Predictive factors for canine position in patients with unilateral cleft lip and palate

2020 ◽  
Author(s):  
Sara Rizell ◽  
Zahra Alhakim ◽  
Hans Mark ◽  
Julia Naoumova
Keyword(s):  
Regression Analysis ◽  
Predictive Factors ◽  
Bone Grafting ◽  
Medical Records ◽  
Hard Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Exact Test ◽  
Multiple Stepwise Regression Analysis ◽  
Surgical Exposure

Summary Objectives The aims were to compare cleft and non-cleft canine position, to find predictive factors for canine position and to assess surgically exposed canines. Materials/Methods One hundred forty-eight individuals, born 1978–2005, with total unilateral cleft lip and palate (including Simonart’s band <5 mm) treated in Gothenburg, were included. Canine angulation as well as vertical and horizontal position were assessed on panoramic radiographs (PAN) taken at the age of 10. Plausible predictive factors were registered from PAN, cast models and medical records. Data on spontaneous eruption or surgical exposure were available for 88 patients. Cleft- and non-cleft side was compared using paired t-test and Fisher’s exact test. Multiple stepwise regression analysis and logistic regression analysis were used to detect possible predictors for cleft canine position. Results The cleft canine angulation was 29.3 ± 13.1 degrees (mean ± standard deviation) versus 7.6 ± 8.2 degrees on the non-cleft side (p < 0.001). Cleft canines were higher positioned and located closer to the midline compared to non-cleft canines (p < 0.001). Age for both hard palate closure and bone grafting, cleft lateral agenesis as well as transposition were associated with canine position. Cleft canines that required surgical exposure (28%) had an increased angulation and were higher positioned than spontaneously erupted canines (p < 0.001). Limitations The shortcomings were the retrospective design and incomplete assessment of the buccal–palatal canine position on 2D images. Conclusions/Implications With increased age for bone grafting, decreased age for hard palate closure and transposition, an association with abnormal canine position was found. A rigorous monitoring of cleft canine eruption is, therefore, advocated.

Mind the Gap: Alveolar Bone Graft Revision in the Era of Computed Tomography

2021 ◽  
pp. 105566562110026
Author(s):  
Ema Zubovic ◽  
Gary B. Skolnick ◽  
Abdullah M. Said ◽  
Richard J. Nissen ◽  
Alison K. Snyder-Warwick ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Tertiary Care ◽  
Radiographic Examination ◽  
Graft Take ◽  
Alveolar Bone Grafting ◽  
Ct Evaluation

Objective: To determine the rate of revision alveolar bone grafting (ABG) in patients with cleft lip and palate (CLP) before and after the introduction of postoperative computed tomography (CT). Design: Retrospective case–control study analyzing the incidence of revision ABG in patients with and without postoperative CT scans for graft success evaluation. Setting: Academic tertiary care pediatric hospital. Patients: Eighty-seven patients with CLP or cleft lip and alveolus treated with autologous iliac crest bone grafting for alveolar clefts over a 10-year period (January 2009 to March 2019) with minimum 6-month follow-up. Fifty patients had postoperative CT evaluation; 37 did not. Interventions: Postoperative CT to determine ABG success, versus standard clinical examination and 2-dimensional radiographs. Main Outcome Measures: Requirement for revision ABG, defined as failure of the original graft by clinical or radiographic examination. Results: Fifty-eight percent of patients underwent a postoperative CT scan at median interval of 10 months after surgery. Patients with postoperative CT evaluation had a 44% rate of revision ABG (22/50) for inadequate graft take, compared to 5% (2/37) in patients without postoperative CT ( P < .001; 95% CT, 31%-58% in the CT group, 1%-16% in the non-CT group). Conclusions: Computed tomography evaluation after ABG is associated with a significantly increased revision rate for inadequate graft take. The presence of a secondary palatal fistula at the time of original ABG is not associated with revision requirement. Lack of standardized dental and orthodontic records complicates the study of ABG outcomes and presents an area for systems-based improvement.

Orthodontic Pre Grafting Closure of Large Alveolar Bony and Soft Tissue Gaps: A Novel Nonsurgical Protraction of the Lesser Segments in Growing Patients With Cleft Lip and Palate

2021 ◽  
pp. 105566562110076
Author(s):  
Maria Costanza Meazzini ◽  
Noah Cohen ◽  
Valeria Marinella Augusta Battista ◽  
Cristina Incorvati ◽  
Federico Biglioli ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Surgical Procedures ◽  
Efficient Method ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Soft Tissues ◽  
Cleft Lip And Palate ◽  
Face Mask ◽  
Younger Patients ◽  
Good Healing

Background: Closure of wide alveolar clefts with large soft tissue gaps and reconstruction of the dentoalveolar defect are challenging for the surgeon. Some authors successfully used interdental segmental distraction, which requires an additional surgical procedure. Objective: This study evaluates the effectiveness of tooth borne devices utilized to orthopedically advance the lesser segments, with a complete approximation of the soft tissue of the alveolar stumps, allowing traditional simultaneous soft tissue closure and bone grafting, and avoiding the need for supplementary surgery. Methods: Eight growing patients, 2 with unilateral complete cleft lip and palate (UCLP) and 6 with bilateral complete cleft lip and palate (BCLP), with large soft tissue and bony alveolar defects prior to bone grafting were prospectively selected. A banded rapid palatal expander (RPE) in BCLP and a modified RPE in UCLP combined with protraction face mask in younger patients or a modified Alt-Ramec in patients older than 12 years were applied. Radiographic and photographic records were available at T0, at the end of protraction (T1) and at least 1 year after bone grafting (T2). Results: Patients with large gaps showed a significant reduction in the bony cleft area and approximation of the soft tissues at T1. All patients received bone grafting with good healing and ossification at T2. Conclusion: In growing patients with UCLP and BCLP with large gaps, presurgical orthodontic protraction seems to be an efficient method to reduce the cleft defect, minimizing the risk of post grafting fistulas, reducing the need for supplementary surgical procedures.

Rehabilitation of a Patient with Cleft Lip and Palate with an Extremely Edentulous Atrophied Posterior Maxilla Using Zygomatic Implants: Case Report

2004 ◽  
Vol 41 (5) ◽  
pp. 571-574 ◽  
Author(s):  
Anh Viet Pham ◽  
Marcelo Abarca ◽  
Albert De Mey ◽  
Chantal Malevez
Keyword(s):  
Case Report ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Oral Implants ◽  
Alveolar Cleft ◽  
Dental Prostheses ◽  
Posterior Maxilla ◽  
Zygomatic Implants ◽  
Dental Rehabilitation

Objective This case report describes the clinical and surgical management of a patient with a unilateral alveolar cleft and associated extremely atrophied totally edentulous maxilla. Method Two zygomatic implants and four endosseous oral implants were placed under general anesthesia in a compromised maxilla to rehabilitate a 33-year-old patient with cleft lip and palate. The two specially designed zygomatic implants were utilized to avoid the need for bone grafting in the patient. The final prosthetic rehabilitation was an esthetic and functional maxillary overdenture prosthesis supported by implants. Results Preliminary results have shown how dental prostheses supported by endosseous implants in grafted alveolar cleft are a reliable possibility in the dental rehabilitation of this malformation. Conclusion The use of zygomatic implants may be considered a reliable alternative to more resource-demanding techniques such as bone grafting in patients with cleft palate.

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