Early Maxillary Dentoalveolar Changes in Children with Unilateral Cleft Lip and Palate After Palatal Repair: A Pilot Study

Objective To assess early maxillary dentoalveolar changes in children with unilateral cleft lip and palate (UCLP) up to 6 months after palatoplasty. Design Pilot study. Patients and Participants Eight children with UCLP at the age of 18 to 30 months, who were awaiting palatal repair, were included. Interventions All participants with repaired lip were scheduled for palatal repair between 18 and 24 months by Bardach's technique. Main Outcome Measure(s) Arch widths, arch depths, and arch perimeter was measured on 32 dental casts of 8 participants at 4 time points: just prior to palatal repair (T1), 1 month (T2), 3 months (T3), and 6 months (T4) after palatal repair. Manual method using digital vernier caliper (Zhart, India) was used for model analysis. Intraexaminer reliability was also assessed. Results Only one examiner assessed all the dental casts after blinding. There was a significant decrease in the intercanine width (29.75 ± 1.98 mm at T1 to 26.42 ± 1.67 mm at T4; P < .001) and anterior arch depth (9.86 ± 1.07 mm at T1 to 8.29 ± 1.51 mm at T4; P < .001). Growth occurred in intertuberosity width (38.18 ± 1.40 mm at T1 to 39.76 ± 1.09 mm at T4; P < .001) and total arch depth (24.36 ± 1.21 mm at T1 to 26.79 ± 1.04 mm; P < .001) over 6 months post-surgery. Conclusions There was growth restriction in the anterior part of the palate, whereas the posterior region continued to grow after palatal repair. These changes were observable even in the early months after palatoplasty.

Validity and Reliability of Peer Assessment Rating Index Measurement Derived from Digital and Plaster Models

Aims The aim of the study was to determine the validity and reliability of Peer Assessment Rating (PAR) index score derived from digital and plaster models of the same patient. Subjects and Methods Thirty orthodontic plaster study models were digitalized using the 3Shape R700™ Orthodontic 3D scanner. PAR Index scoring was carried out on both the plaster and digital models by one independent examiner calibrated in the PAR Index. The measurements were repeated at a second sitting. Measurements were made on plaster models with the PAR Index ruler and on digital models with the 3Shape OrthoAnalyzer™ software. Statistical Analysis Used Bland-Altman plots were used to test for validity and intraexaminer reliability. Results For PAR Index score, overjet and overbite component scores, 28 out of 30 measurements were within 95% limits of agreement. Other components of the PAR Index score had all points within 95% limits of agreement. For intraexaminer reliability, digital models had 28 out of 30 measurements and plaster models had 27 out of 30 measurements that were within 95% limits of agreement. Conclusions Digital models are a clinically acceptable alternative to plaster models in the measurement of the PAR Index. Improvement in software design is necessary to attain greater agreement in the measurement of the overjet and overbite components of the PAR index score between plaster and digital models.

Reproducibility and reliability of three-dimensional soft tissue landmark identification using three-dimensional stereophotogrammetry

ABSTRACT Objective: To evaluate the intraexaminer repeatability and interexaminer reproducibility of soft tissue landmarks on three-dimensional (3-D) stereophogrammetric images. Materials and Methods: Thirty-four stereophotogrammetric images were taken and 19 soft tissue points were identified. The images were obtained using the 3-DMD Face (3-DMD TM Ltd, Atlanta, Ga) system. Two examiners marked 34 images manually with a mouse-driven cursor 4 weeks apart. Intraexaminer marking differences were calculated and classified as &lt;0.5 mm, 0.5–1 mm, and &gt;1 mm. Intraclass correlation coefficients were calculated for intraexaminer reliability. A paired-samples t-test was used to evaluate the difference between the examiners. Interexaminer reproducibility was evaluated by kappa analysis. Statistical significance was set at P &lt; .05. Results: Only one landmark (labiale superior) had an intraexaminer marking difference less than 0.5 mm. Existing landmarks had an intraexaminer difference less than 1 mm, but higher than 0.5 mm. The intraclass correlation coefficients (ICCs) indicated good intraexaminer repeatability for both observers. The ICC range for examiners 1 and 2 was 0.986–1.000 and 0.990–1.000, respectively. Kappa scores showed good interexaminer agreement, especially on the z-axis. Conclusions: Except labiale superior, the soft tissue landmarks used in this study were shown to have moderate reproducibility, but the difference between the landmarks was less than 1 mm, and they had clinically acceptable reproducibility.

Comparative evaluation of sagittal anchorage loss in lingual and labial appliances during space closure: A pilot study

Aim The purpose of this investigation was to assess and compare the anchorage loss between labial and lingual appliance systems during space closure. Materials and Methods Twenty subjects were part of the study among which 10 subjects (mean age 21 ± 3.6 years) were treated using lingual appliance system (0.018” slot-STb™) and 10 subjects (mean age 19 ± 6.1 years) were treated using labial preadjusted edgewise appliance system (0.018” slot-MBT™). First premolar extractions were performed to enable retraction of anterior teeth. Lateral cephalometric radiographs were taken at two intervals, before starting space closure and after space closure that were connoted as T0 and T1 and were analyzed using the method described by Pancherz to measure anchorage loss. Intraclass correlation coefficient (ICC) was used to evaluate intraexaminer reliability of the measurements. Student’s t-test was performed to verify any statistical significant correlation between the labial and lingual appliance systems. Statistical differences were determined at the 95% confidence level (P < 0.05). Results The results showed that all ICC for lingual and labial group were ≥0.90 showing good repeatability of the measurements. Mean anchorage loss of 1.238 ± 0.17 mm in lingual appliance system and an anchorage loss of 2.06 ± 0.39 mm occurred with the labial appliance system. On the comparison between the two appliance systems, lingual appliance demonstrated a significantly lesser anchorage loss than did the labial appliance. Interpretation and Conclusion This prospective study concludes with the fact that lingual appliance provided better anchorage control than labial appliance during space closure. Use of lingual appliance could be considered in critical anchorage cases when compared with labial appliance.