Adherence to Orthodontic Treatment in Youth With Cleft Lip and/or Palate.

OBJECTIVE: To identify rates of nonadherence to orthodontic treatment among youth with cleft lip and/or palate (CL/P) and to compare demographic and clinical characteristics of patients categorized as adherent or nonadherent. DESIGN: Retrospective chart review. SETTING: Orthodontic treatment program affiliated with a US pediatric hospital-based craniofacial team. PARTICIPANTS: Medical charts of 54 patients with CL/P beginning phase I or phase II orthodontics between 2011 and 2014 (54% male; mean age: 11.7 ± 3.2 years) were reviewed. MAIN OUTCOME MEASURE(S): Data abstracted included demographic and clinical characteristics. Patients were classified as nonadherent based upon treatment termination due to nonadherence, treatment courses extending beyond 3 years, and information about missed appointments, poor oral hygiene, and broken appliances. RESULTS: In all, 24% had treatment terminated due to nonadherence and were significantly more likely to have behavioral health diagnoses (P = .01) or visits (P = .02) and social work consults (P = .01) than patients without termination. Thirty-seven percent had treatment courses beyond 3 years; youth with longer courses were significantly more likely to have cleft lip and palate versus cleft palate only or cleft lip (P = .03). Patients who missed more than 4 appointments were less likely to have behavioral health diagnoses (P < .01) compared to those with fewer missed appointments. Poor hygiene and broken appliance notations were common. Youth with poor hygiene notations were significantly older (P < .01) at treatment initiation than those without notations. CONCLUSIONS: Nonadherence was associated with diagnosis, age, and history of behavioral health or social work involvement. An understanding of adherence and relationships with clinical and demographic factors can inform clinical care and support intervention development to improve outcomes.

Adherence to Orthodontic Treatment in Youth With Craniofacial Conditions: A Survey of US Orthodontists.

OBJECTIVE: (1) To explore orthodontists' perceptions of nonadherence and related factors in their patients with craniofacial conditions; (2) to examine differences in adherence perceptions by provider characteristics; (3) to evaluate current adherence interventions. DESIGN: Cross-sectional. SETTING: United States-based orthodontists affiliated with a nonprofit association for providers treating oral cleft and craniofacial conditions received survey invitations via list-serv, e-mail, and social media. PARTICIPANTS: Thirty-eight orthodontists participated (mean age = 50.5 ± 10.7 years; 76% Caucasian; 55% male; 54% private practice). MAIN OUTCOME MEASURE: An 80-item survey assessed demographic characteristics; frequencies of various adherence problems and adherence-related prolonged or terminated treatment; importance of adherence to treatment outcomes; factors that may impact adherence; interest in improving adherence; and use of adherence-enhancing interventions. RESULTS: Adherence problems were common, yet 80.6% of participants rated adherence as "very important" to cleft treatment outcomes. Child behavior and motivation, caregiver reinforcement of behavior, and provider communication with the family were identified as factors that greatly impact adherence. Orthodontists in university-affiliated programs were more likely to rate individual, family, health-care system, and community factors as impacting adherence compared to private practice orthodontists; 80.6% used adherence interventions; these strategies were all rated as "sometimes successful." CONCLUSIONS: Nonadherence to cleft lip/palate-related orthodontic care is common and potentially detrimental to care. Current interventions are not uniformly successful and could be better tailored. Understanding provider, patient, and family factors that affect adherence can inform individualized treatment planning to improve adherence and ultimately, treatment outcomes.

Influence of palatal expanders on oral comfort, speech, and mastication.

INTRODUCTION: It is not known whether the design of the expander has an effect on initial adaptation, comfort level, speech, chewing, and swallowing, or whether age is a crucial aspect when dealing with speech adaptations. The objectives of this study were to assess whether patients of different age groups undergoing palatal expansion with various types of expanders experienced discomfort, speech impairment, chewing difficulty, and swallowing disturbances. METHODS: A questionnaire was developed and distributed to patients who had received palatal expanders in the preceding 3 to 12 months. RESULTS: Regardless of the type of expander, most patients initially felt oral discomfort, and had problems with speech and mastication. However, these disturbances were confined to the first week after cementation of the device. Remarkable adaptation to the device in all aspects studied was observed by the end of the first week. In addition, age did not influence the variables; younger patients and older teenagers responded similarly to the survey. In addition, the questionnaire responses did not appear to be related to the respondents' sex. CONCLUSIONS: Discomfort might not be a deciding variable when choosing an appliance. Instead, clinicians should base their decision on factors such as its biomechanics.

Long-term effects of orthodontic therapy on the maxillary dental arch and nasal cavity.

INTRODUCTION: Rapid maxillary expansion (RME) can enlarge the maxillary dental arch while increasing nasal cavity volume and nasal valve area, and decreasing upper airway resistance over time. However, the long-term effects of RME on arch morphology and nasal cavity geometry in patients treated with RME compared with the general population are unclear. METHODS: Three-dimensional morphometic analysis and acoustic rhinometry were used to evaluate the maxillary dental arches and nasal cavities in a post-RME-treatment group (n = 25) and a control group (n = 25). RESULTS: Palatal area and volume increased substantially after expansion and remained stable until posttreatment. Small increases in intermolar distance were not significant between the time points. Nasal airway resistance significantly decreased after RME and remained stable until posttreatment. Nasal cavity volume was stable during expansion and posttreatment. It increased significantly during expander stabilization and 9-12 months after expander removal. The minimal cross-sectional area significantly increased between the end of expansion and expander removal and remained stable until posttreatment. All measurements were comparable with those of the matched controls at posttreatment except for palatal area, which was smaller in the treatment group. CONCLUSIONS: RME is a powerful tool to normalize most of the variables investigated. Edgewise orthodontic treatment and a retention regimen that consisted of maxillary circumferential or traditional Hawley retainers met satisfactory standards to stabilize the achieved outcomes. Future studies should include morphometric, functional, and skeletal analyses so that the effects of growth and remodeling are better elucidated.

Relationship between rapid maxillary expansion and nasal cavity size and airway resistance: short- and long-term effects.

INTRODUCTION: The availability of new, reliable, objective, and 3-dimensional techniques to assess the effects of rapid maxillary expansion on the morphology of the maxillary dental arch, nasal cavity dimensions, and nasal airway resistance led to the development of this research. METHODS: Thirty-eight subjects participated in this study (mean age, 13 years). Data were collected before expansion, when the expander was stabilized, when the expander was removed, and 9 to 12 months after the expander was removed. Subjective assessment of improvement in nasal respiration was obtained when the expander was stabilized. Three-dimensional imaging and acoustic rhinometry were used to assess the virtual cast and the nasal cavity, respectively. RESULTS AND CONCLUSIONS: The statistically significant short-term effects of RME were (1) mean increases in palatal area, volume, and intermolar distance; (2) a mean reduction of nasal airway resistance; and (3) mean increases in total nasal volume and nasal valve area. Our long-term findings were the following: (1) mean palatal area and intermolar distance were reduced, while palatal volume was stable, and (2) nasal airway resistance was stable, whereas mean nasal cavity volume and minimal cross-sectional area increased. Additionally, 61.3% of our subjects reported subjective improvement in nasal respiration. Weak correlations were found between all variables analyzed.

Three-dimensional assessment of morphologic changes of the maxilla: a comparison of 2 kinds of palatal expanders.

Previous studies of the morphologic changes of the maxilla after palatal expansion have used 2-dimensional methodologies. In the present study, we used a 3-dimensional surface laser scanning technique and computerized cast analysis, in addition to analysis of anteroposterior cephalograms, to assess the morphologic changes of the palate by 2 kinds of expanders: tissue borne (Haas; n = 9) and tooth borne (Hyrax; n = 10). Cast analysis demonstrated that, although all patients started treatment with similar malocclusion, treatment outcomes were different depending on the appliance used. Both appliances generated maxillary expansion (ie, improved mean surface area, mean intermolar linear distance, and mean perimeter) (P <.05). However, the appliances performed differently to achieve the final expansion. Haas appliances demonstrated a greater orthopedic movement (ie, improvement of the mean interpalatal distance) (P <.05), and Hyrax appliances demonstrated dentoalveolar expansion by increasing the mean palatal angulation of the alveolus (P <.05). Anteroposterior cephalometric analysis showed that both appliances increased mean maxillary width and mean intermolar distance significantly (P <.05). On the other hand, differences in nasal cavity width and upper incisal apex distance were not statistically significant (P >.05). This new 3-dimensional methodology proved useful for comparing treatment outcomes by evaluating the morphologic changes induced by palatal expansion and generated a better visualization of these outcomes.

Three-dimensional technology for documentation and record keeping for patients with facial clefts.

The surface laser scanner has great potential as a method for documentation of cleft infant due to its accuracy, ease of use, and convenience. The image scan be stored in the computer for easy access. As purchasing costs decrease, its acquisition will be facilitated, resulting in an increase in its use.

Modified nasal alveolar molding appliance for management of cleft lip defect.

Nasal alveolar molding is used effectively to reshape the nasal cartilage and mold the maxillary arch before cleft lip repair and primary rhinoplasty. It provides aesthetic and functional benefits of nasal tip and alar symmetry and improved dental arch form. At The Craniofacial Center at the University of Illinois at Chicago, the authors have developed a modification of a nasal alveolar molding appliance previously described in the literature. The key modification is the use of an orthodontic wire from the palatal prosthesis with an acrylic bulb positioned inside the nose, underneath the apex of the alar cartilage, as the nasal stent. This modification allows easier adjustment of the position of the bulb during treatment to achieve a more symmetrical relationship between the nasal cartilages, columella, philtrum, and alveolar segments.

Craniofacial applications of three-dimensional laser surface scanning.

Recent innovations in technology have generated a variety of techniques for medical imaging. One of these initially developed for industry is laser surface scanning. Laser surface scanning is a noninvasive method for acquiring three-dimensional (3D) images. In this article, the technology of 3D laser surface scanning is described, and a few applications are reported as it relates to craniofacial research and clinical practice. Advantages and disadvantages of this imaging modality are discussed. Three-dimensional laser surface scanning holds great promise as it relates to the documentation, analysis, and evaluation of treatment results in craniofacial anomalies.