Occlusal Outcome of Orthodontic Treatment for Patients With Complete Cleft Lip and Palate

2021 ◽  
pp. 105566562199611
Author(s):  
Daniel Stonehouse-Smith ◽  
Aida N.A. Abd Rahman ◽  
Jeanette Mooney ◽  
Haydn Bellardie
Keyword(s):  
Orthodontic Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Treatment Time ◽  
Peer Assessment ◽  
Tertiary Care ◽  
Standard Of Care ◽  
High Volume ◽  
Retrospective Assessment ◽  
Par Index

Aim: To assess occlusal outcomes of orthodontic treatment for patients with complete cleft lip and palate. Design: Retrospective assessment using the Peer Assessment Rating (PAR) index. Setting: Consecutive patients treated by one consultant orthodontist at a tertiary care cleft center. Participants: One hundred twenty-seven patients with either complete unilateral cleft lip and palate (UCLP) or bilateral cleft lip and palate (BCLP) consecutively treated with fixed appliances. Intervention: Fixed orthodontic appliance treatment and orthognathic surgery when required. Outcomes: The PAR index assessment was carried out by a calibrated-independent assessor. Treatment duration, the number of patient visits, and data on dental anomalies were drawn from patient records and radiographs. Results: One hundred two patients’ study models were assessed after exclusions. Mean start PAR score for UCLP (n = 71) was 43.9 (95% CI, 41.2-46.6, SD 11.5), with a mean score reduction of 84.3% (95% CI, 81.9-86.7, SD 10.1). The UCLP mean treatment time was 23.7 months with 20.1 appointments. Mean start PAR score for BCLP (n = 31) was 43.4 (95% CI, 39.2-47.6, SD 11.4), with a mean score reduction of 80.9% (95% CI, 76.3-85.5, SD 12.5). The BCLP mean treatment time was 27.8 months with 20.5 appointments. Conclusion: These results compare well with other outcome reports, including those for patients without a cleft, and reflect the standard of care provided by an experienced cleft orthodontist. As with high-volume surgeons, orthodontic treatment for this high need group is favorable when provided by a high-volume orthodontist. These findings may be used for comparative audit with similar units providing cleft care.

scholarly journals Evaluation of Postorthodontic Changes in the Treatment of Cleft Lip and Palate Patients Using the PAR Index

2019 ◽  
Vol 57 (1) ◽  
pp. 29-34
Author(s):  
Kunakorn Trimetsuntorn ◽  
Amornrut Manosudprasit ◽  
Aggasit Manosudprasit ◽  
Natthawee Phaoseree ◽  
Araya Pisek ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Orthodontic Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Peer Assessment ◽  
Statistical Significance ◽  
P Values ◽  
Retention Period ◽  
Par Index ◽  
Dental Model

Objective: To evaluate dental changes in cleft patients after undergoing orthodontic treatment for at least 2 years. Hypothesis: The dental change would decline significantly after 2 years of completing orthodontic treatment. Design: This is a retrospective study. Patient: Eighteen repaired cleft lip and palate patients from the Faculty of Dentistry, KhonKaen University, Thailand, participated in this study. Mean Outcome Measures: A dental model with before treatment (T0), completed treatment (T1), and retention period (T2) data was analyzed using the peer assessment rating (PAR) index. Result: The results showed that the PAR score improved enormously after treatment; from T0 to T1, it was 34.00 ± 10.01 to 4.67 ± 2.47, and there was a reversion in the retention period. There was statistical significance between T0, T1, and T2, with P values <.001, .005, and <.001 when comparing T0 with T1, T1 with T2, and T0 with T2, respectively. Conclusion: Occlusion in cleft lip and palate patients changed from the time of completing treatment to the final results after the retention period. To sustain satisfactory results, orthodontists should plan carefully for the retention period before performing the treatment.

Postoperative Management of Cleft Lip and Palate Surgery

2018 ◽  
Vol 34 (06) ◽  
pp. 605-611 ◽  
Author(s):  
Ullas Raghavan ◽  
Dipesh Rao ◽  
Gautham Ullas ◽  
Vishwas Vijayadev
Keyword(s):  
Postoperative Care ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Care Center ◽  
Tertiary Care ◽  
High Volume ◽  
Postoperative Management ◽  
Orofacial Clefts ◽  
Procedural Complications

AbstractCleft lip and palatal clefts are one of the most common birth defects with a global incidence of 1 in 700 live births. The majority of these orofacial clefts are nonsyndromic. However, a general screening for syndromes and other organ anomalies should always be performed as their association with orofacial clefts cannot be overlooked. With the recent progress in the knowledge of cleft repair, the procedures to correct cleft lip and palate though complex, have been simplified to allow improvisation in outcome and to achieve even better finesse of surgical result. The procedural complications and the pursuit of having near perfect esthetics and functionality, make this deformity a recipient of multiple procedures. This ensures that the patient is under the care of the treating surgeon for long term and allows the surgeon to follow-up on the result, not only to provide care but also to intercept any deviation in the desired outcome. Postoperative care of cleft lip and palate surgery is largely underdiscussed and a set of fixed guidelines will help the treating surgeon to provide the most comprehensive care to the cleft patients. The authors review the practices followed at their hospitals—a high volume cleft and craniofacial care center, a tertiary care multispeciality teaching hospital, and a community teaching and training hospital. The commonly followed practices with suitable evidence in postoperative care of these patients are enlisted here.

The role of general dentists in the management of cleft lip and palate patients

2013 ◽  
Vol 4 (3) ◽  
pp. 124-131
Author(s):  
Madhura Vasanth ◽  
Anne-Marie Smith ◽  
Alison Murray
Keyword(s):  
Orthodontic Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Treatment Approach ◽  
Multidisciplinary Treatment ◽  
Standard Of Care ◽  
Effective Management ◽  
Adult Age ◽  
General Dentists

The management of children with cleft lip and palate (CLP) presents many challenges, and effective management involves a multidisciplinary treatment approach, which is now considered the standard of care for these patients. Patients with CLP generally require extensive and prolonged orthodontic treatment and this can be at any stage from birth to young adult age.

scholarly journals Two-phase orthodontic treatment in a unilateral cleft lip and palate patient with 1-year follow-up results

2017 ◽  
Vol 7 ◽  
pp. 101-107
Author(s):  
Prashant M. Dhole ◽  
Divya O. Maheshwari
Keyword(s):  
Orthodontic Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Treatment Time ◽  
Two Phase ◽  
Total Treatment Time ◽  
Total Treatment ◽  
Growth Modification ◽  
Palate Patient

Treatment of a patient with cleft lip and palate can be challenging. A 10-year and 10-month-old girl presented with uneven and crowded teeth. She had unilateral cleft lip and palate on left side for which she had undergone primary lip repair and palatoplasty when she was younger. On examination, she had concave facial appearance, crossbite of upper arch with reverse overjet of 2 mm, wits appraisal of 6 mm and impacted 23. She was treated with two-phase orthodontic treatment; growth modification appliances followed by fixed mechanotherapy. Total treatment time was 5 years. 1-year follow-up shows that results have been stable with good facial aesthetics and functional occlusion.

Aspects of orthodontic protocol in cleft lip and palate patients

2020 ◽  
Vol 20 (2) ◽  
pp. 137-142
Author(s):  
O. V. Dudnik ◽  
Ad. A. Mamedov ◽  
O. I. Admakin ◽  
A. A. Skakodub ◽  
Y. O. Volkov ◽  
...  
Keyword(s):  
Oral Hygiene ◽  
Orthodontic Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Comprehensive Approach ◽  
Maxillofacial Region ◽  
Indirect Methods ◽  
Indirect Bonding ◽  
The Face ◽  
Direct And Indirect Methods

Relevance. Cleft lip and palate is one of the severe malformations of the face and jaw, requiring a comprehensive approach to the rehabilitation of the patients, including doctors of various specialties, one of which is orthodontists. A feature of orthodontic treatment is difficulty of fixing bracket systems, as well as lowering the level of oral hygiene, caused by deformation and displacement of fragments of the maxillofacial region.Purpose. Improving the effectiveness of orthodontic treatment and hygiene of the oral caviti in patients with cleft lip and palate in permanent bite period.Materials and methods. A comparison was made of the effetctiveness of fixing brackets systmes with direct and indirect bonding techniques and the effectiveness of oral hygiene during orthodontic treatment using irrigators.Results. The results of the study showed a difference in the effectiveness of using direct and indirect methods of fixing bracket systems in patients with cleft and palate. The use of irrigators as additional means of oral hygiene has demonstrated a positive dynamic of hygiene indices.Conclusions. Results of the study demonstrate the advantages of fixation the brackets by indirect bonding and use additional hygiene products irrigator for improving of oral hygiene.

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.

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