Dentition patterns in bilateral cleft lip subphenotypes: multicenter study.

OBJECTIVES: Here, we retrospectively investigated cases of bilateral oral clefts (OCs) to determine the clinical relevance of detailed distinction of incomplete cleft lip subphenotypes, based on morphological severity of the cleft, within the categories cleft lip with or without alveolus (CL ± A) and cleft lip, alveolus, and palate (CLAP). We further assessed possible associations between CL subphenotypes (complete vs different incomplete types) and different dentition patterns of the lateral incisor. MATERIALS AND METHODS: Our analysis included 151 non-syndromic Caucasian bilateral OC-patients (8-20 years old) from the Dutch Association for Cleft Palate and Craniofacial Anomalies registry. Six different deciduous and permanent lateral incisor patterns were distinguished: normal position (z/Z), supernumerary lateral incisor (n/N), presence in the anterior (x/X) or posterior (y/Y) segment of the cleft, one in each cleft segment (xy/XY), and agenesis (ab/AB). Logistic regression was performed to show the associations between the CL subphenotypes and dentition patterns of the lateral incisor. RESULTS: One hundred three had complete, while 48 had incomplete CLs. Patterns z/Z and n/N were associated with a submucous/vermillion notch, incomplete CL, and intact alveolus. Patterns x/X, y/Y, and xy/XY were most common in patients with two-thirds to subtotal CL and complete CL. The most severe pattern, ab/AB, was most commonly associated with complete CL. CONCLUSIONS: Based on the morphological severity of the CLs, it can be stated that the more severe the CL in bilateral CL ± A and CLAP, the more severe the abnormal pattern of the dentition. CLINICAL RELEVANCE: Further distinction of incomplete cleft lip subphenotypes (submucous/vermillion notch, one-third to two-thirds CL, two-thirds to subtotal CL) in bilateral CL ± A and CLAP has clinical relevance.

The Asher-McDade Aesthetic Index in Comparison With Two Scoring Systems in Nonsyndromic Complete Unilateral Cleft Lip and Palate Patients.

OBJECTIVE: To compare the Asher-McDade aesthetic index with 2 systems used to score the appearance of the nasolabial area in patients with a complete cleft lip and palate. DESIGN: Retrospective analysis of the results of complete unilateral cleft lip and palate patients. SETTING: Academic Center for Dentistry of Amsterdam and the VU University Medical Center. PATIENTS: Six-year-olds with complete unilateral cleft lip and palate. MAIN OUTCOME MEASURES: Cleft lip and palate patients assessed using the scoring system proposed by Prahl et al, a 5-point ordinal scale, and the scoring system proposed by Asher-McDade et al by 6 judges, 3 orthodontists, and 3 plastic surgeons. A calculation of intra- and interobserver reliability was made. A comparison was made of all the assessment methods using Kendalls' tau. RESULTS: Photographs of 55 children (38 boys and 17 girls) with complete unilateral cleft lip and palate were assessed. For the scoring system of Prahl et al, interobserver reliability varied from 0.43 to 0.53, for the 5-point scale between 0.45 and 0.57, and for the scoring system by Asher-McDade et al these varied between 0.52 and 0.66. Multiple significant correlations were found between the used scoring systems. CONCLUSION: It can be concluded that the Asher-McDade aesthetic index is still superior to the other scoring systems used in this study. However, all 3 scoring systems can reliably be used when 3 or more observers are used.

Transverse dental arch relationship at 9 and 12 years in children with unilateral cleft lip and palate treated with infant orthopedics: a randomized clinical trial (DUTCHCLEFT).

OBJECTIVE: A long-term evaluation to assess the transverse dental arch relationships at 9 and 12 years of age in unilateral cleft lip and palate treated with or without infant orthopedics (IO). The hypothesis is that IO has no effect on the transverse dental arch relationship. MATERIAL AND METHODS: A prospective two-arm randomized controlled trial (DUTCHCLEFT) in three academic cleft palate centers (Amsterdam, Nijmegen and Rotterdam, the Netherlands). Fifty-four children with complete unilateral cleft lip and palate and no other malformations were enrolled in this evaluation. One group wore passive maxillary plates (IO+) during the first year of life, and the other group did not (IO-). Until the age of 1.5, all other interventions were the same. Hard palate was closed simultaneously with bone grafting according to protocol of all teams. Orthodontic treatment was performed when indicated. The transverse dental arch relationship was assessed on dental casts using the modified Huddart/Bodenham score to measure the maxillary arch constriction at 9 and 12 years of age. RESULTS: No significant differences were found between the IO+ and IO- groups. Differences between the centers increased from 9 to 12 years of age. CONCLUSIONS: Transverse dental arch relationships at 9 and 12 years of age do not differ between children with UCLP treated with or without IO. CLINICAL RELEVANCE: There is no orthodontic need to perform IO as applied in this study in children with UCLP.

Comparison of two scoring systems in the assessment of nasolabial appearance in cleft lip and palate patients.

OBJECTIVE: The aim of this study was to determine the reliability of 2 scoring systems. DESIGN: This study used a retrospective analysis of the results of complete unilateral cleft lip and palate patients. SETTING: The study was conducted at the VU Medical Center and the Academic Center for Dentistry of Amsterdam. PATIENTS: Patients were complete unilateral cleft lip and palate patients at the age of 6 years. MAIN OUTCOME MEASURES: Assessment of the nose and lip together and separately with a numerical photographic reference scoring system and with a 5-point ordinal scale without the use of a reference photograph by 6 judges. Intraobserver and interobserver reliability was calculated; both ways of assessment were compared by using Kendall tau. RESULTS: Photographs were available of 55 children (6 years old, 38 boys and 17 girls) with a complete unilateral cleft lip and palate. The interobserver reliabilities of the lip and nose together were 0.53 and, for the nose and lip separately, 0.51 and 0.43, respectively with the use of the numerical scale. In the 5-point scale, these were 0.55 for the nose and lip together and 0.57 and 0.45 for the nose and lip separately, respectively. Furthermore, it was found that the lip dominates in the scorings of the lip and nose together (linear regression analysis). CONCLUSIONS: The 2 tested systems are equivalent in their reliability and outcome. The lip is dominating in the overall scorings. It is advocated to use the 5-point scale without the use of a reference photograph and to assess the lip and nose separately.