scholarly journals Role of orthodontist in cleft lip and palate

2021 ◽  
Vol 6 (2) ◽  
pp. 008-015
Author(s):  
Sharma Prashant ◽  
Khera Amit Kumar ◽  
Raghav Pradeep
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Treatment Protocol ◽  
Nutritional Deficiencies ◽  
Efficient Treatment ◽  
Alveolar Bone Grafting ◽  
The Individual ◽  
Highly Able

Cleft lip and palate is one of the most common congenital anomalies occurring round the world varying with the race, ethnicity and geography. Cleft lip and/or palate problems tends to worsen as the individual grows older. Although it occurs as a different entity in itself but its presence can hamper aesthetics as well as functions by effecting growth, dentition, speech, hearing and overall appearance resulting in social and psychological problems for the child as well as the parents. Cleft lip and palate is of a multifactorial origin such as inheritance, teratogenic drugs, and nutritional deficiencies and can also occur as syndromic or non-syndromic cleft. Treatment of Cleft Lip and Palate comprises of different specialists having an individual insight in a particular case ultimately reaching to a consensus for a successful culmination of the treatment. Although appropriate timing and method of each intervention is still arguable. An orthodontist plays a role in pre surgical maxillary orthopaedics, in aligning the maxillary segments and dentition, in preparation for secondary alveolar bone grafting and finally in obtaining ideal dental relation and preparing the dentition for prosthetic rehabilitation or orthognathic surgery if required. Therefore, for efficient treatment outcome and refinement of individual techniques or variations of the treatment protocol a highly able team of specialists from different specialities is a must, preferably on a multicentre basis.

The use of 2D radiographs for the assessment of effectiveness of secondary alveolar bone grafting in patients with cleft lip and palate. A literature review

2018 ◽  
Vol 14 (3) ◽  
pp. 199-213
Author(s):  
Marcin Stasiak ◽  
Anna Wojtaszek-Słomińska ◽  
Bogna Racka-Pilszak
Keyword(s):  
Literature Review ◽  
Bone Grafting ◽  
Surgical Procedure ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Treatment Protocol ◽  
Assessment Methods ◽  
Alveolar Bone Grafting ◽  
Secondary Alveolar Bone Grafting

Clefts of the lip and the palate (CLP) represent the most common craniofacial developmental defects. The CLP surgical treatment protocol involves an autogenous secondary alveolar bone grafting (SABG). <b>Aim.</b> The aim of the study was to review the methods for the SABG assessment in CLP patients based on 2D radiographs and the assessment of the effectiveness of the foregoing surgical procedure based on those methods. <b>Material and methods.</b> Papers, published in the years 1981-2018, regarding SABG assessment in CLP patients based on 2D radiographs were reviewed. Nineteen papers in which the material was closely associated with the study assumptions were qualified for the review. <b>Results.</b>major part of the papers under analysis use a single post-operative radiograph. The others are based on two or three radiographic projections. There are seven basic methods and three modified methods used for the assessment of SABG effectiveness. The SABG assessment methods based on 2D radiographs are similar to one another. The main criterion of surgery effectiveness is the position of the alveolar process edge within the cleft with relation to the tooth roots adjacent to the cleft. Said classification results differ in terms of the degree of complexity and the manner of presentation of the surgery outcomes. The Abyholm (Bergland) scale was the most commonly applied assessment method. As demonstrated in all the studies in which 2D radiographs were used, the SABG effectiveness varied from 71% to 95%. <b>Conclusions.</b>1. The SABG assessment methods based on 2D radiographs are a useful manner of surgical procedure assessment. 2. The studies in which the SABG assessment methods based on 2D radiographs are used demonstrate a high effectiveness of the SABG procedure. <b>(Stasiak M, Wojtaszek-Słomińska A, Racka-Pilszak B. The use of 2D radiographs for the assessment of effectiveness of secondary alveolar bone grafting in patients with cleft lip and palate. A literature review. Orthod Forum 2018; 14: 199-213).</b>

scholarly journals Maxillary Canine Impaction and Unilateral Cleft Lip and Palate: A Review of the Current Literature

2018 ◽  
Author(s):  
Ali Alqerban
Keyword(s):  
Bone Graft ◽  
Current Literature ◽  
Bone Grafting ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Dental Anomalies ◽  
Maxillary Canine ◽  
Alveolar Bone Grafting

The present review aims to investigate the effect of alveolar bone grafting in canine impacted unilateral cleft lip and palate patients. The goal of this review is to identify and highlight the factors that may cause maxillary canine impaction, the role of primary and secondary bone graft and dental anomalies that may affect canine impaction in patients with cleft lip and palate.

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.

scholarly journals Alveolar bone heights of maxillary central incisors in unilateral cleft lip and palate patients using cone-beam computed tomography evaluation

2021 ◽  
Author(s):  
Marcin Stasiak ◽  
Anna Wojtaszek-Słomińska ◽  
Bogna Racka-Pilszak
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Contralateral Side ◽  
Cone Beam ◽  
Rank Test ◽  
Cross Sectional ◽  
Alveolar Bone Grafting

Abstract Purpose The aims of this retrospective cross-sectional study were to measure and compare labial and palatal alveolar bone heights of maxillary central incisors in unilateral cleft lip and palate patients, following STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Patients and methods The study group consisted of 21 patients with a mean age of 16 years. High-resolution cone-beam computed tomography was performed at least one year after secondary alveolar bone grafting. The experimental side was the cleft side and the contralateral side without congenital cleft was the control. Measurements were performed on incisors’ midsagittal cross-sections. The Wilcoxon signed-rank test was used for intergroup comparisons. Results The labial and palatal distances between alveolar bone crests and cementoenamel junctions were significantly greater on the cleft side than on the noncleft side. Mean differences were 0.75 and 1.41 mm, respectively. The prevalence of dehiscences at the cleft side maxillary central incisors was 52% on the labial surface and 43% on the palatal surface. In the controls, it was 19% and 14%, respectively. Conclusion The cleft-adjacent maxillary central incisors had more apically displaced alveolar bone crests on the labial and palatal sides of the roots than the controls. Higher prevalence of dehiscences was found on the cleft side. Bone margin differences predispose to gingival height differences of the central incisors. These differences could increase the demands of patients to obtain more esthetic treatment results with orthodontic extrusion and periodontal intervention on the cleft side.

An Evaluation of a Noninvasive Method of Assessing Alveolar Bone Levels in an Experimental Model of Cleft Lip and Palate

1998 ◽  
Vol 35 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Robert B. Lawson ◽  
Malcolm. L. Jones
Keyword(s):  
Direct Measurement ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Measurement Techniques ◽  
Membrane Thickness ◽  
Ultrasound Technique ◽  
Measuring Device ◽  
Alveolar Bone Grafting ◽  
Mucosal Thickness

Objective The purpose of this study was to evaluate an ultrasound mucous-membrane-thickness-measuring device as a noninvasive, nonionizing alternative to radiography in the assessment of alveolar bone grafting. Design This was a prospective experimental study on porcine cadaver models. Method An ultrasound technique (Krupp SDM) was assessed ex vivo on three specially developed porcine cadaver models in comparison to radiography and ridge-mapping. Direct measurement of the mucosal thickness provided a standard for comparison. In each model, 30 measurement sites were identified for comparison of the techniques. Results All measurement techniques demonstrated clinically acceptable re-producibility. Of the clinical measurement techniques, radiography proved to be the most reliable, showing a small, nonsignificant statistical difference from direct measurement. Both the ultrasound technique and ridge-mapping showed significant tendencies to underestimate mucosal thickness that became greater with increasing mucosal thickness. At sites where mucosal thickness was less than 6 mm, the ultrasound technique underestimated mucosal thickness by 0.6 mm on average. At sites where mucosal thickness exceeded 6 mm, ultrasonic artifacts rendered the ultrasound technique unreliable. Conclusion The ultrasound technique could prove to be a useful clinical adjunct to radiography in the assessment of alveolar bone grafts, but in this particular application, care should be taken when using it to assess deeper alveolar defects.

Reliability of the SWAG—The Standardized Way to Assess Grafts Method for Alveolar Bone Grafting in Patients with Cleft Lip and Palate

2017 ◽  
Vol 54 (6) ◽  
pp. 680-686 ◽  
Author(s):  
Kathleen Russell ◽  
Ross E. Long ◽  
John Daskalogiannakis ◽  
Ana Mercado ◽  
Ronald Hathaway ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Intrarater Reliability ◽  
Root Coverage ◽  
Treatment Protocols ◽  
Retrospective Comparison ◽  
Alveolar Bone Grafting ◽  
Outcome Comparison ◽  
Better Than

Objective The objective of this study was to test a new method, a Standardized Way to Assess Grafts (SWAG), to rate alveolar bone graft (ABG) outcomes for patients with cleft lip and palate. Design This was a retrospective comparison using the SWAG scale. Setting This study took place in four cleft palate centers with different treatment protocols. Methods A total of 160 maxillary occlusal radiographs taken 3 to 18 months post-ABG for sequentially treated patients with cleft lip and palate were assessed using the SWAG scale. Radiographs were scanned, standardized, blinded, and rated by 6 calibrated orthodontists to assess vertical thirds, bony root coverage, and complete bony fill. All radiographs were rated twice, 24 hours apart, by the same raters. Main Outcomes Intra- and interrater reliabilities were assessed. Results Intrarater reliability was good to very good (.760; .652–.834), and interrater reliability was moderate to good (.606; .569–.681), comparable to previously published methods. Conclusions Rater reliabilities were shown to be comparable to or better than existing methods. The SWAG method was validated for ABG assessments in the mixed and permanent dentitions based on reliabilities in an intercenter outcome comparison.

Cleft Lip and Palate Care in the United Kingdom—The Clinical Standards Advisory Group (CSAG) Study. Part 4: Outcome Comparisons, Training, and Conclusions

2001 ◽  
Vol 38 (1) ◽  
pp. 38-43 ◽  
Author(s):  
David Bearn ◽  
Sue Mildinhall ◽  
Terrie Murphy ◽  
John J. Murray ◽  
Debbie Sell ◽  
...  
Keyword(s):  
United Kingdom ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Dental Health ◽  
Parent Satisfaction ◽  
Advisory Group ◽  
Dental Arch ◽  
The United Kingdom ◽  
Alveolar Bone Grafting

Objective A critical appraisal of cleft care in the United Kingdom. Design Retrospective comparative study. Setting All National Health Service cleft centers in the United Kingdom. Patients/Participants Children born with unilateral complete clefts of the lip and palate between April 1, 1982, and March 31, 1984 (12-year-olds), and April 1, 1989, and March 31, 1991 (5-year-olds). Newly appointed and senior cleft clinicians. Main Outcome Measures Skeletal pattern, dental arch relationship, success of alveolar bone grafting, dental health, facial appearance, oral health status, patient/parent satisfaction. Conclusions This paper highlights the poor outcomes for the fragmented cleft care in the United Kingdom, compared with European centers. There is an urgent need for a review of structure, organization, and training.

scholarly journals Permanent maxillary central incisor and first molar rotations in the mixed dentition in repaired complete unilateral cleft lip and palate and their relationship with absence of teeth in their vicinity

2018 ◽  
Vol 88 (5) ◽  
pp. 567-574
Author(s):  
Sunjay Suri ◽  
Suteeta Disthaporn ◽  
Bruce Ross ◽  
Bryan Tompson ◽  
Diogenes Baena ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Alveolar Bone ◽  
Permanent Tooth ◽  
Mixed Dentition ◽  
Central Incisor ◽  
Maxillary Central Incisor ◽  
Anterior Teeth ◽  
Alveolar Bone Grafting

ABSTRACT Objectives: To describe qualitatively and quantitatively the directions and magnitudes of rotations of permanent maxillary central incisors and first molars in the mixed dentition in repaired complete unilateral cleft lip and palate (UCLP) and study their associations with absence of teeth in their vicinity. Materials and Methods: Dental casts and orthodontic records taken prior to orthodontic preparation for alveolar bone grafting of 74 children with repaired UCLP (53 male, 21 female; aged 8.9 ± 1.0 years) were studied. Directions and magnitudes of permanent maxillary central incisor and first molar rotations were recorded. Tooth absence was confirmed from longitudinal radiographic records. Incisor and molar rotations were analyzed in relation to the absence of teeth in their vicinity. Results: Distolabial rotation of the permanent maxillary central incisor was noted in 77.14% on the cleft side, while distopalatal rotation was noted in 82.19% on the noncleft side. Incisor rotation was greater when a permanent tooth was present distal to the cleft side central incisor, in the greater segment. The permanent maxillary first molar showed mesiopalatal rotation, which was greater on the cleft side and when there was absence of one or more teeth in the buccal segment. Conclusions: Presence and absence of teeth were associated with the severity of incisor and molar rotations in UCLP. Crowding of anterior teeth in the greater segment was associated with a greater magnitude of rotation of the cleft side permanent central incisor. Absence of one or more buccal segment teeth was associated with greater magnitude of rotation of the molar.

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