casts were digitized using a 3D scanner linked to a computer. Measurements of the intercanine distance were measured on the digital casts. Intergroup comparisons were performed using ANOVA (p<0.05). RESULTS: The results showed a mean of 36.5 mm for unilateral cleft lip and palate group, 34.8 mm for bilateral cleft lip and palate group and 27.52 mm for the control group. There was a statistically significant difference between the control group and both groups of patients with cleft lip and palate. There was no statistically significant difference between complete unilateral and bilateral cleft lip and palate groups. CONCLUSIONS: Patients with complete cleft lip and palate were born with an increased anterior dimension of the maxillary dental arch compared to non cleft patients. .

Avaliação da resposta do complexo dentino-pulpar de dentes decíduos após procedimentos clínicos conservadores / Response evaluation of dentin pulp complex of primary teeth after conservative procedures

O objetivo do presente estudo foi avaliar por meio de observações clínicas e radiográficas a resposta in vivo do complexo dentino-pulpar de dentes decíduos humanos após a realização da remoção parcial e total do tecido cariado. Quarenta e nove molares decíduos de crianças com idades entre 5 a 9 anos foram criteriosamente selecionados. Os dentes foram divididos em dois grupos: Grupo I remoção parcial do tecido cariado; Grupo II remoção total do tecido cariado. As avaliações clínicas e radiográficas foram realizadas nos períodos de 4 a 6 meses do pós-operatório. A reprodutibilidade intra-examinador foi determinada pelo teste Kappa. O teste exato de Fisher foi utilizado para determinar a diferença estatística entre os grupos. Todos os dentes apresentaram sucesso clínico no período de avaliação de 4 a 6 meses. A avaliação radiográfica mostrou 94,2% e 89,6% de sucesso no Grupo I e no Grupo II, respectivamente. Os resultados radiográficos não mostraram diferença estatisticamente significativa nos grupos estudados em nenhum dos critérios avaliados (p>0,05). Com base nos resultados obtidos para amostra estudada, e de acordo com a metodologia aplicada, a remoção parcial do tecido cariado exibiu resultados clínicos e radiográficos satisfatórios, sugerindo que a abordagem minimamente invasiva para remoção de cárie dentária pode substituir a remoção total do tecido cariado quando indicada corretamente.

The aim of this study was to evaluate through clinical and radiographic observation the in vivo response of the dentin pulp complex of human deciduous teeth after the partial and total removal of the caries. Forty-nine deciduous molars in children with the age between 5 and 9 years old were carefully selected. The teeth were divided in two groups: Group I partial removal of caries; Group II total removal of caries. Clinical and radiographic evaluations were performed during the period of 4 to 6 months after procedure. The intra-examiner reproducibility was determined by the Kappa test. The exact fisher test was used to determine the statistical difference between the groups. All teeth showed clinical success in the evaluation period of 4 to 6 months. The radiographic evaluation showed 94,2% and 89,6% of success rate in Group I and in Group II, respectively. Radiographic results did not show statistically significant differences between the studied groups (p>0,05). Based on the obtained results to this sample, and according to the applied methodology, the partial removal of the caries showed satisfactory clinical and radiographic results, suggesting that the minimally invasive approach to the removal of dental caries might substitute the total removal of the caries when correctly indicated.

Three-dimensional morphometric analysis of dental arches of children with cleft lip and palate: longitudinal study / Análise morfométrica tridimensional dos arcos dentários de crianças com fissura labiopalatina: estudo longitudinal

This study aimed to present two papers that show the alterations in the dental arch dimensions of children with cleft lip and palate before and after the primary surgeries. The first study aimed to evaluate the dimensional alterations of the dental arches of neonates with unilateral complete cleft lip and palate before and after two different primary plastic surgeries. The sample was composed of 114 dental casts of 57 children, divided into two groups: Group 1 ­ 26 neonates whose lip closure was accomplished at 3 months of life by Millard´s technique and the anterior and posterior palate closure by von Langenback's technique (VL); Group 2 ­ 31 neonates whose lip closure, nose's ala correction, and anterior palate closure were accomplished of life by Millard´s technique, Mcomb's or Skoog's technique, and vomer's flap, respectively at 3 months of life; posterior palate closure was accomplished by VL at 12 months of life. The dental casts were analyzed at two phases: (T1) pre-cheiloplasty and (T2) one year after palatoplasty. The second study aimed to evaluate morphometrically and longitudinally the alterations of the dental arch dimensions of children with cleft lip and palate. The sample was composed by digital dental casts of children with complete cleft lip (Group 1), complete cleft lip and palate (Group 2), and complete cleft palate (Group 3), obtained at pre-cheiloplasty (T1), pre-palatoplasty (T2), and one year after palatoplasty (T3). The measurements of the dental arch dimensions of both studies were performed directly on the digitized models and analyzed by Appliance Designer software. The following dimensions were obtained: intercanine distance, inter-tuberosity distance, anterior arch length, and total arch length. A previously trained and calibrated examiner performed the assessments of both studies. To verify the alterations among groups, t test and ANOVA followed by Tukey was applied. In the first study, no statistically significant differences occurred at pre-cheiloplasty. At one year after palatoplasty, Group 1 had statistically significant greater anterior-posterior arch length (P=0.002) than Group 2. This suggested that the outcomes of the different surgical techniques may cause alterations in the dental arch growth and development of neonates with cleft lip and palate. In the second study, in Group 1, the distances C-C', T-T', and I-TT' were statistically greater at T2 than at T1. In Group 2, the distances C-C' and I-CC' were smaller at T3. T-T' distance decreased and I-TT' distance increased at all phases. In Group 3, the C-C', T-T', and I-TT' distances were statistically greater at T3. The intergroup comparisons showed that C-C' and T-T' distances were statistically greater in Group 1; C-C' and I-CC' distances were statistically smaller in Group 2; and I-TT' distance was statistically greater in Group 3. The longitudinal evaluation of the changes occurred in the dental arches of children with different oral cleft types showed that cheiloplasty and palatoplasty caused the most alterations in the growth and development of the maxillary dimensions of children with complete cleft lip and palate.(AU)

O propósito deste estudo foi apresentar dois artigos que mostram as alterações das dimensões dos arcos dentários de crianças com fissura labiopalatina antes e depois das cirurgias primárias. O primeiro estudo foi proposto para avaliar as alterações dimensionais dos arcos dentários de neonatos com fissura labiopalatina antes e após a realização de duas técnicas distintas de cirurgias plásticas primárias. A amostra foi composta de 114 modelos dentários em gesso de 57 crianças, divididos em dois grupos: Grupo I ­ 26 neonatos, fechamento do lábio realizado aos 3 meses de vida pela técnica de Millard e palato total aos 12 meses, pela técnica de von Langenback (VL); Grupo II ­ 31 neonatos, fechamento do lábio pela técnica de Millard aos 3 meses de vida, correção de asa nasal (técnicas de Mcomb ou Skoog) e palatoplastia anterior com retalho de vômer aos 3 meses. A palatoplastia posterior foi realizada aos 12 meses pela técnica VL. Os modelos foram analisados em 2 fases: (F1) pré-queiloplastia e (F2) 1 ano pós-palatoplastia. No segundo estudo o objetivo foi realizar uma avaliação longitudinal das alterações das dimensões dos arcos dentários de crianças com fissura labiopalatina. A amostra foi composta de modelos digitais de crianças com fissura completa de lábio (Grupo 1), completa de lábio e palato (Grupo 2), e completa de palato (Grupo 3), obtidos nas fases de pré-queiloplastia (Fase 1), pré-palatoplastia (Fase 2), 1 ano póspalatoplastia (Fase 3). As medidas das dimensões dos arcos dentários nos dois estudos foram realizadas nos modelos digitalizados e analisados utilizando software Appliance Designer. As seguintes dimensões foram obtidas: distância intercaninos, distância intertuberosidade, comprimento anterior do arco dentário e comprimento total do arco. Um avaliador previamente calibrado e treinado realizou as avaliações para os dois estudos. Foi aplicado o Teste t e a Análise de Variância, seguida do Teste de Tukey. Para o primeiro estudo não houve diferença estatisticamente significante na fase pré-queiloplastia entre os grupos. Na fase 1 ano pós-palatoplastia houve diferença para o comprimento anteroposterior do arco dentário (p=0,002), entre os grupos, com valores maiores para o grupo I. Para o segundo estudo, no Grupo 1, as distâncias C-C', T-T' e I-TT' apresentaram diferença estatisticamente significante entre a F1 e F2, com aumento na F2. Para o Grupo 2, houve diferença estatisticamente significante em todas as fases avaliadas. As distâncias C-C' e I-CC' apresentaram menor valor na F3, T-T' diminuiu em todas as fases, e I-TT' aumentou em todas as fases. No Grupo 3, as distâncias C-C', T-T' e I-TT' mostraram diferença estatisticamente significante com aumento na F3. Quando avaliadas as medidas entre os grupos e fases, C-C' e T-T' mostraram um valor maior para o Grupo 1. A comparação entre F2 e F3 mostraram para as distâncias C-C' e I-CC' valor menor para o Grupo 2, e I-TT' foi maior para o Grupo 3. As avaliações longitudinais nos arcos dentários mostraram que a queiloplastia e palatoplastia causam maiores alterações de crescimento e desenvolvimento maxilares de pacientes com fissura completa de lábio e palato.(AU)