Minimal incision palatoplasty with or without muscle reconstruction in patients with isolated cleft palate: a cast and medical records analysis.

Objectives: To compare the minimal incision (MI) technique with the minimal incision including muscle reconstruction (MMI) technique regarding surgical complications and dentoalveolar status at 5 years of age. Subjects and method: A consecutive series of 202 Caucasian non-syndromic children (apart from Pierre Robin Sequence) born with isolated cleft palate between 1987 and 2007 and treated with MI (n = 78) or MMI (n = 102) palatoplasty at a mean age of 12.7 (SD = 1.43) months in Stockholm. Twenty-two patients did not fulfill the inclusion criteria. The patients were divided into two subgroups: clefts within the soft palate only (small cleft, n = 50) and clefts within the hard and soft palate (big cleft, n = 130). Dental relations, structure of the palatal mucosa, and height of the palatal vault at 5 (mean age 5.3, range: 4.4-6.9) years of age were studied using plaster models. Time for surgery, blood loss, complications in the immediate postoperative period, frequency of fistulas, and additional pharyngeal flap surgery were evaluated. Student's t-test, chi-square test and 95 per cent confidence intervals were calculated. Results: MMI compared to MI technique result in statistically significant increased operation time, less need for pharyngeal flap surgery, and to shallower palatal vault. Big clefts result in statistically significant increased operation time and need for pharyngeal flap surgery. Dental relations were the same in all groups. Limitations: Retrospective single centre study, limited sample size, more than one surgeon. Conclusions: The muscle reconstruction results in a reduced subsequent need for pharyngeal flap surgery, but to shallower palatal vault and demand for almost double operation time. The dental relations were the same in all groups.

Evaluation of the variable anchorage straightwire technique using Ricketts' growth prediction.

The purpose of this retrospective study was to evaluate the treatment effects of the variable anchorage straightwire technique (VAST) in Angle Class II patients using Ricketts' growth prediction analysis. The subjects belonged to two groups: a control, consisting of 30 untreated Class II Swedish individuals (20 girls, 10 boys) with a mean age of 11.2 years, and the other 29 Swedish patients (14 girls, 15 boys), mean age 12.6 years, post-normal and with an increased overbite (OB), treated with the VAST. Two lateral cephalograms were available for every individual. Growth prediction according to Ricketts' visual treatment objective (VTO) was used to estimate the expected growth increments for a 2-year period. It was first used in the control group to determine its validity and then applied to the treated group to evaluate the net effects of treatment. Cephalometric evaluation based on Ricketts' analysis and additional dentoalveolar variables were carried out. Statistical analysis was undertaken using a paired Student's t- and Wilcoxon signed ranks tests. The method of predicting growth according to the VTO was, in general, valid in the untreated subjects, apart from the inclination of the lower incisors, where the proclination had been underestimated. In the treated group, the net effects of treatment were significant for the dentoalveolar variables: reduction of overjet (OJ) and OB, proclination and relative intrusion of the lower incisors, extrusion of the molars, and increase in lower face height. The growth prediction method according to VTO was found to be valid in a sample of Swedish post-normal children concerning skeletal and dentoalveolar variables. The VAST treatment net effects in these growing patients were achieved mainly by dentoalveolar changes.

Evaluation of the validity of tooth size and arch width measurements using conventional and three-dimensional virtual orthodontic models.

Measurements and different analyses of dental casts are essential for precise diagnosis of an orthodontic case. At present, virtual computerized models, such as OrthoCAD, are available for clinicians, supplemented by dedicated software for performing needed measurements on them. The purpose of this study was to test the accuracy of measuring casts with the aid of calipers or OrthoCAD and compare these two techniques. Twenty setups using artificial teeth corresponding to various malocclusions were created. Impressions were taken of them, providing 20 plaster and 20 virtual orthodontic models. Measurements of mesiodistal tooth dimension as well as intercanine and intermolar width were made on both. Additionally, values of tooth size were calculated from the isolated artificial teeth removed from the setups and of arch width from the existing setups. The resulting values were compared by the use of nonparametric statistics, and methods' errors were also calculated. Results showed the methods being highly valid and reproducible for both tooth size and arch width. For the tested clinically applicable methods, measurement with digital calipers on plaster models showed the highest accuracy and reproducibility, closely followed by OrthoCAD. Digital calipers seem to be a more suitable instrument for scientific work. However, OrthoCAD's accuracy is clinically acceptable, and most likely, considering its present advantages and future possibilities, the examined or an equivalent 3D virtual models' procedure would become the standard for orthodontic clinical use.