Three-dimensional evaluation of secondary alveolar bone grafting in patients with unilateral cleft lip and palate: A 2-3 year post-operative follow-up.

OBJECTIVES: The present study aims to quantitatively assess secondary alveolar bone graft (SABG) resorption in unilateral cleft lip, alveolus and palate (UCLAP) patients in a 2-3 year longitudinal follow-up setting by using a validated 3D protocol. Furthermore, the potential relation of SABG resorption with maxillary canine position and a number of patient-related factors was investigated. METHODS: UCLAP patients who underwent SABG and had good quality CBCT images at the following timepoints were included in the study: pre-operative (T0), immediate (T1), 6 months (T2) and either 1-2 years (T3) or 2-3 years (T4) post-operative. The final bone grafted region was defined on the T1 scans and refined in the registered T0 scans. The bone graft after resorption was determined by applying threshold-based segmentation on the registered T2, T3 or T4 scans within the segmented bone graft volume. The position of the canines was determined at every timepoint at the cleft and non-cleft side. RESULTS: Forty-five UCLAP patients (mean age 9.0 ± 1.3 years) were included. In the first 6 months after SABG, 43.6% bone resorption was recorded. 2-3 years post-operative, 56% bone resorption was found if the maxillary canine was not yet erupted and 42.7% if it erupted through the graft. The vertical position of the canines was significantly higher on the cleft side at T3. CONCLUSIONS: The present study reports significant SABG resorption over time. However, no correlation was found between SABG resorption and canine position, nor between other patient-related factors.

Risk factors for orthodontic fixed retention failure: A retrospective controlled study.

Objective: : To investigate the potential correlation between fixed orthodontic retention failure and several patient- and treatment-related factors. Methods: : Patients finishing treatment with fixed appliances between 2016 and 2017 were retrospectively included in this study. Those not showing fixed retention failure were considered as control group. Patients with fixed retention failure were considered as the experimental group. Additionally, patients with failure of fixed retainers in the period of June 2019 to March 2021 were prospectively identified and included in the experimental group. The location of the first retention failure, sex, pretreatment dental occlusion, facial characteristics, posttreatment dental occlusion, treatment approach and presence of oral habits were compared between groups before and after treatment separately by using a Fisher exact test and a Mann-Whitney U test. Results: : 206 patients with fixed retention failure were included, 169 in the mandibular and 74 in the maxillary jaws. Significant correlations were observed between retention failure in the mandibular jaws and mandibular arch length discrepancy (P = 0.010), post-treatment growth pattern (P = 0.041), nail biting (P < 0.001) and abnormal tongue function (P = 0.002). Retention failure in the maxillary jaws was more frequent in patients with IPR in the mandibular jaws (P = 0.005) and abnormal tongue function (P = 0.021). Conclusions: : This study suggests a correlation between fixed retention failure and parafunctional habits, such as nail biting and abnormal tongue function. Prospective studies with larger study populations could further confirm these results.

Relation between Maximum Oral Muscle Pressure and Dentoalveolar Characteristics in Patients with Cleft Lip and/or Palate: A Prospective Comparative Study.

BACKGROUND: Perioral muscle function, which influences maxillofacial growth and tooth position, can be affected in patients with oral clefts due to their inherent anatomical characteristics and the multiple surgical corrections performed. This research aims to (1) compare the maximum oral muscle pressure of subjects with and without isolated cleft palate (CP) or unilateral cleft lip and palate (UCLP), (2) investigate its influence on their dentoalveolar characteristics, and (3) investigate the influence of functional habits on the maximum oral muscle pressure in patients with and without cleft. MATERIAL AND METHODS: Subjects with and without CP and UCLP seeking treatment at the Department of Orthodontics of University Hospitals Leuven between January 2021 and August 2022 were invited to participate. The Iowa Oral Performance Instrument (IOPI) was used to measure their maximum tongue, lip, and cheek pressure. An imbalance score was calculated to express the relationship between tongue and lip pressure. Upper and lower intercanine (ICD) and intermolar distance (IMD) were measured on 3D digital dental casts, and the presence of functional habits was reported by the patients. The data were analyzed with multivariable linear models, correcting for age and gender. RESULTS: 44 subjects with CP or UCLP (mean age: 12.00 years) and 104 non-affected patients (mean age: 11.13 years) were included. No significant differences in maximum oral muscle pressure or imbalance score were detected between controls and clefts or between cleft types. Significantly smaller upper ICDs and larger upper and lower IMDs were found in patients with clefts. A significant difference between controls and clefts was found in the relationship between oral muscle pressure and transversal jaw width. In cleft patients, the higher the maximum tongue pressure, the wider the upper and lower IMD, the higher the lip pressure, the smaller the upper and lower ICD and IMD, and the higher the imbalance score, the larger the upper and lower IMD and lower ICD. An imbalance favoring the tongue was found in cleft patients. The influence of functional habits on the maximum oral muscle pressure was not statistically different between clefts and controls. CONCLUSION: Patients with CP or UCLP did not present reduced maximum oral muscle pressure compared with patients without a cleft. In cleft patients, tongue pressure was consistently greater than lip pressure, and those who presented a larger maxillary width presented systematically higher imbalance scores (favoring the tongue) than those with narrow maxillae. Therefore, the influence of slow maxillary expansion on maximum oral muscle pressure in cleft patients should not be underestimated.

Performance of the Malmgren Index for Assessing Root Resorption on 2D vs. 3D Radiographs: A Pilot Study.

OBJECTIVES: To compare the performance of the Malmgren index on 2D and 3D radiographs. METHODS: Patients with a panoramic radiograph and a cone beam computed tomography (CBCT) taken at an interval of <3 months and presenting root resorption (RR) on at least one incisor and/or canine were retrospectively included. RR was scored twice by two observers using the Malmgren index in both the 2D and 3D sets, and intra-class correlation coefficient (ICC) was calculated. RESULTS: 155 teeth were analyzed. The ICC was the lowest in 2D, followed by overall, transversal and sagittal 3D. Malmgren scores were systematically higher in 2D, which overestimated RR, especially in the transversal plane on all incisors and canines and in the sagittal plane on the maxillary incisors. 2D respectively leads to 28.0-34.8% of false positives and negatives when discriminating between RR or not. The early stages of RR are often misdiagnosed in 2D, while later stages are more accurate. CONCLUSIONS: The original Malmgren index is not suited for 3D images, especially axial, where using dichotomized values (resorption yes/no) leads to overestimation of RR. A low-dose CBCT of the upper incisors could detect RR with high diagnostic accuracy in the early stages of orthodontic treatment, especially in patients with dental trauma or familial RR history.

Third molar position after completion of orthodontic treatment: a prospective follow-up.

OBJECTIVES: To prospectively follow up a previously reported sample, analyzing (1) changes in third molar (M3) position after completion of 2 different types of orthodontic treatment: (2) non-extraction treatment with (HG) vs without cervical headgear (non-HG) and (3) first or second premolar extractions (PM1-2) compared to a non-extraction group (NE). METHODS: A total of 474 patients were prospectively followed up. Panoramic radiographs were taken pre- (T1), post-treatment (T2) and at follow-up (T3). T3 records (a mean of three years after treatment) were available for 135 (HG vs non-HG) and 134 patients (PM1-2 vs NE), respectively. Angulation, vertical position, relation with the mandibular canal and mineralization status of M3 at T2 and T3 were statistically compared. RESULTS: The HG group presented more M3 with ideal vertical orientation at T3. In NE-cases, further improvement in angulation and orientation can be expected after debonding, as well as a deterioration in the relationship with the mandibular canal. Extractions accelerated upper M3 vertical eruption and PM2 extractions led to long-term larger lower retromolar spaces. CONCLUSIONS: The use of cervical headgear increased upper M3 uprighting three years after debonding, while little changes in M3 position were found after orthodontic treatment with extractions. However, PM2 extractions led to larger retromolar spaces and better M3 angulation in the long term.

The use of blended learning in postgraduate education in orthodontics: student versus teacher perception.

OBJECTIVE: To investigate the use of blended learning (BL) in Postgraduate Education in Orthodontics. METHODS: A self-developed online questionnaire was sent to 244 teaching staff members of the European Orthodontic Departments. They were asked to answer it and share it with their postgraduate students. 18 questions for teaching staff and 27 for postgraduate students evaluated the use, perceptions, feedback options, learning outcomes, and teacher's role in BL. The answers of teaching staff and students were statistically compared by Fisher's Exact Test, Chi-Square Test, Unpaired t-test, and Mann-Whitney Test. RESULTS: 124 completed questionnaires were received, 44 from teaching staff and 80 from postgraduate students. Teaching staff is more acquainted with BL than students (P = 0.001). Both groups found BL courses a good alternative to traditional courses (P = 0.654). The use of interactive multimedia was more appreciated by students (P = 0.015). Both groups found students' results not to change with BL, but teaching staff had a more negative perception (P = 0.012). In general, teaching staff perceived feedback and interaction as less essential than postgraduates in BL. Teaching staff felt more like coaches when using BL, while postgraduates did not perceive any changes in teachers' roles (P = 0.006). Limitations: Due to the General Data Protection Regulation it was not possible to directly contact the postgraduate students in Postgraduate Orthodontic Programs throughout Europe. Therefore, this study completely relied on the goodwill of the teaching staff being contacted. CONCLUSION: The main differences in perception between teaching staff and postgraduate students were student results, teachers' role, use, and importance of feedback and interactive multimedia. Although both groups found BL courses to stimulate students' learning and to be a relevant cost-effective addition to traditional courses, they were hesitant to fully replace them with BL.

Determination of craniofacial and dental characteristics of individuals with Williams-Beuren syndrome by using 3D facial scans and radiographs.

BACKGROUND: Williams-Beuren syndrome (WBS) is caused by a microdeletion on chromosome 7q11-23 and clusters a variety of systemic affectations. AIM: To investigate whether 3D facial scans can detect WBS by objectively addressing their craniofacial, skeletal and dental characteristics, compared with those of a non-affected control group. MATERIALS AND METHODS: 3D facial surface scans of 17 WBS individuals and 33 normal developing patients were analysed. Additionally, cephalometric and panoramic radiographs of subjects with WBS were compared with those of non-affected individuals. RESULTS: The 3D surface scans showed significant facial differences around the nose and mouth area. The cephalometric aspects of individuals with WBS differed mainly at the lower incisor region. Additionally, hypoplastic tooth morphology seems to be more often present in WBS. CONCLUSION: 3D images are a non-invasive, efficient method to observe facial anomalies and facilitate an early diagnosis of WBS. Additionally, the analysis of the cephalometric and panoramic images revealed significant differences in dental characteristics. Together with early diagnosis through 3D images, these can help in the establishment of adequate medical, dental and orthodontic treatment planning.

Validation of a 3D methodology for the evaluation and follow-up of secondary alveolar bone grafting in unilateral cleft lip and palate patients.

OBJECTIVE: The aim of the study was to propose and validate a method for three-dimensional (3D) quantitative assessment of secondary alveolar bone grafting (SABG) and its stability in time for patients with unilateral cleft lip and palate (UCLP). SETTINGS AND SAMPLE POPULATION: Ten non-syndromic UCLP patients (9 males and 1 female with a mean age of 9.5 ± 0.9 years) undergoing SABG with good quality preoperative, immediate postoperative (6 weeks) and 6 months postoperative Cone Beam Computed Tomography (CBCT) scans were selected. MATERIALS AND METHODS: The preoperative and 6 months postoperative scans were registered onto the immediate postoperative scan. The bone-grafted region was defined on the immediate postoperative scan and refined on the registered preoperative scan resulting in a 3D volume. The residual bone graft was calculated by applying threshold based segmentation on the registered 6 months postoperative scan within the segmented bone graft volume of the previous step. Inter and intra observer tests using intra-class correlation coefficient (ICC) were applied comparing the volumes of the 3D models. RESULTS: An excellent reliability was found for inter and intra observers with ICC ≥ 0.95. CONCLUSIONS: The presented method proved to be reliable for volumetric assessment of the alveolar bone graft in UCLP patients, as well as to assess the percentage of bone resorption during follow-up.

Self-Esteem and Oral Health-Related Quality of Life within a Cleft Lip and/or Palate Population: A Prospective Cohort Study.

(1) Objective: To investigate the oral health-related quality of life (OHRQoL) and self-esteem (SE) of a population with cleft lip and/or palate (CLP) and to compare it with a non-affected control cohort. (2) Materials and methods: This study comprised 91 CLP patients and a control group of 790 individuals, seeking orthodontic treatment. OHRQoL and SE were assessed by the Child's Perception Questionnaire (CPQ) and the Dutch adaptation of the Harter's Self-Perception Profile for Adolescents. Treatment need and self-perception of oral aesthetic were assessed using the Index of Orthodontic Treatment Need (IOTN) and the Oral Aesthetic Subjective Impact Scale (OASIS). Patients' expectations and motivation for treatment were also scored. Linear models were used for statistical comparisons between groups. (3) Results: The cleft group scored higher in all domains of the CPQ, OASIS, IOTN and regarding SE for the domains of scholastic competence, athletic competence, physical appearance and behavioral conduct. The cleft group was not only more motivated and expected less discomfort during treatment but also had higher expectations for the treatment outcome. (4) Conclusions: The OHRQoL of CLP patients is strongly correlated with the presence of an oral cleft, while SE remains a personal resource not influenced by the malocclusion or medical condition.

Dental and Craniofacial Characteristics in Patients With 14Q22.1-Q22.2 Deletion: A Case Series.

This case series is a follow-up report focusing on dental and facial characteristics in patients with a rare microdeletion in chromosome 14q22.1-q22.2. Usually, these patients have severe ocular, brain, and digital abnormalities. However, this case series shows that clinical presentation can be mild. Four relatives spanning 3 generations were diagnosed with a familial autosomal dominant 2.79 Mb microdeletion in chromosome 14q22.1-q22.2. Genetic screening was done by the Bacterial Artificial Chromosome array-comparative genome hybridization and was confirmed by the fluorescence in situ hybridization technique. Dental and craniofacial data were collected from medical files, clinical examinations, clinical photos, panoramic and cephalometric radiographs, and dental casts. Written informed consent for scientific use was obtained for all family members. No larger syndrome could be identified. All cases had similar facial red flag characteristics, consisting of a long face with retrognathia and open mouth relation, associated oral clefts in varying degrees, depressed nasal bridge, delayed tooth development, hypertelorism, and low-set angular ears. The dental casts showed a distal molar occlusion and a lack of space in the dental arches. Developmental delay was noted together with limb defects such as poly- and syndactyly. Microphthalmia and hearing loss were present in the most severe cases. This rare congenital disorder, associated with facial dysmorphia, oral clefts, and tooth agenesis, can remain undiagnosed until adulthood. A family history of short stature, developmental delay, poly- or syndactyly, and micropthalmia are suggestive features. Similar reports help to raise awareness among dental practitioners, leading to an early genetic diagnosis.

Dental development in patients with and without unilateral cleft lip and palate (UCLP): a case control study.

OBJECTIVE: To evaluate if the presence of unilateral cleft lip and palate (UCLP) causes delay in dental age and tooth development. MATERIALS AND METHODS: Panoramic radiographs of 189 non-syndromic UCLP patients, aged from 6 to 20 years, were collected. Two measures of tooth development were examined: dental maturity scale for the seven left mandibular teeth (dental age-DA) and the degree of each tooth development (developmental score-DS). All the teeth except third molars were staged according to the Demirjian's method. The data of the cleft group were compared with a control group matched for age and gender, based on the findings observed in other 189 panoramic radiographs. RESULTS: At all ages, DA was lower in the UCLP group, but not always significantly; the highest difference was - 1.411 for females at 13 years old and - 0.776 for males at 12 years old. DS of all teeth was significantly lower in the UCLP group, at all ages under 17 in females, and at all ages under 18 in males. In UCLP group, tooth development was more delayed in the maxilla compared with the mandible. No evidence of a slower development at the cleft side compared with the non-cleft side was highlighted. CONCLUSIONS: Significant lower dental development was observed in UCLP patients compared with control ones by using DS and DA indexes. CLINICAL RELEVANCE: These findings can help the clinicians in establishing a proper orthodontic and surgical diagnosis and treatment planning in UCLP patients and for forensic age estimation's purposes.

The evolution of self-esteem before, during and after orthodontic treatment in adolescents with dental malocclusion, a prospective cohort study.

OBJECTIVES: This study aimed (1) to investigate the evolution of self-esteem through orthodontic treatment, and (2) to study how key demographic factors would affect these evolutions and to assess relationships between self-esteem and orthodontic treatment need. METHODS: This longitudinal prospective cohort study comprised of 326 adolescents (172 girls and 154 boys) aged 11-16 years; data were obtained from 325 adolescents at T0 and 123 at T2. Three hundred twenty-one adolescents filled in questionnaires at T0, whereas 118 at T2. They were selected in the University Hospitals Leuven, Belgium, where they all received orthodontic treatment. Self-esteem was assessed with the Dutch adaptation of the Harter's test and treatment need was defined by the Index of Orthodontic Treatment Need (IOTN). Data were analysed with multivariate linear models and Spearman correlations. RESULTS: There was no evidence of a change in global self-esteem during orthodontic treatment. A significant gender by time interaction for scholastic competence (P < 0.05), a decrease in self-esteem for females, and an increase for males between T0 and T1 was observed. A significant age (at T0) by time interaction for physical appearance and global self-worth (P < 0.05) and a negative correlation between self-esteem and self-assessed IOTN aesthetic component for the subdomain of close friendship (P < 0.05) were found. CONCLUSIONS: Global self-esteem acts as a stable construct during orthodontic treatment. The subdomains of self-esteem could be influenced by age and gender. Self-esteem and the subjective need for orthodontic treatment were found to be negatively correlated.

Dental development in cleft lip and palate patients: A systematic review.

OBJECTIVE: To investigate a potential delay in dental development in cleft patients compared with non-cleft patients. SEARCH METHODS: An unlimited electronic search was performed in four databases (PubMed, Embase, Lilacs and OpenGrey), from inception until October 2018. Full text articles concerning dental development or tooth eruption of non-syndromic children with cleft lip and/or palate (CL(P)) were included and reviewed. Case reports/series, review articles, articles in languages other than English, Dutch, French or Spanish and studies considering the eruption of deciduous teeth were excluded. Data extraction followed the PRISMA guidelines and study quality was assessed using MINORS. RESULTS: The primary search resulted in 991 citations, of which 36 studies were finally analyzed. Most articles were retrospective studies based on panoramic radiographs. A delay in tooth development or -eruption in CL(P) patients was found in 32 out of the 36 included articles. The amount of delay varied from 0.20 to 0.90 years, with a mean delay of 0.56 years for all types of clefts. In UCLP patients, a mean delay of 0.53 years was found. The lateral incisor at the cleft side was generally the most delayed. Conflicting results were found regarding the influence of sex and age. The amount of delay was reported to be independent of the cleft severity or type. The teeth near the cleft generally showed a greater delay than the teeth further away from it. Finally, an increased risk of asymmetrical tooth development in CL(P) patients was observed in all publications studying this aspect. 31 articles were comparative, 5 were non-comparative; with a median MINORS score of 16/24 (range 10-18) and 10/16 (range 8-10) for both groups respectively. CONCLUSIONS: The majority of the included articles reports a delay in dental development or tooth eruption in CL(P) patients compared to non-CL(P) patients. The obtained results could be important for forensic age estimation outcomes and for orthodontic and surgical treatment planning in CL(P) patients. The delay in tooth development implies a delay in start of orthodontic treatment. Moreover, CL(P) patients could falsely be considered to be a minor when applying the existing reference tables for dental age estimation. SYSTEMATIC REVIEW REGISTRATION: International prospective register of systematic reviews (PROSPERO: CRD42018082106).

Difference and relation between adolescents' and their parents or caregivers' reported oral health-related quality of life related to orthodontic treatment: a prospective cohort study.

BACKGROUND: Parents/caregivers play an important role in deciding whether their children will undergo orthodontic treatment or not. Their perceptions also have an influence on other choices involving orthodontic treatment. The purpose of this study was to investigate the difference and correlation between the ratings given by children and their parents or caregivers on their oral health-related quality of life (OHRQoL) before, during and after orthodontic treatment. METHODS: In this ongoing observational prospective cohort study, 498 children aged 11 to 16 years-old and one of their parents/caregivers completed questionnaires before (T0), 1 year after start (T1) and 1 month after the end of orthodontic treatment (T2). OHRQoL was scored by using the Child Perception Questionnaire (CPQ11-14) and the Parental-Caregiver Perception questionnaire (P-CPQ). The self-perception of oral aesthetics was evaluated with the Oral Aesthetic Subjective Impact Scale (OASIS) in addition to the aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN). Spearman correlations, Mann-Whitney U-tests and linear models were used to analyze the longitudinal data. RESULTS: At T0, the ratings of parents/caregivers were significantly lower for the total CPQ as well as for the subdomains of oral symptoms, functional limitations and emotional well-being. Parents/caregivers also scored significantly lower at T2 for the total CPQ and the subdomain of oral symptoms. The relations between the scores of children and their parents/caregivers were significant at all three time points, as were the changes in scores, but all of them were at most moderate in size. Parents/caregivers scored significantly lower for OASIS than their children at all time points and only at baseline a significant, weak correlation was found. CONCLUSION: The reports of parents/caregivers should be seen as important complementary information in OHRQoL research. TRIAL REGISTRATION: This study was approved by the Medical Ethical Commitee of the University Hospitals Leuven and the Katholieke Universiteit Leuven (ML5739), Leuven, Belgium, on the 12th of May of 2009, with the registration number S51642. All procedures performed are in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Reported changes in oral health-related quality of life in children and adolescents before, during, and after orthodontic treatment: a longitudinal study.

OBJECTIVES: To investigate the changes in oral health-related quality of life (OHRQoL) before, during, and after orthodontic treatment, determine the relationship with the original treatment need and evaluate the influence of self-esteem (SE). MATERIALS AND METHODS: OHRQoL questionnaires were used in an ongoing observational prospective cohort study at baseline (T0), 1 year after start (T1), and 1 month after the end of active orthodontic treatment (T2). Participants were 11-16-year-old at baseline and 215 complete cases were obtained from a total of 498. OHRQoL was scored by using the Child Perception Questionnaire (CPQ11-14), SE was assessed by the Dutch adaptation of the Harter's Self-Perception Profile for Adolescents and treatment need was defined by the Index of Orthodontic Treatment Need (IOTN). The Oral Aesthetic Subjective Impact Scale (OASIS) was included to score perceived treatment need. Data were analyzed with Spearman correlation, Mann-Whitney U-test and linear models for longitudinal data. RESULTS: A significant decrease in IOTN and in OASIS was noted from T0-T1-T2 (P < 0.0001). CPQ results show a decrease from T0 to T2, from T1 to T2 and an increase from T0 to T1 (P < 0.0001). This was valid for the overall CPQ scores and its subdomains except for emotional well-being (EW), which decreases from T0-T1-T2. A correlation was found between baseline SE and the change of total CPQ scores between T0 and T2, also for EW (r = 0.325 and r = 0.354). CONCLUSIONS: OHRQoL ameliorates after orthodontic treatment. High baseline SE works as a protective factor for OHRQoL.

Associated parameters of canine impaction in patients with unilateral cleft lip and palate after secondary alveolar bone grafting: a retrospective study.

Objectives: To compare parameters related to impacted canines at the cleft versus the normal contralateral side and with non-impacted canines at the cleft side in unilateral cleft lip and palate (UCLP) patients. We also aim to search for possible associated parameters enabling prediction of canine impaction in these patients. Materials and methods: Ninety-five non-syndromic UCLP patients were included and divided into group A (n = 41 patients) with unilateral impacted canines at the cleft side (A1) and spontaneously erupted canines at the non-cleft side (A2) and group B with spontaneously erupted canines at the cleft side (n = 54 patients). Clinical information and radiographic parameters on panoramic radiographs were collected and compared between groups using a generalized linear mixed model, a Mann-Whitney U-test, a Fisher's exact test, and receiver operating characteristic tests. Results: Impaction of the maxillary canine at the cleft side in UCLP patients can be suspected in case of delayed canine root development, a higher vertical position and sector score (P < 0.05) and higher angles between the canine and the midline, as well as between canine and lateral incisor and between first premolar (P < 0.001). Results clearly indicate that the erupting canine position at the cleft side, even when not impacted, is different from the non-cleft side. Conclusion: There is a great risk for canine impaction at the cleft side in UCLP patients when the canine position is more apical than one-third of the root of the adjacent lateral incisor and when the angles between canine and midline and between canine and first premolar are higher than 23.82 and 16.1 degrees, respectively. These associated parameters should have to be studied in a prospective setting to confirm their predictive value.

An optimized imaging protocol for orofacial cleft patients.

The objective was to present an optimized imaging protocol for orofacial cleft (OFC) patients, which might be used as an international recommendation for OFC care programs. The present radiological protocol has been structured by the OFC team of the University Hospitals Leuven based on a combined approach of clinical experience and scientific evidence. The development was based on careful monitoring of the existing needs for radiological diagnosis by the involved disciplines. Needs were revised by expert consensus and radiological optimization. Effective doses were converted to panoramic equivalents (professional conversion) and background radiation (patient conversion). At the age of 6, a panoramic radiograph is taken for the evaluation of dental anomalies. For the preoperative planning of secondary alveolar bone, grafting a low-resolution cone beam computer tomography (CBCT) of a limited field of the maxilla is taken at the age of 7 to 9. At the age of 10, 15, and 20, a low-resolution CBCT of both jaws with the smallest possible field is taken serving as conventional, presurgical, and end of treatment records, respectively. Two-dimensional images are reconstructed out of 3D ones. There are currently no international guidelines concerning the imaging protocol for OFC patients. It is clear that a multidisciplinary approach plays a key role in radiation hygiene. In this article, we presented an optimized imaging protocol for OFC patients based on European guidelines to accomplish the concepts of justification and optimization, which might be used as an international recommendation for OFC care programs.

Three-dimensional radiological evaluation of secondary alveolar bone grafting in cleft lip and palate patients: a systematic review.

OBJECTIVES: To systematically review the existing literature on the three-dimensional (3D) radiological evaluation of secondary alveolar bone grafting (SABG) in cleft lip and palate (CLP) patients, with specific interest in 3D imaging protocols and assessment methods.  Methods: A comprehensive literature search on PubMed, Embase and the Cochrane Library was conducted. Included publications concerned 3D imaging for evaluation of SABG in CLP patients while articles about primary or tertiary bone grafting or using of two-dimensional images only were excluded. Study quality was evaluated using the Methodological Index for Non-Randomized Studies  or the Cochrane Collaboration tool for assessing risk of bias. RESULTS: The search yielded 1735 citations, of which 38 met the inclusion criteria. We noticed a large variability in imaging protocols and bone graft evaluation methods between studies. Most articles were observational studies with medium to low methodological quality, except for the one randomised clinical trial having a low risk of bias.  Conclusions: There is a lack of prospective, controlled trials based on a consistent imaging protocol with a sufficiently long follow-up period. A pressing need exists for the development of a consistent optimized imaging protocol for diagnosis and follow up of SABG in CLP patients. Although 3D evaluation methods seem to be more precise than two-dimensional methods, we should be careful when comparing the outcomes arising from different 3D measuring techniques.

Three-dimensional imaging of soft and hard facial tissues in patients with craniofacial syndromes: a systematic review of methodological quality.

OBJECTIVES: To systematically review the methodological quality of three-dimensional imaging studies of patients with craniofacial syndromes and to propose recommendations for future research. METHODS: PubMed, Embase and Cochrane databases as well as Grey literature were electronically searched. Inclusion criteria were patients with genetic syndromes with craniofacial manifestations and three-dimensional imaging of facial soft and/or hard tissues. Exclusion criteria consisted of non-syndromic conditions or conditions owing to environmental causes, injury or trauma, facial soft and hard tissues not included in the image analysis, case reports, reviews, opinion articles. No restrictions were made for patients' ethnicity nor age, publication language or publication date. Study quality was evaluated using the Methodological Index for Non-Randomized Studies (MINORS). RESULTS: The search yielded 2228 citations of which 116 were assessed in detail and 60 were eventually included in this review. Studies showed a large heterogeneity in study design, sample size and patient age. An increase was observed in the amount of studies with time, and the imaging method most often used was CT. The most studied craniofacial syndromes were Treacher Collins, Crouzon and Apert syndrome. The articles could be divided into three main groups: diagnostic studies (34/60, 57%), evaluation of surgical outcomes (21/60, 35%) and evaluation of imaging techniques (5/60, 8%). For comparative studies, the median MINORS score was 13 (12-15, 25-75th percentile), and for non-comparative studies, the median MINORS score was 8 (7-9, 25-75th percentile). CONCLUSIONS: The median MINORS scores were only 50 and 54% of the maximum scores and there was a lack of prospective, controlled trials with sufficiently large study groups. To improve the quality of future studies in this domain and given the low incidence of craniofacial syndromes, more prospective multicentre controlled trials should be set up.

The effect of headgear on upper third molars: a retrospective longitudinal study.

OBJECTIVES: To investigate the effects of orthodontic non-extraction treatment with or without headgear on the position of and the space available for upper third molars in growing children with class II malocclusions. MATERIALS AND METHODS: The sample consisted of pre- and post-treatment panoramic radiographs and lateral cephalograms of 294 class II orthodontic patients; 160 were treated with headgear and 134 were treated without headgear. The space available for the upper third molar was measured on the lateral cephalogram as the distance from pterygoid vertical (PTV) to the distal surface of the upper first molar crown (PTV-M1). Angulation, vertical position and tooth development stage of the upper third molars were evaluated on panoramic radiographs. All measurements were evaluated statistically. RESULTS: In both groups PTV-M1 increased, but the increase in PTV-M1 was significantly higher for patients treated without headgear. A linear model for repeated measures revealed that this difference was still significant after correction for age, gender and molar occlusion. Further, there is no evidence that the change in angulation, vertical position and development stage of the upper third molars during orthodontic treatment is influenced by headgear therapy. CONCLUSION: This study indicates that the use of headgear in growing patients significantly affects the space available for upper third molars. However, orthodontic treatment with headgear does not influence the angulation, vertical position and development stage of upper third molars. It is therefore important to always take into account third molars during treatment planning.