Transverse effect of Haas and Hyrax appliances on the upper dental arch in patients with unilateral complete cleft lip and palate: a comparative study.

OBJECTIVE: The aim of the present study was to evaluate the transverse effect of rapid maxillary expansion in patients with unilateral complete cleft lip and palate while comparing the Haas and Hyrax appliances. METHODS: The sample consisted of 48 patients divided into two groups: Group I = 25 patients treated with modified Haas appliance (mean age: 10 years and 8 months); and Group II = 23 patients treated with Hyrax appliance (mean age: 10 years and 6 months). Cast models were taken during pre-expansion and after removal of the appliance, at the end of the retention period. The models were scanned with the aid of the 3 Shape R700 3D scanner. Initial and final transverse distances were measured at cusp tips and cervical-palatal points of maxillary teeth by using the Ortho Analyzer 3D software. RESULTS: The mean expansion obtained between cusp tips and between cervical-palatal points was, respectively: for inter-canine width, 4.80 mm and 4.35 mm with the Haas appliance and 5.91 mm and 5.91 mm with the Hyrax appliance; as for first deciduous molars or first deciduous premolars, the values obtained were 6.46 mm and 5.90 mm in the Haas group, and 7.11 mm and 6.65 mm in the Hyrax group; with regard to first molars, values were 6.11 mm and 5.24 mm in the Haas group, and 7.55 mm and 6.31 mm in the Hyrax group. CONCLUSION: Rapid maxillary expansion significantly increased the transverse dimensions of the upper dental arch in patients with cleft palate, with no significant differences between the Hass and Hyrax expanders.

Prevalence of dental anomalies of number in different subphenotypes of isolated cleft palate.

OBJECTIVE: This study aimed at carrying out a radiographic analysis on the prevalence of dental anomalies of number (agenesis and supernumerary teeth) in permanent dentition, in different subphenotypes of isolated cleft palate preadolescent patients. METHODS: Panoramic radiographs of 300 patients aged between 9 and 12 years, with cleft palate and enrolled in a single treatment center, were retrospectively analyzed. The sample was divided into two groups according to the extension/severity of the cleft palate: complete and incomplete. The chi-square test was used for intergroup comparison regarding the prevalence of the investigated dental anomalies (P<0.05). RESULTS: Agenesis was found in 34.14% of patients with complete cleft palate and in 30.27% of patients with incomplete cleft palate. Supernumerary teeth were found in 2.43% of patients with complete cleft palate and in 0.91% of patients with incomplete cleft palate. No statistically significant difference was found between groups with regard to the prevalence of agenesis and supernumerary teeth. There was no difference in cleft prevalence between genders within each study group. CONCLUSIONS: The prevalence of dental anomalies of number in preadolescents with cleft palate was higher than that reported for the general population. The severity of cleft palate did not seem to be associated with the prevalence of dental anomalies of number.

Increase in age is associated with worse outcomes in alveolar bone grafting in patients with bilateral complete cleft palate.

This prospective study aimed at evaluating the surgical outcomes of alveolar bone grafting (ABG) in subjects with bilateral cleft lip and palate treated at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil, by means of cone-beam computed tomography. Twenty-five patients with bilateral complete cleft lip and palate, resulting in 50 clefts, were analyzed. Subjects were divided into 2 groups according to the dentition status at the time of surgery: (1) SABG group: subjects with mixed dentition operated on before or immediately after eruption of the permanent canine (10-13 years); (2) TABG group: subjects with permanent dentition (15-23 years). Cone-beam computed tomography analysis was performed in the buccal, intermediate, and palatal views, 2 and 6 to 12 months postoperatively. In the SABG group, 96% of the grafts were classified as successful, and no failure cases were observed. In the TABG group, successful cases decreased to 65%, and failures were seen in 27% of the cleft sites. In both postoperative periods, significantly better outcomes (lower mean scores) were observed for the SABG group in all the cone-beam computed tomography views (P < 0.05). Results show that the timing of surgery is an important factor in determining the outcomes of ABG in patients with bilateral cleft lip and palate, with increasing age being associated with the worse outcomes.

Prevalence of mesiodens in orthodontic patients with deciduous and mixed dentition and its association with other dental anomalies.

OBJECTIVE: To determine the prevalence of mesiodens in deciduous and mixed dentitions and its association with other dental anomalies. MATERIAL AND METHODS: Panoramic radiographs of 1,995 orthodontic patients were analyzed retrospectively, obtaining a final sample of 30 patients with mesiodens. The following aspects were analyzed: gender; number of mesiodens; proportion between erupted and non-erupted mesiodens; initial position of the supernumerary tooth; related complications; treatment plan accomplished; and associated dental anomalies. The frequency of dental anomalies in the sample was compared to reference values for the general population using the chi-square test, with a significance level set at 5%. RESULTS: The prevalence of mesiodens was 1.5% more common among males (1.5:1). Most of the mesiodens were non-erupted (75%) and in a vertical position, facing the oral cavity. Extraction of the mesiodens was the most common treatment. The main complications associated with mesiodens were: delayed eruption of permanent incisors (34.28%) and midline diastema (28.57%). From all the dental anomalies analyzed, only the prevalence of maxillary lateral incisor agenesis was higher in comparison to the general population. CONCLUSIONS: There was a low prevalence of mesiodens (1.5%) in deciduous and mixed dentition and the condition was not associated with other dental anomalies, except for the maxillary lateral incisor agenesis.

Reconstruction of alveolar cleft with allogenous bone graft: Clinical considerations.

INTRODUCTION: Secondary bone grafting consists in a routine procedure on the treatment of patients with alveolar cleft. Usually, it is performed by the end of the mixed dentition, when the permanent canine is erupting, with autogenous cancellous bone from the iliac crest. OBJECTIVE: The present article discusses the alternative of autogenous bone grafting with allogeneic bone, obtained from human bone bank, illustrating the result with the report of a clinical case of left unilateral alveolar cleft.

Influence of intentional ankylosis of deciduous canines to reinforce the anchorage for maxillary protraction.

INTRODUCTION: This retrospective cephalometric study analyzed the influence of intentional ankylosis of deciduous canines in patients with Class III malocclusion and anterior crossbite, in the deciduous and early mixed dentition stages, treated by orthopedic maxillary expansion followed by maxillary protraction. METHODS: Lateral cephalograms of 40 patients were used, divided in 2 groups paired for age and gender. The Ankylosis Group was composed of 20 patients (10 boys and 10 girls) treated with induced ankylosis and presenting initial and final mean ages of 7 years 4 months and 8 years 3 months, respectively, with a mean period of maxillary protraction of 11 months. The Control Group comprised 20 patients (10 boys and 10 girls) treated without induced ankylosis, with initial and final mean ages of 7 years 8 months and 8 years 7 months, respectively, with a mean period of maxillary protraction of 11 months. Two-way analysis of variance and covariance analysis were applied to compare the initial and final cephalometric variables and the treatment changes between groups. RESULTS: According to the results, the variables evidencing the significant treatment changes between groups confirmed that the intentional ankylosis enhanced the sagittal response of the apical bases (Pg-NPerp) and increased the facial convexity angles (NAP and ANB). CONCLUSIONS: The protocol involving intentional ankylosis of deciduous canines enhanced the sagittal response of the apical bases.

Timing of alveolar bone grafting determines different outcomes in patients with unilateral cleft palate.

The objective of the current study was to assess the outcome of the alveolar bone grafting (ABG) in patients with cleft palate. Thirty-one patients with complete unilateral cleft lip and palate were prospectively divided into 2 groups according to the timing of surgery: (1) secondary ABG (SABG), undertaken during mixed dentition (n = 16); and (2) tertiary ABG (TABG), undertaken during permanent dentition (n = 15). Septum height was assessed using cone beam computed tomography in 3 views (buccal, intermediate, palatal) and classified according to the modified Bergland Index, which scores the results into 5 types according to the height of the neoformed bone septum (excellent: septum with a normal height; good: septum with minor deficiency; regular: marginal defect of >25% of the root length; bad: bone deficiency on the nasal aspect; and failure). In the SABG group, 6 to 12 months postoperatively, 75% of the patients were classified as having excellent/good conditions and 25% as having regular/bad conditions. No patients were observed as having failure conditions. In the TABG group, 53% of the patients were classified as having excellent/good, 21% were classified as having regular/bad conditions, and 26% were classified as having failure conditions. Significantly better outcomes were observed for the SABG group when compared with the TABG group. In conclusion, the age at which ABG is performed is a factor that impacts on the surgical outcome. Specifically, increasing age is associated with worse outcomes.

Facial profile evaluation of isolated Pierre Robin sequence.

OBJECTIVE: To evaluate numerically the facial profile of children with isolated Pierre Robin sequence (PRS) and to compare them with a control group that has no pathologies and exhibits regular and balanced facial growth, with no skeletal alterations. PATIENTS: Eighty-three children aged 5 to 10 years (PRS group, n  =  60; control group, n  =  23) were selected. SETTING: Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC-USP). Children from the control group were taken from the program of Interceptive Orthodontics at HRAC-USP. DESIGN: Angular and ratio analyses of the facial profiles in both groups were realized through digital photographs. The PRS group was subdivided into two groups--complete and incomplete--according to the sagittal extension of the cleft palate, to investigate the possible influence of cleft extension on the face. RESULTS: The facial convexity angle and the facial inferior third angle were considerably higher in the PRS groups than in the control group and were not significantly different between PRS groups. Nasolabial angle did not differ between groups. CONCLUSION: The facial profile was more convex in individuals with PRS than in those with regular facial growth and with no pathology. The mandible was responsible for the convexity of the profile in PRS because of its lack off anterior projection. An important relationship between the extension of the cleft palate and alterations in facial profile in PRS was not observed.

Rapid maxillary expansion after secondary alveolar bone grafting in patients with alveolar cleft.

OBJECTIVE: To test the hypothesis that it is possible to perform rapid maxillary expansion (RME) after alveolar bone grafting in patients with clefts of the lip and palate (CLP) without compromising the final result of the bone graft. DESIGN: Occlusal and periapical radiographs of the grafted area of 17 unilateral and 11 bilateral patients with CLP (n = 28) were obtained before and after RME. SETTING AND SAMPLE POPULATION: Hospital for Rehabilitation of Craniofacial Anomalies (HRAC), University of São Paulo. Twenty-eighty patients with CLP who had undergone RME. INTERVENTIONS: RME was performed in patients with CLP who had already undergone RME before secondary bone grafting but with relapse of the maxillary dental arch constriction, as well as in patients with CLP who had never undergone expansion before bone grafting. OUTCOME MEASURE: Qualitative evaluation in occlusal and periapical radiographs after alveolar bone grafting. RESULTS: Findings showed opening of the midpalatal suture in 42.8% of patients in this study. Regardless of the success rate of RME, the alveolar bone grafting was not affected when the procedures were inverted. CONCLUSION: The hypothesis was accepted. RME can be performed after secondary alveolar bone grafting without affecting it.

Dental arch dimensions in Class II division 1 malocclusions with mandibular deficiency.

OBJECTIVE: To test the hypothesis that there is no difference in the dimensions of the upper and lower dental arches in Class II division 1 malocclusion with a mandibular deficiency compared to normal Class I occlusion dental arches. MATERIALS AND METHODS: Photocopies of the dental arches of 48 patients exhibiting Class II division 1 malocclusion with mandibular deficiency and of 51 individuals with normal occlusion were compared. Mandibular deficiency was diagnosed clinically. All 99 individuals were in the permanent dentition. The ages of the subjects ranged from 11 years 4 months to 20 years (mean age = 12 years 5 months). RESULTS: When compared to subjects with normal occlusion, the upper dental arches of the Class II division 1 patients presented reduced transverse dimensions and longer sagittal dimensions while the lower arches were less influenced. CONCLUSION: The hypothesis is rejected. Significant differences are present between the dimensions of the upper and lower dental arches in Class II division 1 malocclusion (with a mandibular deficiency and in the permanent dentition) compared to normal Class I occlusion dental arches.

Epidemiology of posterior crossbite in the primary dentition.

This epidemiological survey was conducted on 2,016 children from 8 private and 12 public preschools at the city of Bauru, São Paulo, Brazil. The sample was composed of 1,032 males and 984 females in the primary dentition stage, aged 3 to 6 years. Normal occlusion was observed in 26.74% of the sample; thus, 73.26% of children presented some type of malocclusion. Among the malocclusions, the following transverse problems were diagnosed: unilateral posterior crossbite (11.65%), anterior open bite associated with posterior crossbite (6.99%), bilateral posterior crossbite (1.19%), unilateral posterior crossbite associate with anterior crossbite (0.79%) and full crossbite (0.19%) totalizing 20.81% of the transverse problems. Mandibular functional deviation was observed in 91.91% of children with unilateral posterior crossbite, characterizing the functional unilateral posterior crossbite. The results demonstrated that the prevalence of posterior crossbite was compatible with previous data in the literature, with predominance of functional unilateral posterior crossbite.

Influence of isolated cleft palate and palatoplasty on the face.

INTRODUCTION: The literature has demonstrated that alterations in craniofacial morphology characterizing individuals with cleft palate are observed in both operated and unoperated patients. OBJECTIVE: This study evaluated the influence of isolated cleft palate and palatoplasty on the face, based on facial analysis. MATERIAL AND METHODS: Lateral facial photographs of the right side of 85 young adult patients with cleft palate were analyzed, of whom 50 were operated on and 35 had never received any previous surgical treatment. The nasolabial angle and zygomatic projection were used to define the maxillary position in the face. Mandibular positioning was classified as Pattern I, II and III. RESULTS: Patients were distributed into 54.12% as Pattern I, 32.94% Pattern II and 12.94% Pattern III. Distribution of facial patterns did not show statistically significant differences between groups (p>0.05). Although palatoplasty did not influence the facial pattern, the zygomatic projection was vulnerable to plastic surgeries. Twenty-eight percent of the patients in the operated group showed zygomatic deficiency, compared to only 8.5% in the unoperated group. CONCLUSIONS: In patients with isolated cleft palate, palatoplasty may influence negatively the sagittal behavior of the maxilla, according to the zygomatic projection of the face, though without compromising the facial pattern.

Prevalence of a Simonart's band in patients with complete cleft lip and alveolus and complete cleft lip and palate.

OBJECTIVE: To investigate the prevalence of the presence of a soft tissue bridge (Simonart's band) in patients with complete cleft lip and alveolus and complete cleft lip and palate. DESIGN: Cross-sectional. SAMPLE: We assessed 407 consecutive unoperated patients first attending the Hospital for Rehabilitation of Craniofacial Anomalies of University of São Paulo, in Bauru, São Paulo, Brazil, in the year 2000. The patients were classified as presenting complete cleft of the primary palate or of the primary and secondary palate, unilateral or bilateral, as follows: unilateral cleft lip, bilateral cleft lip, unilateral cleft lip and palate, and bilateral cleft lip and palate. METHOD: Clinical examination. The band was considered as present whenever there was a soft tissue bridge between the separated alveolar ridges, regardless of volume and position. Results were analyzed by descriptive statistics and were expressed as percentages, according to the type of cleft. CONCLUSION: 31.2% of patients presented with Simonart's band. The band was observed more frequently in patients with unilateral clefts than in patients with bilateral clefts, and in patients with complete cleft lip and alveolus than in patients with complete cleft lip and palate.

Post expansion evaluation of the midpalatal suture in children submitted to rapid palatal expansion: a CT study.

The aim of this prospective study was to evaluate the midpalatal suture in children submitted to rapid palatalexpansion, at the end of the retention stage, with CT scans. The sample was comprised of 17 children aged between 5 years 2 months and 10 years 5 months. The tomographic images showed that the midpalatal suture was completely ossified from the anterior nasal spine area to the posterior nasal spine area at the end of the retention phase, that is, 8 to 9 months post-expansion.

Evaluation of the midpalatal suture during rapid palatal expansion in children: a CT study.

The midpalatal suture of 18 children submitted to rapid palatal expansion with the Haas fixed expander and ranging in age from 5 years 2 months to 10 years 5 months was evaluated with computerized tomography. The posterior nasal spine undergoes the impact of RPE in patients in the primary and mixed dentition stages, similarly to the anterior nasal spine though to a lesser extent. The average opening of the midpalatal suture was 2.21 mm in the anterior nasal spine region and 0.95 mm in the posterior nasal spine region.

Delayed formation of a lower second premolar.

Delayed odontogenesis of a lower second premolar is presented in a case treated without extraction and focuses on the 7-year follow-up of the delayed tooth bud. The follow-up was initiated when the crown formation was diagnosed and was finished when the tooth erupted completely into the orthodontically provided space, which enabled the orthodontic leveling and alignment of the delayed premolar. The long follow-up indicates that delayed tooth buds may develop completely and normally.

Behavior of partially formed roots of teeth submitted to orthodontic movement.

The occurrence of root resorption in orthodontically treated permanent incisors with partially formed roots was investigated using periapical radiographs taken before and after the orthodontic leveling in the mixed dentition. The mean age at the beginning of treatment was 9 years and the mean treatment time was 7.1 months. The findings showed that the orthodontic movement during root formation causes no root resorption. The longitudinal follow-up showed that incompletely formed roots developed normally.

Influence of lip repair on craniofacial morphology of patients with complete bilateral cleft lip and palate.

OBJECTIVE: The aim of this study was to compare two groups of adult male patients with complete bilateral cleft lip and palate (BCLP) on the basis of lateral cephalometric radiographs. PATIENTS: The first group of adult male patients with complete BCLP was comprised of 13 unoperated patients with an average age of 21 years. The second group was comprised of 14 patients with an average age of 21 years 7 months, who had been operated only on the lip prior to 2 years of age. DESIGN: The following measurements were evaluated: angle and length of cranial base; maxillary spatial positioning and length; mandibular spatial positioning; morphology and length; maxillomandibular relationship; vertical facial length; dental positioning; interdental arch relationship; and soft profile. RESULTS: The results suggest that lip repair has a significant influence on certain areas of the craniofacial complex, mainly the premaxilla and the upper incisors. CONCLUSIONS: The most significant findings consequent to lip repair consisted of reduction of the premaxillary anterior projection and lingual tipping of the upper incisors. Retropositioning of the premaxilla, especially in the alveolar part, is a desired effect of lip repair in complete BCLP. Such effect on the projected premaxilla is usually beneficial, except when the exceedingly severe lip pressure, unfavorable growth pattern, or both retropositions the midface profile beyond acceptable sagittal limits.