Impact of Cleft Lip and Palate on Oral Health-Related Quality of Life (OHRQOL) in Brazilian Patients

Objective: To evaluate self-esteem, satisfaction with facial aesthetics and the impact of oral health on the quality of life of patients with cleft lip and palate aged from 12 years treated at the Hospital for Rehabilitation of Craniofacial Anomalies (HRAC), Brazil. Material and Methods: A cross-sectional study was conducted with patients (n=94) with cleft lip and palate, aged 12 years and older, treated at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Brazil. The instruments used in this study were: Rosenberg's Self-Esteem Scale, the Oral Health Impact Profile-14 (OHIP), and a visual analogue scale of self-perceived facial aesthetics were applied, and socioeconomic and contextual data were collected from all patients. The statistical analysis included Poisson regression with robust variance (RR ­ rate ratio) and it was performed to evaluate the association between predictors and the outcome oral health related-quality of life. Results: Worse OHRQoL was reported by female patients (RR 1.21; 95%CI: 1.09-1.35) and older individuals (RR 1.25; 95%CI:1.13- 1.39). Conclusion: The presence of cleft lip and palate has a negative impact on OHRQoL. Females and older individuals reported worse qualify of life.

Força de mordida em pacientes com fissura labiopalatina reabilitados proteticamente / Bite force in patients with cleft lip and palate with prosthetic rehabilitation

O objetivo deste trabalho foi comparar a força de mordida máxima entre indivíduos sem fissura labiopalatina e com dentes naturais, indivíduos com fissura labiopalatina reabilitados com prótese parcial fixa sobre implante e indivíduos com fissura labiopalatina reabilitados com prótese parcial fixa convencional, principalmente na região de incisivo lateral e canino. Para isso, os sujeitos da pesquisa foram divididos em 2 grupos experimentais: Prótese Parcial Fixa Sobre Implante (n=6) e Prótese Parcial Fixa Convencional (n=10) e grupo Controle (n=11). As medidas de força de mordida foram realizadas com um gnatodinamômetro, sendo então analisadas estatisticamente por meio do teste de Kruskal-Wallis com nível de significância de 0,05. Quando verificada significância estatística, utilizou-se o método de Dunn em seguida. Na região de molares direitos foi observada significância estatística (p=0,048) entre os grupos Controle e Prótese Parcial Fixa Sobre Implante. Quando a variável incisivos centrais foi examinada, verificou-se diferença estatística (p=0,036) entre o grupo Controle e o grupo Prótese Parcial Fixa Sobre Implante. Na área de incisivo lateral e canino a diferença estatisticamente significativa (p=0,003) foi averiguada apenas nas comparações envolvendo o grupo Controle, não sendo encontrada entre os grupos experimentais. Já nos molares esquerdos não foi observada diferença estatisticamente significativa entre os grupos (p=0,085). Concluiu-se que, apesar da força de mordida máxima mediana ter sido maior para o grupo prótese parcial fixa convencional, não é possível afirmar que a mesma apresenta função mastigatória superior à prótese parcial fixa sobre implante na região de incisivo lateral e canino em pacientes com fissura labiopalatina

The aim of this study was compare the maximal bite force among individuals without cleft lip and palate and with natural teeth, individuals with cleft lip and palate rehabilitated with implant-supported partial fixed prosthesis and individuals with cleft lip and palate rehabilitated with conventional partial fixed prosthesis, especially in the lateral incisor and canine region. For this, the subjects were divided in 2 groups: ImplantSupported Partial Fixed Prosthesis (n= 6) and Conventional Partial Fixed Prosthesis (n=10) and Control group (n=11). The bite force measurements were performed with a gnathodynamometer and statistically analyzed by Kruskal-Wallis test with a 0,05 significance level. When was verified statistical significance, the Dunn’s method was used. In the right molars region was observed statistical significance (p=0,048) between the groups Control and ImplantSupported Partial Fixed Prosthesis. When the central incisors variable was examined, there was a statistical difference (p=0,036) between Control group and Implant-Supported Partial Fixed Prosthesis group. In the lateral incisor and canine area the statistically significant difference (p=0,003) was ascertained only in comparisons involving the Control group, not being found between the experimental groups. Already in the left molars was not observed statistically significant difference between groups (p=0,085). It was concluded that, although the median maximal bite force has been greater for Conventional Partial Fixed Prosthesis group, it’s not possible affirm that it presents higher masticatory function than implant-supported partial fixed prosthesis in the lateral incisor and canine region in patients with cleft lip and palate

Interrelationship between implant and orthognathic surgery for the rehabilitation of edentulous cleft palate patients: a case report.

A 43-year-old woman with a unilateral cleft lip and palate, presenting a totally edentulous maxilla and mandible with marked maxillomandibular discrepancy, attended the Prosthodontics section of the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo for treatment. She could not close her mouth and was dissatisfied with her complete dentures. Treatment planning comprised placement of six implants in the maxilla, four in the mandible followed by prostheses installation and orthognathic surgery. The mandibular full arch prosthesis guided the occlusion for orthognathic positioning of the maxilla. The maxillary complete prosthesis was designed to assist the orthognathic surgery with a provisional prosthesis (no metal framework), allowing reverse treatment planning. Maxillary and mandibular realignment was performed. Three months later, a relapse in the position of the maxilla was observed, which was offset with a new maxillary prosthesis. This isa complex interdisciplinary treatment and two-year follow-up is presented and discussed. It should be considered that this type of treatment could also be applied in non-cleft patients.

Alternatives for rehabilitation of cleft patients with severe maxillomandibular discrepancy.

Rehabilitation of cleft patients is a process that occurs from birth to adult life and involves a team of many professionals. Reconstructive plastic surgery, despite its functional and aesthetic benefits to the patient, can restrict the normal anterior displacement that occurs in the growth of the maxilla, which, in turn, can lead to a concave profile that requires correction. This study aimed to demonstrate an alternative rehabilitation treatment for cleft patients who have severe maxillomandibular discrepancy and choose not to undergo orthognathic surgery. A retrospective review and case reports of rehabilitation treatment of cleft patients were performed, with an emphasis on prosthetic rehabilitation without orthognathic surgical procedures. Prosthetic rehabilitation is a fast and reversible option for cleft patients that provides facial harmony and facilitates the reintegration of these patients into society.

Interrelationship between implant and orthognathic surgery for the rehabilitation of edentulous cleft palate patients: a case report

A 43-year-old woman with a unilateral cleft lip and palate, presenting a totally edentulous maxilla and mandible with marked maxillomandibular discrepancy, attended the Prosthodontics section of the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo for treatment. She could not close her mouth and was dissatisfied with her complete dentures. Treatment planning comprised placement of six implants in the maxilla, four in the mandible followed by prostheses installation and orthognathic surgery. The mandibular full arch prosthesis guided the occlusion for orthognathic positioning of the maxilla. The maxillary complete prosthesis was designed to assist the orthognathic surgery with a provisional prosthesis (no metal framework), allowing reverse treatment planning. Maxillary and mandibular realignment was performed. Three months later, a relapse in the position of the maxilla was observed, which was offset with a new maxillary prosthesis. This isa complex interdisciplinary treatment and two-year follow-up is presented and discussed. It should be considered that this type of treatment could also be applied in non-cleft patients.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) - Part 5: institutional outcomes assessment and the role of the Laboratory of Physiology.

The Laboratory of Physiology provides support for the diagnosis of functional disorders associated with cleft lip and palate and also conducts studies to assess, objectively, the institutional outcomes, as recommended by the World Health Organization. The Laboratory is conceptually divided into three units, namely the Unit for Upper Airway Studies, Unit for Stomatognathic System Studies and the Unit for Sleep Studies, which aims at analyzing the impact of different surgical and dental procedures on the upper airways, stomatognathic system and the quality of sleep of individuals with cleft lip and palate. This paper describes the main goals of the Laboratory in the assessment of procedures which constitute the basis of the rehabilitation of cleft lip and palate, i.e., Plastic Surgery, Orthodontics and Maxillofacial Surgery and Speech Pathology.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) - Part 4: oral rehabilitation.

Treatment of patients with cleft lip and palate is completed with fixed prostheses, removable, total, implants and aims to restore aesthetics, phonetics and function and should be guided by the basic principles of oral rehabilitation, such as physiology, stability, aesthetics, hygiene and the expectations of the patient. In order to obtain longevity of a prosthetic rehabilitation, the periodontal and dental tissue as well as the biomechanics of the prosthesis are to be respected. The purpose of this article is to describe the types of prosthetics treatment, which are performed at HRAC/USP for the rehabilitation of cleft area in adult patients.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) - Part 5: Institutional outcomes assessment and the role of the Laboratory of Physiology

The Laboratory of Physiology provides support for the diagnosis of functional disorders associated with cleft lip and palate and also conducts studies to assess, objectively, the institutional outcomes, as recommended by the World Health Organization. The Laboratory is conceptually divided into three units, namely the Unit for Upper Airway Studies, Unit for Stomatognathic System Studies and the Unit for Sleep Studies, which aims at analyzing the impact of different surgical and dental procedures on the upper airways, stomatognathic system and the quality of sleep of individuals with cleft lip and palate. This paper describes the main goals of the Laboratory in the assessment of procedures which constitute the basis of the rehabilitation of cleft lip and palate, i.e., Plastic Surgery, Orthodontics and Maxillofacial Surgery and Speech Pathology.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) Part 4: Oral Rehabilitation

Treatment of patients with cleft lip and palate is completed with fixed prostheses, removable, total, implants and aims to restore aesthetics, phonetics and function and should be guided by the basic principles of oral rehabilitation, such as physiology, stability, aesthetics, hygiene and the expectations of the patient. In order to obtain longevity of a prosthetic rehabilitation, the periodontal and dental tissue as well as the biomechanics of the prosthesis are to be respected. The purpose of this article is to describe the types of prosthetics treatment, which are performed at HRAC/USP for the rehabilitation of cleft area in adult patients.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies - USP (HRAC-USP) - part 3: Oral and Maxillofacial Surgery

This paper presents the treatment protocol of maxillofacial surgery in the rehabilitation process of cleft lip and palate patients adopted at HRAC-USP. Maxillofacial surgeons are responsible for the accomplishment of two main procedures, alveolar bone graft surgery and orthognathic surgery. The primary objective of alveolar bone graft is to provide bone tissue for the cleft site and then allow orthodontic movements for the establishment of an an adequate occlusion. When performed before the eruption of the maxillary permanent canine, it presents high rates of success. Orthognathic surgery aims at correcting maxillomandibular discrepancies, especially anteroposterior maxillary deficiencies, commonly observed in cleft lip and palate patients, for the achievement of a functional occlusion combined with a balanced face.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies-USP (HRAC-USP)--part 2: pediatric dentistry and orthodontics.

The aim of this article is to present the pediatric dentistry and orthodontic treatment protocol of rehabilitation of cleft lip and palate patients performed at the Hospital for Rehabilitation of Craniofacial Anomalies-University of São Paulo (HRAC-USP). Pediatric dentistry provides oral health information and should be able to follow the child with cleft lip and palate since the first months of life until establishment of the mixed dentition, craniofacial growth and dentition development. Orthodontic intervention starts in the mixed dentition, at 8-9 years of age, for preparing the maxillary arch for secondary bone graft procedure (SBGP). At this stage, rapid maxillary expansion is performed and a fixed palatal retainer is delivered before SBGP. When the permanent dentition is completed, comprehensive orthodontic treatment is initiated aiming tooth alignment and space closure. Maxillary permanent canines are commonly moved mesially in order to substitute absent maxillary lateral incisors. Patients with complete cleft lip and palate and poor midface growth will require orthognatic surgery for reaching adequate anteroposterior interarch relationship and good facial esthetics.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies - USP (HRAC-USP) - Part 2: Pediatric Dentistry and Orthodontics

The aim of this article is to present the pediatric dentistry and orthodontic treatment protocol of rehabilitation of cleft lip and palate patients performed at the Hospital for Rehabilitation of Craniofacial Anomalies - University of São Paulo (HRAC-USP). Pediatric dentistry provides oral health information and should be able to follow the child with cleft lip and palate since the first months of life until establishment of the mixed dentition, craniofacial growth and dentition development. Orthodontic intervention starts in the mixed dentition, at 8-9 years of age, for preparing the maxillary arch for secondary bone graft procedure (SBGP). At this stage, rapid maxillary expansion is performed and a fixed palatal retainer is delivered before SBGP. When the permanent dentition is completed, comprehensive orthodontic treatment is initiated aiming tooth alignment and space closure. Maxillary permanent canines are commonly moved mesially in order to substitute absent maxillary lateral incisors. Patients with complete cleft lip and palate and poor midface growth will require orthognatic surgery for reaching adequate anteroposterior interarch relationship and good facial esthetics.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP)--Part 1: overall aspects.

Cleft lip and palate is the most common among craniofacial malformations and causes several esthetic and functional implications that require rehabilitation. This paper aims to generally describe the several aspects related to this complex pathology and the treatment protocol used by the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC-USP) along 40 years of experience in the treatment of individuals with cleft lip and palate.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) - Part 1: overall aspects

Cleft lip and palate is the most common among craniofacial malformations and causes several esthetic and functional implications that require rehabilitation. This paper aims to generally describe the several aspects related to this complex pathology and the treatment protocol used by the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC-USP) along 40 years of experience in the treatment of individuals with cleft lip and palate.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies-USP (HRAC-USP)--part 3: oral and maxillofacial surgery.

This paper presents the treatment protocol of maxillofacial surgery in the rehabilitation process of cleft lip and palate patients adopted at HRAC-USP. Maxillofacial surgeons are responsible for the accomplishment of two main procedures, alveolar bone graft surgery and orthognathic surgery. The primary objective of alveolar bone graft is to provide bone tissue for the cleft site and then allow orthodontic movements for the establishment of an an adequate occlusion. When performed before the eruption of the maxillary permanent canine, it presents high rates of success. Orthognathic surgery aims at correcting maxillomandibular discrepancies, especially anteroposterior maxillary deficiencies, commonly observed in cleft lip and palate patients, for the achievement of a functional occlusion combined with a balanced face.

Levantamento de parasitos intestinais nas áreas urbana e rural de Itambé do Mato Dentro, Minas Gerais, Brasil / Survey of intestinal parasites in urban and rural areas of Itambé do Mato Dentro, Minas Gerais, Brazil

Com o objetivo de verificar a distribuição de parasitos intestinais em Itambé do Mato Dentro (região central de Minas Gerais) e comparar os dados referentes à área urbana com os dos distritos rurais do município, realizou-se uma análise dos resultados de rotina de exames parasitológicos de fezes (sedimentação espontânea) de 817 pacientes obtidos entre julho de 2005 e fevereiro de 2007. Verificou-se que 33,2por cento dos exames foram positivos, sendo observada mais de uma espécie de parasito em 8,1por cento dos casos. A ocorrência de parasitos intestinais na zona rural (39,5por cento) foi significativamente maior (p menor que 0,05) que na área urbana (24,3por cento).

In order to evaluate the distribution of intestinal parasites in Itambé do Mato Dentro (central region of Minas Gerais) and to compare data of the urban area to those of rural districts of the municipality, an analysis of stool parasitological tests was carried out. Between July 2005 and February 2007, results of 817 patients tested using the sedimentation method were obtained. It was verified that 33.2% of testswere positive and more than one species of parasites were observed in 8.1% of cases. The occurrence of intestinal parasites in rural areas (39.5%) was significantly higher (p <0.05) than in urban areas (24.3%).

Efeito de diferentes elastômeros na adaptação cervical de coroas totais metálicas / Effect of different elastomers on cervical fit of full metal crowns

Objective: The aim of this study was to evaluate the cervical fit of full metal crowns using four different elastomers. Methods: A stainless steel metallic die similar to a prepared first upper molar was obtained. Four di-fferent elastomeric impression materials were utilized: polysulfide (A), polyether (B), condensation silicone (C) and addition silicone (D). Forty molds were created, 10 for each group. It was obtained 40 gypsum abutments. After the end of this stage, it was performed complete metal crowns on all specimens. Crown displacement was measured through a comparative microscope, obtaining diametrically opposite points. Results: The re-sults were the following: Group D (31.97 um), Group B (49.57 um), Group A (51.12 um), Group C (61.12 um). The analysis of variance (ANOVA) test and a Tukey test for multiple comparisons were used to analyze the results. Conclusions: There were significant differences among all groups, except for Groups A and B. The major result of displacement was Group C. The best results were shown by Group D (p < 0.05).

Etiologia das más oclusões: perspectiva clínica (parte III): fissuras labiopalatinas / Etiology of malocclusions: clinical perspective (part III): cleft lip and palate

A fissura labiopalatina, como o nome sugere, aloja-se na face média, rompendo lábio, palato ou as duas estruturas. Portanto, está na área de alcance do dentista e causa problemas estruturais no osso alveolar e na maxila como um todo, na dependência da extensão da fissura. A relação óbvia e urgente com a má oclusão é compreendida de três maneiras: 1) pela ruptura anatômica que compromete a integridade do rebordo alveolar, 2) pelos problemas dentários, agenesias e más posições envolvendo os dentes adjacentes à fissura, e 3) pela deficiência maxilar, sagital e transversal induzida pelas cirurgias plásticas reconstrutivas. O presente artigo se dedica a um repasse panorâmico sobre a etiologia dessa anomalia que acomete 1 em cada 650 brasileiros.

Cleft palate obturation with Brånemark protocol implant-supported fixed denture and removable obturator.

A 41-year-old man with cleft palate presented with a wide dehiscence and missing teeth. Six implants had been placed for fabrication of an overdenture, which was unsatisfactory. A bar was waxed and cast for connection to the implants; precision attachments were placed laterally for retention. A fixed partial denture was fabricated, and milled crowns were fabricated at the molar region to provide a guiding plane for insertion of a removable palatal obturator. Good swallowing and speech outcomes were achieved. This technique provided functional and esthetic benefits, enhanced oral hygiene, and improved the psychological condition of the patient.