Condylar and ramal vertical asymmetry in adolescent patients with cleft lip and palate evaluated with cone-beam computed tomography

Orthognathic Considerations of Maxillary and Mandibular Asymmetry at Skeletal Maturity in Patients with Cleft Lip and Palate

BACKGROUND

Improving occlusion and aesthetics is the primary objective of orthognathic surgery for patients with cleft lip and palate (CLP). However, these patients often have horizontal, vertical, and rotational asymmetry in addition to maxillary retrusion. This study aimed to describe maxillary and mandibular asymmetry in patients with CLP undergoing orthognathic surgery and to analyze its anatomic basis.

METHODS

Patients with isolated CLP undergoing computed tomographic imaging before orthognathic surgery were retrospectively reviewed. Maxillary and mandibular positioning and dimensional symmetry were evaluated. Incidence of clinically significant asymmetry, correlations between areas of asymmetry, and associations with clinical history were analyzed.

RESULTS

Fifty-eight patients, with a mean age of 17 years, were analyzed, including 32 patients with unilateral and 26 with bilateral CLP. Twenty patients (34%) demonstrated chin deviation of 4 mm or greater, and 21 (36%) had a 5% or greater discrepancy in mandibular ramus lengths. Horizontal occlusal plane cant of 2 degrees or greater was seen in 20 maxillae (34%) and 28 mandibles (48%), with a dental arch yaw of 2 degrees or greater noted in 55% of both maxillae and mandibles ( n = 32). Chin deviation correlated with maxillary cant, discrepancy in ramus length, discrepancy in mandibular body length, and discrepancy in condylar volume ( P < 0.05). Bilateral and unilateral CLP did not show significantly different asymmetry on any measure ( P > 0.05).

CONCLUSIONS

Both maxillary and mandibular asymmetry are common in skeletally mature patients with CLP and frequently results in notable chin deviation. Preoperative 3-dimensional imaging and virtual surgical planning of orthognathic surgery aid in the recognition of facial asymmetries and reveal opportunities to optimize results in this population.

Three-dimensional assessment of mandibular asymmetry in patients with unilateral cleft lip and palate at different growth stages: a cross-sectional study

INTRODUCTION

The early diagnosis of mandibular asymmetry (MA) in patients with unilateral cleft lip and palate (UCLP) can contribute to its treatment.

OBJECTIVE

The aim of this study was to evaluate the occurrence and the extent of MA in UCLP patients at different growth stages.

METHODS

Cone-beam computed tomography (CBCT) of 47 UCLP patients were included, and divided into two groups (prepubertal stage and pubertal stage). The mandibular ramus height (Co-Go), mandibular body length (Go-Me), total mandibular length (Co-Me), gonial angle (CoGoMe), the volume of the mandibular condyles, and lateral chin deviation were evaluated. The cleft side (CS) and noncleft side (NCS) were compared using the paired t-test for dependent samples. Chin deviation and its possible association with specific sides were evaluated using the Mann-Whitney and Fisher's Exact tests, respectively. The significance level was set at 5%.

RESULTS

Comparison of CS and NCS revealed that in prepubertal stage, Co-Me was shorter (105.5 ± 5.7 mm; p = 0.036) in the CS, and that in pubertal stage, Co-Go was lower (46 ± 6 mm; p= 0.004) and Go-Me was greater (78.5 ± 5.8 mm; p = 0.026) in the CS. In both growth stages, a significant association (p< 0.05) was observed between the side to which the chin has deviated and the CS.

CONCLUSIONS

Although patients with UCLP in the prepubertal and pubertal stages presented significant measurements revealing MA, only Co-Go in the pubertal stage showed a clinically relevant difference. This specific result indicates that MA must be monitored during patients' growth.

Condylar Volumetric Asymmetry Predicts Need for Surgical Intervention in Patients With Cleft Lip and/or Palate

OBJECTIVE

In this study, the authors investigate the associations between the mandibular condyle and facial asymmetry in patients with cleft lip and/or palate (CLP).

METHODS

Condylar volume was calculated by measuring the bony volume of the posterior mandible superior to the sigmoid notch in skeletally mature patients with CLP and controls. Relationships between condylar asymmetry, facial deviation, and malocclusion were compared using t-tests, correlation analysis, and receiver operating characteristic curves.

RESULTS

This study included 118 patients: 60 with CLP preparing for orthognathic surgery, 17 with CLP who did not undergo orthognathic surgery, and 41 controls. Condylar volumes in patients with CLP preparing for orthognathic surgery were more asymmetric than those with CLP not requiring surgery (16.4 ± 17.4% vs 7.1 ± 6.0%, P = 0.03). Patients with CLP who did not undergo orthognathic surgery and controls had similar degrees of condylar asymmetry (7.1 ± 6.0% vs 5.9 ± 3.8%, P = 0.35). Condylar asymmetry correlated with chin deviation (P < 0.01). Patients with CLP and clinically significant chin deviation (>4 mm) had more asymmetric condyles than those without significant chin deviation, and the chin usually deviated toward the smaller condyle (P = 0.03). Condylar asymmetry >11% predicted undergoing orthognathic surgery in CLP with 70% sensitivity and 67% specificity.

CONCLUSION

Condylar asymmetry is associated with facial asymmetry in patients with CLP, and the facial midline often deviates towards the smaller condyle. Condylar volumetric asymmetry in patients with CLP may be a predictor for needing orthognathic surgery, useful information for surgeons and families alike.

Comparison of temporomandibular joint osseous components in unilateral and bilateral cleft lip and palate patients and normal controls: A CBCT study

OBJECTIVE

The objective of this study was to conduct a comparative analysis of the components of the temporomandibular joint in individuals with unilateral, bilateral cleft lip and palate (CLP), and in healthy individuals, utilizing cone beam computed tomography (CBCT) images.

METHOD AND MATERIAL

The present study employed a cross-sectional design and recruited participants aged 18 to 30 years. The participants were categorized into three groups: a control group consisting of 36 individuals without any cleft, a group of 35 patients with unilateral cleft lip and palate (UCLP), and a group of 15 patients with bilateral cleft lip and palate (BCLP). The analysis of CBCT images encompassed the examination of condylar height and angulation, glenoid fossa height and width, articular eminence inclination, as well as joint spaces across all three groups. The Kruskal-Wallis and Mann-Whitney tests were employed to ascertain the significant differences among the three groups.

RESULTS

The UCLP and BCLP groups demonstrated a statistically significant reduction in condylar height and articular eminence inclination in comparison to the control group. Furthermore, a significant difference in the width of the glenoid fossa was seen between the group with clefts and the control group.

CONCLUSION

The CBCT images showed significant differences in several aspects of the temporomandibular joint, including condylar height, articular eminence inclination, and glenoid fossa width, in individuals with cleft palate. These abnormalities can contribute to the development of temporomandibular joint diseases. Therefore, recognizing these distinctions can help prevent further deterioration and progression of temporomandibular disorders (TMD) in CLP patients.

Does cleft lip and palate affect the severity of malocclusion?

OBJECTIVE

The purpose of this study was to evaluate the 3D anatomical features of unilateral (UCLP) and bilateral (BCLP) complete cleft lip and palate with those of skeletal Class III dentofacial deformities.

MATERIALS AND METHODS

In total, 92 patients were divided into cleft and noncleft groups. The cleft group comprised 29 patients with UCLP and 17 patients with BCLP. The noncleft group comprised 46 patients with Class III dentofacial deformities. 3D anatomical landmarks were identified and the corresponding measurements were made on the cone-beam computed tomography (CBCT).

RESULTS

The differences between the affected and unaffected sides of the patients with UCLP were nonsignificant. The differences between the patients with UCLP and BCLP were nonsignificant except for the SNA angle. Significant differences between the patients with clefts and Class III malocclusion were identified for the SNA, A-N perpendicular, and A-N Pog line, indicating that the maxillae of the patients in the cleft group were more retrognathic and micrognathic. Relative to the noncleft group patients, the cleft group patients had a significantly smaller ramus height.

CONCLUSION

The affected and unaffected sides of the patients with UCLP did not exhibit significant differences. The maxillae of the patients with UCLP were significantly more retrognathic than those of the patients with BCLP. The maxillae and mandibles of the patients in the cleft group were more micrognathic and retropositioned relative to those of the noncleft Class III patients.

CLINICAL RELEVANCE

The maxillary and mandibular findings indicated greater deficiencies in the patients with UCLP or BCLP than in those with skeletal Class III malocclusion. Appropriate surgical design should be administered.

Condylar Changes after Maxillary Expansion in Children with Cleft Lip and Palate—A Three-Dimensional Retrospective Study

Background: The presence of posterior crossbite can trigger aesthetic and functional changes as mandibular asymmetry in individuals, contributing to asymmetrical muscle function. Mandibular asymmetry and respective condyle adaptation may be an etiological factor in temporomandibular disorder. This study aims to evaluate the effects of maxillary expansion on the position and angulation of the condyles as well as the intercondylar distance in children with cleft lip and palate. Methods: Twenty-five individuals with cleft lip and palate who underwent maxillary expansion were selected. Condylar changes were evaluated by cone beam computed tomography using the Pullinger and Hollender formula. To determine the statistically significant differences between the variables, the Student t-test and the Benjamini–Hochberg correction method for multiple comparisons were used. Results: No statistically significant differences between angulation and condylar position before and after maxillary expansion were found. The intercondylar distance tended to increase in growing individuals with cleft lip and palate after maxillary expansion. Conclusions: Intercondylar distance shows a tendency to increase after expansion regardless of the cleft phenotype. No differences were found in angulation and condylar position with the changes in occlusion resulting from maxillary expansion.

Assessment of the asymmetry of the lower jaw, face, and palate in patients with unilateral cleft lip and palate

Background:

This study aimed to assess the asymmetry of the lower jaw, face, and palate in patients with unilateral cleft lip and palate (UCLP) using photography, cone-beam computed tomography (CBCT), and digitized three-dimensional casts.

Methods:

This case–control study was conducted on photographic, CBCT, and digital cast records of 14 UCLP patients and 24 healthy controls between 10 and 16 years. Totally, 65 variables were measured on photographs, CBCT scans, and on digitized casts. Measurements were compared between the two groups and within each group between the two sides. For easier measurement, in patients who had right side CLP, the cleft was transferred to the left side and in subjects without cleft, mild chin deviation was transferred to the left side.

Results:

The anteroposterior dimensions of the two condyles in the UCLP group were greater than those in the control group, while the mediolateral dimensions of the left condyle and ramus height, mandibular body length, and total length of the mandible in the control group were greater than those in the UCLP group. Right ocular, nasal, and angular variables were greater in the UCLP group. Other variables except for the palatal width from the right canine to midline were greater in the control group.

Conclusion:

Our findings highlighted the presence of asymmetry in the nasal and palatal areas in patients with UCLP while these patients had no significant difference with healthy controls in the relationship of condyles with the temporomandibular fossa.

Vertical Facial Skeletal Asymmetry and Occlusal Cant Relationship in Patients With Unilateral Cleft Lip and Palate

OBJECTIVE

To evaluate the maxillary and mandibular vertical skeletal asymmetries, and the correlation between these asymmetries and occlusal cant in patients with unilateral cleft lip-palate (UCLP).

METHODS

Anteroposterior radiographs of 25 patients with UCLP (UCLP group, mean age: 20.98 ± 4.88 years) and 25 subjects without cleft (control group, mean age: 19 ± 2.86 years) were included. Independent samples t test, Mann-Whitney U test and Pearson correlation analysis were performed based on linear and angular measurements.

RESULTS

Lower facial horizontal asymmetry did not show statistically significant difference between the UCLP and control groups. However, vertical asymmetry of (a) the lateral cranial base (P = .014), (b) the nasomaxillary region (P < .001), (c) the maxillary dentoalveolus (P = .001), and (d) the lower face (P = .038) were all found to be significantly greater in UCLP group. The occlusal cant angle was also significantly greater in patients with UCLP compared to the controls (P = .016). While the occlusal cant angle was found to be correlated with the vertical asymmetry of the occlusal cant (r = 0.931, P < .001), maxillary cant angle was found to be correlated with the vertical asymmetry of the maxillary dentoalveolus (r = 0.655, P < .001).

CONCLUSIONS

There was no correlation between the occlusal cant and the vertical and horizontal skeletal asymmetries. Vertical asymmetries of the lower face and the medial cranial base were negatively correlated with the horizontal lower facial asymmetry.

Mandibular ramus height and condyle distance asymmetries in individuals with different facial growth patterns: a cone-beam computed tomography study

PURPOSE

This study aimed to quantify mandibular ramus height and condylar distances asymmetry indexes in adult patients with different vertical facial growth pattern using Cone Beam computed tomography (CBCT).

METHODS

An observational cross-sectional study was conducted by using CBCT of 159 patients (mean age 26.36 ± 5.32 years). Vistadent 3D^® software was used to determine the facial pattern in 3 groups (N = 53): hypodivergent, normodivergent and hyperdivergent-by Ricketts VERT index. Mandibular ramus height and the condylar linear distance in relation to the median sagittal plane were evaluated. The asymmetry index was calculated considering the right and left sides. Data were analyzed by generalized linear models and Tukey post-hoc test (α = 0.05).

RESULTS

Significantly lower values were found for the left and right mandibular ramus height in the hyperdivergent skeletal pattern (P < 0.05). There was no statistically significant difference for condylar and intercondylar distances among the facial groups (P > 0.05). Asymmetry indexes (mandibular ramus height and condylar distance) were similar, and no statistically significant differences were found among the skeletal patterns. In most subjects, the severity of mandibular ramus height asymmetry varied from light to not clinically significant independently of the facial type.

CONCLUSION

The findings suggest that vertical facial growth pattern not affected the asymmetry index of mandibular ramus height and the intercondylar distance. The results also demonstrated significantly shorter mandibular ramus height for the hyperdivergent skeletal pattern individuals.

Linear and Volumetric Mandibular Asymmetries in Adult Patients With Different Skeletal Classes and Vertical Patterns: A Cone-Beam Computed Tomography Study

This study aimed to quantify the height of the mandibular condyle and ramus, condylar volume, and the asymmetry index in adult patients of different sex, skeletal class and vertical pattern using Cone-Beam Computed Tomography (CBCT), and to determine whether there were differences between these groups. The study used CBCT scans of 159 patients with a mean age of 32.32 ± 8.31 years. InVivoDental® software was used to perform both linear (condylar, ramal, and total height) and condylar volume measurements. Linear and volumetric asymmetries were calculated. There were not significant differences between right and left sides. The mean value obtained for condyle height was 7.27 mm, ramus height 42.3 mm, total height 49.6 mm and condyle volume 1907.1 mm3, with significant differences between men and women. Significantly higher values were found for condylar volume in hypodivergent patterns (p = 0.001) and for the asymmetry index of the condylar volume in Class II patients (p < 0.05). The prevalence of relevant asymmetry was high for condyle height and volume (73.1% y 75.6% respectively). Higher height and volume values were found among men, Class III, and hypodivergent patients. Linear and volumetric asymmetries were more prevalent among men, Class III and hyperdivergent patterns.

Cone Beam Computed Tomographic Evaluation of Mandibular Asymmetry in Patients with Cleft Lip and Palate

Objective:

The purpose of the present study was to compare mandibular vertical asymmetry in patients with unilateral and bilateral cleft lip and palate and subjects with normal occlusion.

Materials and Methods:

Cone beam computed tomography scans of three groups consisting of 20 patients with unilateral cleft lip and palate, 20 patients affected by bilateral cleft lip and palate, and a control group of 20 subjects with normal occlusion were analyzed for this study. Condylar, ramal, and condylar plus ramal asymmetry indices were measured for all subjects using the method of Habets et al. Kruskal-Wallis and Mann-Whitney tests were used to determine any significant differences between the groups for all indices at the 95% level of confidence.

Results:

There were no significant differences regarding sex for all mandibular asymmetry indices in all three groups. All Asymmetry indices (condylar, ramal, and condylar plus ramal asymmetry) were significantly higher in the unilateral cleft group compared with the other two groups.

Conclusion:

Cone beam computed tomography images showed that patients with cleft lip and palate suffered from mandibular asymmetry. Subjects with unilateral cleft lip and palate had a more asymmetric mandible compared with the bilateral cleft lip and palate and control groups. Therefore, the mandible appears to be the leading factor in facial asymmetry in subjects with unilateral cleft lip and palate.

Cone-Beam Computed Tomography Analysis of the Nasopharyngeal Airway in Nonsyndromic Cleft Lip and Palate Subjects

Objective

To assess the nasopharyngeal airway volume, cross-sectional area, and depth in previously repaired nonsyndromic unilateral cleft lip and palate versus bilateral cleft lip and palate patients compared with noncleft controls using cone-beam computed tomography with the ultimate goal of finding whether cleft lip and palate patients are more liable to nasopharyngeal airway obstruction.

Design

A retrospective analysis comparing bilateral cleft lip and palate, unilateral cleft lip and palate, and control subjects. Significance at P ≤ .05.

Setting

Cleft Care Center and the outpatient clinic that are both affiliated with our faculty.

Participants

Cone-beam computed tomography data were selected of 58 individuals aged 9 to 12 years: 14 with bilateral cleft lip and palate and 20 with unilateral cleft lip and palate as well as 24 age- and gender-matched noncleft controls.

Variables

Volume, depth, and cross-sectional area of nasopharyngeal airway were measured.

Results

Patients with bilateral cleft lip and palate showed significantly larger nasopharyngeal airway volume than controls and patients with unilateral cleft lip and palate ( P < .001). Patients with bilateral cleft lip and palate showed significantly larger cross-sectional area than those with unilateral cleft lip and palate ( P < .001) and insignificant cross-sectional area compared with controls ( P > .05). Patients with bilateral cleft lip and palate showed significantly larger depth than controls and those with unilateral cleft lip and palate ( P < .001). Patients with unilateral cleft lip and palate showed insignificant nasopharyngeal airway volume, cross-sectional area, and depth compared with controls ( P > .05).

Conclusions

Unilateral and bilateral cleft lip and palate patients did not show significantly less volume, cross-sectional area, or depth of nasopharyngeal airway than controls. From the results of this study we conclude that unilateral and bilateral cleft lip and palate patients at the studied age and stage of repaired clefts are not more prone to nasopharyngeal airway obstruction than controls.

Evaluation of temporomandibular fossa and mandibular condyle in adolescent patients affected by bilateral cleft lip and palate using cone beam computed tomography

The purposes of this study were to investigate the position of the mandibular condyle and temporomandibular fossa between the adolescent patients affected by bilateral cleft lip and palate (BCLP) and well-matched controls without any cleft by using cone-beam computed tomography (CBCT). The study sample consisted of 17 patients (7 females and 10 males; mean age, 14.27 ± 2.83 years) affected by BCLP and 17 patients (6 females and 11 males; mean age, 14.27 ± 2.12 years) as age-and sex-matched control group without any cleft. Using cone-beam computed tomography segmented three-dimensional temporomandibular fossa and mandibular condyle images were reconstructed and angular, linear, and volumetric measurements of the patients in both sides of the groups were examined using Paired and Student's t-tests. Comparison of the sides showed that both sides were found to be similar in BCLP and control groups, except the condylar angulation of the right side was found to be higher compared to that of the left side in both groups (p < 0.05). Comparison of the groups showed that the patients affected by BCLP and non-cleft patients had similar values for all parameters, except for the condylar angulation in the right side (BCLP group had less angulation compared to controls; p < 0.05). The condylar volume was found to be slightly less in the BCLP group in both sides compared to the controls (p > 0.05). The positions of the mandibular condyle and temporomandibular fossa were found to be similar in patients affected by BCLP and control group of without any cleft. SCANNING 38:720-726, 2016. © 2016 Wiley Periodicals, Inc.

Cone Beam Computed Tomography Analysis of Oropharyngeal Airway in Preadolescent Nonsyndromic Bilateral and Unilateral Cleft Lip and Palate Patients

OBJECTIVE

The objective of this study was to assess the volume, area, and dimensions of the oropharyngeal airway (OPA) in a previously repaired nonsyndromic unilateral cleft lip and palate (UCLP) versus bilateral cleft lip and palate (BCLP) patients when compared with noncleft controls using cone beam computed tomography (CBCT).

DESIGN

This was a retrospective case-control study.

SETTING

The Cleft Care Center and outpatient clinic that are affiliated to our faculty were the settings for the study.

PARTICIPANTS

A total of 58 CBCT scans were selected of preadolescent individuals: 14 BCLP, 20 UCLP, and 24 age- and gender-matched noncleft controls.

VARIABLES

Variables were volume, cross-sectional area (CSA), midsagittal area (MSA), and dimensions of OPA.

STATISTICAL ANALYSIS

One-way analysis of variance and post hoc tests were used to compare variables. Statistical significance was set at P ≤ .05.

RESULTS

UCLP showed significantly smaller superior oropharyngeal airway volume than both controls and BCLP ( P ≤ .05). BCLP showed significantly larger CSA at soft palate plane and significantly larger MSA than both UCLP and controls ( P < .05).

CONCLUSIONS

UCLP patients at the studied age and stage of previously repaired clefts have significantly less superior oropharyngeal airway volume than both controls and BCLP patients. This confirms that preadolescents with UCLP are at greater risk for superior oropharyngeal airway obstruction when compared with those BCLP and controls. Furthermore, BCLP patients showed significantly larger CSA at soft palate plane and MSA than both controls and UCLP patients. These variations in OPA characteristics of cleft patients can influence function in terms of respiration and vocalization.

Are there any differences in mandibular morphology of patients with bisphosphonate-related osteonecrosis of jaws?: a case-control study

OBJECTIVES:

The aim of this study was to compare the morphological differences in the mandible between patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ) and healthy individuals and to detect the correlation between these parameters on panoramic radiography and CBCT.

METHODS:

The CBCT and panoramic images of patients with BRONJ (n = 32) and control groups (n = 32) were included in the study. All the comparisons were analyzed between the osteonecrosed and healthy sides of patients with BRONJ and control group. The panoramic radiographs were used to measure the values of the condyle angle, gonial angle, antegonial angle, antegonial depth, condylar height and ramal height. The mandibular cortical index (MCI) and bone quality index (BQI) were also examined on cross-sectional scans of CBCT images.

RESULTS:

There were significant differences in the MCI (p = 0.014) and BQI (p = 0.021) between the left and right side of the BRONJ group and also between the osteonecrosed side of the BRONJ and control group (p < 0.0001). No significant difference was found in other comparisons.

CONCLUSIONS:

The outcomes of the present study indicate that bisphosphonates influenced some internal morphological changes in the mandible. These changes may be a reason of BRONJ. But, these changes are not reflective of the measured values obtained using panoramic radiographs on the external morphology of the mandible.

Assessment of the Facial Soft Tissue Thickness of the Patients Affected by Unilateral Cleft Lip and Palate Using Cone Beam Computed Tomography

AIM

The aim of the study was to evaluate the soft tissue thickness of the patients affected by unilateral cleft lip and palate (UCLP) and to compare the findings with a matched control group without cleft using cone beam computed tomography (CBCT).

METHODS

The study sample consisted of 66 patients (31 women and 35 men) divided into 2 groups as UCLP group (34 patients; 23 men and 11 women; 9 right sided and 25 left sided; mean age: 14.11 ± 3.48 years) and control group (32 patients; 12 men and 20 women; mean age: 15.10 ± 3.13 years) without any cleft. Angular angle between Nasion-A line and Nasion-B line (ANB), angle between Sella-Nasion line and Gonion-Menton line (SN-MP) and linear (glabella, nasion, rhinion, subnasale, labrale superius, stomion, labrale inferius, labiomentale, pogonion, and gnathion) measurements were done using CBCT. Student t test was performed to compare the variables between the groups.

RESULTS

Soft tissue thickness values for men were higher in both groups, except for rhinion and glabella. Subnasale for women (P = 0.000), men (P = 0.006), and total samples (P = 0.000) and the variable of the labrale superius for men (P = 0.047) and total samples (P = 0.040) were found to be statistically significantly thinner in the UCLP group. SN-MP had significant affect on subnasale thickness (R = 15.8; Beta = -0.397; P = 0.001).

CONCLUSION

Thickness of the subnasale and the labrale superius were found to be statistically significantly thinner in the UCLP group compared with the controls.

Mandibular vertical asymmetry in adult orthodontic patients with different vertical growth patterns: A cone beam computed tomography study

OBJECTIVE

To evaluate condylar and ramal vertical asymmetry in adult orthodontic patients with different vertical growth patterns and a clinically normal sagittal skeletal pattern using cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

The study sample consisted of 101 adult orthodontic patients (48 men and 53 women) divided into three groups according to their vertical growth patterns: high- (33 patients; mean age, 25.06 ± 6.05 years), low- (34 patients; mean age, 24.88 ± 5.22 years), and normal-angle (34 patients; mean age, 24.14 ± 4.26 years) groups. Condylar, ramal, condylar plus ramal height, and index measurements were performed using CBCT images and analyzed using one-way analysis of variance and post hoc Tukey tests.

RESULTS

There was no statistically significant difference in height measurements between right and left sides in each group, except a slight difference of approximately 0.5 mm for condylar height (CH) in the low-angle group (P < .05). No statistically significant gender differences were found for the values (P > .05). In the high-angle group, the ramal height (RH) and condylar plus ramal height (CH + RH) on both sides were found to be less than those of the low- (P < .001) and normal-angle groups (P < .017 and P > .017, respectively), and the asymmetry index values were slightly higher than those of the low- and normal-angle groups (P > .05).

CONCLUSIONS

The high-angle group showed statistically significantly smaller values of RH and CH + RH on both sides and statistically insignificantly higher asymmetry index values than the low- and normal-angle groups.

Evaluation of the mandibular volume and correlating variables in patients affected by unilateral and bilateral cleft lip and palate: a cone-beam computed tomography study

OBJECTIVES

The aims of the present study were to evaluate the mandibular volume in patients affected by unilateral (UCLP) and bilateral cleft lip and palate (BCLP) and to compare the findings with a well-matched normal occlusion sample without cleft.

MATERIALS AND METHODS

The study sample consisted of 66 patients divided into UCLP (24 patients; mean age, 14.46 ± 3.24 years), BCLP (17 patients; mean age, 14.28 ± 2.85 years), and control (25 patients; mean age, 14.40 ± 2.81 years) groups. The volume of the mandible including the condyle and the roots of the teeth and craniofacial measurements were performed using cone-beam computed tomography and analyzed using the one-way variance analysis and post hoc Tukey's tests. Regression analyses were used to evaluate the relationships of the measurements and the mandibular volume.

RESULTS

Patients affected by UCLP and BCLP had similar craniofacial features (p > 0.05), including decreased SNB, Co-A, Co-Gn, Co-Go, and Go-Gn and increased ANB and SN-MP measurements compared to the control group. Both UCLP and BCLP groups had decreased values of mandibular volume compared to the normal occlusion group, while these differences were found to be statistically insignificant (p > 0.05). Co-Go (Beta = 0.420; p = 0.014) and Co-Gn variables (Beta = 0.708; p = 0.045) were positively correlated with mandibular volume, while SNB (Beta = -0.669; p = 0.044) and SN-MP (Beta = -0.358; p = 0.049) variables were negatively correlated (R (2) = 60.3 and p = 0.000).

CONCLUSION

Mandibular volume insignificantly differs in cleft patients (p > 0.05), and the variables of Co-Go, Co-Gn, SNB, and SN-MP significantly correlate with the volume.

CLINICAL RELEVANCE

This article investigates mandibular volume in patients affected by UCLP and BCLP that has never been investigated in the literature. The present study showed that both UCLP and BCLP groups had insignificantly decreased values of mandibular volume compared to the normal occlusion group.

Evaluation of dehiscence and fenestration in adolescent patients affected by unilateral cleft lip and palate: A retrospective cone beam computed tomography study

OBJECTIVE

To evaluate the presence of dehiscence and fenestration defects around anterior teeth in the cleft region and to compare these findings with the noncleft side in the same patients using cone beam computed tomography (CBCT).

MATERIALS AND METHODS

CBCT scans of 44 patients (26 males, 18 females; mean age, 14.04 ± 3.81 years) with unilateral cleft lip and palate (UCLP) were assessed to define dehiscences and fenestrations of the anterior teeth in both cleft and noncleft sides of the UCLP patients and a control group of noncleft patients (51 patients; 21 males, 30 females; mean age, 14.52 ± 1.16 years). Data were analyzed using Pearson's χ(2) and Student's t-test.

RESULTS

The prevalence of dehiscences at the maxillary central incisors, lateral incisors, and canines teeth were 43.2%, 70.6%, and 34.1% on the cleft side and 22.7%, 53.1%, and 27.3% on the noncleft side of UCLP patients, and 13.7%, 7.8%, and 13.7% in controls, respectively (statistically no difference between the sides of cleft patients). The cleft patients had a statistically significantly higher prevalence of dehiscences than did the controls on both the cleft and noncleft sides (P < .05), except for the maxillary central incisors. Fenestrations for these teeth were significantly more common on the cleft side in UCLP patients compared with controls (P < .05), whereas the difference for maxillary lateral incisors was not statistically significant.

CONCLUSIONS

Patients with UCLP showed a higher prevalence of dehiscence and fenestration defects around the maxillary anterior teeth.

Cone-Beam Computed Tomography Assessment of Lower Facial Asymmetry in Unilateral Cleft Lip and Palate and Non-Cleft Patients with Class III Skeletal Relationship

Introduction

To evaluate, using cone-beam computed tomography (CBCT), both the condylar-fossa relationships and the mandibular and condylar asymmetries between unilateral cleft lip and palate (UCLP) patients and non-cleft patients with class III skeletal relationship, and to investigate the factors of asymmetry contributing to chin deviation.

Methods

The UCLP and non-cleft groups consisted of 30 and 40 subjects, respectively, in mixed dentition with class III skeletal relationships. Condylar-fossa relationships and the dimensional and positional asymmetries of the condyles and mandibles were examined using CBCT. Intra-group differences were compared between two sides in both groups using a paired t-test. Furthermore, correlations between each measurement and chin deviation were assessed.

Results

It was observed that 90% of UCLP and 67.5% of non-cleft subjects had both condyles centered, and no significant asymmetry was found. The axial angle and the condylar center distances to the midsagittal plane were significantly greater on the cleft side than on the non-cleft side (P=0.001 and P=0.028, respectively) and were positively correlated with chin deviation in the UCLP group. Except for a larger gonial angle on the cleft side, the two groups presented with consistent asymmetries showing shorter mandibular bodies and total mandibular lengths on the cleft (deviated) side. The average chin deviation was 1.63 mm to the cleft side, and the average absolute chin deviation was significantly greater in the UCLP group than in the non-cleft group (P=0.037).

Conclusion

Compared with non-cleft subjects with similar class III skeletal relationships, the subjects with UCLP showed more severe lower facial asymmetry. The subjects with UCLP presented with more asymmetrical positions and rotations of the condyles on axial slices, which were positively correlated with chin deviation.

The effect of different concentrations of topical ozone administration on bone formation in orthopedically expanded suture in rats

BACKGROUND/OBJECTIVE

The aim of this study was to investigate the effects of different concentrations of ozone (O3) therapy on bone regeneration in response to an expansion of the inter-premaxillary suture in rats.

MATERIALS AND METHODS

Forty-eight Wistar rats were randomly divided into four groups (n = 12). In groups I, II, and III, 1ml of O3 at 10, 25, and 40 µg/ml was injected at the premaxillary suture, respectively. In group IV (control group), 1ml of saline solution was injected at the same point during the expansion procedure for 5 days. Bone regeneration in the suture was evaluated histomorphometrically. The area of new bone and fibrotic area, the number of osteoblasts and osteoclasts, and the amount of vascularity were measured and compared. The density of the newly formed bone in the expansion area was measured by using cone beam computed tomography. Data were analyzed using the Kruskal-Wallis one-way analysis of variance and post hoc Student-Newman-Keuls tests.

RESULTS

New bone area, fibrotic area, osteoblast and osteoclast numbers, and the amount of vascularity were significantly higher in experimental groups compared with the control group (P < 0.001). The density of newly formed bone (P < 0.001), new bone formation (P = 0.009), number of capillaries (P < 0.001), number of osteoclasts (P = 0.016), and number of osteoblasts (P < 0.001) in the maxillary sutures were highest in the 25 μg/ml O3 group compared with the other experimental groups and control group.

CONCLUSIONS/IMPLICATIONS

The application of O3 therapy can stimulate bone regeneration in an orthopedically expanded inter-premaxillary suture during both the expansion and retention periods.

Assessment of the soft tissue thickness at the lower anterior face in adult patients with different skeletal vertical patterns using cone-beam computed tomography

OBJECTIVE

To evaluate and compare the soft tissue thickness values at the lower anterior face among adult patients with different vertical growth patterns using cone-beam computed tomography.

MATERIAL AND METHODS

The study sample consisted of 105 adult patients (54 women and 51 men) with a normal sagittal skeletal pattern divided into three groups according to the vertical growth pattern: high-angle (women/men, 22/13; mean age, 24.54 ± 4.45 years), low-angle (women/men, 14/21; mean age, 24.62 ± 5.08 years), and normal-angle (women/men, 18/17; mean age, 24.22 ± 5.40 years) groups. The soft tissue thickness measurements at the lower anterior face in each group were done and analyzed using the one-way analysis of variance and Tukey tests.

RESULTS

Soft tissue thickness values were the lowest in the high-angle group for both women and men. For women, the thickness values at the labrale superius, labrale inferius, and pogonion were found to be statistically significantly smaller in the high-angle group (11.49 ± 1.05 mm, 12.70 ± 1.92 mm, and 11.64 ± 2.65 mm, respectively) compared with the values in the normal-angle group (13.31 ± 2.01 mm, 15.08 ± 1.94 mm, and 14.69 ± 3.08 mm, respectively) (P < .05, P < .05, and P < .01, respectively). For men, however, no statistically significant differences were found among the vertical growth patterns (P > .05).

CONCLUSION

Women had statistically significantly thinner thickness at the labrale superius, labrale inferius, and pogonion in the high-angle group compared with the normal-angle group.

Assessment of the alveolar bone support of patients with unilateral cleft lip and palate: a cone-beam computed tomography study

OBJECTIVE

To assess the bone support of the teeth adjacent to a cleft using cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

The CBCT scans of 31 patients with unilateral cleft lip and palate (UCLP) were assessed. The data for teeth neighboring the cleft were compared with those of contralateral noncleft teeth. For each tooth analyzed, the distance between the cementoenamel junction (CEJ) and the bone crest (AC) at the buccal side was measured as was the thickness of the buccal bone level at 0, 1, 2, and 4 mm.

RESULTS

The bone thicknesses of the central teeth at the cleft region at the crest and 2 mm apically were statistically significantly thinner than that of the central incisor at a noncleft region. The CEJ-AC distance for central teeth at the cleft region was higher than that for central teeth in a noncleft region.

CONCLUSIONS

Subjects with UCLP showed reduced bone support at teeth neighboring the cleft compared with controls. This may cause some problems during orthodontic treatment.

Facial soft-tissue thickness in patients affected by bilateral cleft lip and palate: a retrospective cone-beam computed tomography study

INTRODUCTION

The purposes of this study were to evaluate the facial soft-tissue thicknesses and craniofacial morphologies of patients affected by bilateral cleft lip and palate (BCLP) and to compare the findings with a well-matched control group without any clefts using cone-beam computed tomography.

METHODS

The study sample consisted of 40 retrospectively and randomly selected patients divided into 2 groups: a BCLP group (20 patients; mean age, 13.78 ± 3.20 years) and an age- and sex-matched control group without clefts (20 patients; mean age, 13.94 ± 2.52 years). Craniofacial and facial soft-tissue thickness measurements were made with cone-beam computed tomography. The Student t test and multiple linear regression analyses were performed for the statistical evaluations.

RESULTS

The BCLP group had an increased SN-MP angle (P = 0.003), a decreased Co-A (P = 0.000), and retruded maxillary (P = 0.000) and mandibular (P = 0.026) incisors. In addition, patients affected by BCLP had statistically significantly decreased thickness measurements for the variables subnasale (P = 0.005) and labrale superior (P = 0.026) compared with the controls. The most predictive variables were found at U1-SN (r = 0.417, P = 0.004), IMPA (r = 0.368, P = 0.010), and ANB (r = -0.297, P = 0.031) for subnasale and U1-SN (r = 0.284, P = 0.038) for labrale superior.

CONCLUSIONS

The BCLP group showed greater vertical growth, greater retrusion of the maxilla and the maxillary and mandibular incisors, and decreased subnasale and labrale superior thicknesses compared with the well-matched controls without clefts. These differences should be taken into account when planning orthodontic and orthognathic surgery treatment for those patients.

Evaluation of mandibular transverse widths in patients affected by unilateral and bilateral cleft lip and palate using cone beam computed tomography

OBJECTIVE

To evaluate the mandibular dental, alveolar, and skeletal transversal widths in patients affected by unilateral (UCLP) and bilateral (BCLP) cleft lip and palate and to compare the findings with a well-matched normal occlusion sample using cone beam computed tomography images.

MATERIALS AND METHODS

The study sample consisted of 75 patients divided into three groups: the UCLP (29 patients; mean age: 15.40 ± 3.22 years), BCLP (18 patients; mean age: 15.54 ± 3.72 years), and normal occlusion (28 patients; mean age: 15.82 ± 2.11 years) groups. Mandibular dental (intercanine and -molar), alveolar (intercanine and -molar), and skeletal (bigonial width) transversal measurements were performed three-dimensionally and analyzed using the one-way variance analysis and post hoc Tukey tests.

RESULTS

Patients affected by UCLP and BCLP had statistically significantly lower intercanine alveolar widths (P < .05 and P < .001, respectively) and larger intermolar (P < .001 and P < .05, respectively) and intermolar alveolar widths (P < .001) compared with the normal occlusion group. Furthermore, the patients affected by UCLP and BCLP had similar mandibular dental, alveolar, and skeletal transversal widths (P > .05).

CONCLUSION

The UCLP and BCLP groups showed statistically significantly smaller values for intercanine alveolar widths and larger values for intermolar dental and alveolar widths compared with the normal occlusion group. This shows the importance of using individualized archwires according to the pretreatment arch widths of the patients affected by UCLP and/or BCLP.

Three-dimensional evaluation of the pharyngeal airway volumes in patients affected by unilateral cleft lip and palate

INTRODUCTION

Patients affected by cleft lip and palate often have complaints of snoring and respiratory difficulties during sleep. The purposes of this study were to evaluate nasopharyngeal, oropharyngeal, and total airway volumes of patients affected by unilateral cleft lip and palate and to compare them with a well-matched control group without unilateral cleft lip and palate using cone-beam computed tomography.

METHODS

The study sample consisted of 60 patients (26 girls, 34 boys) divided into 2 groups: unilateral cleft lip and palate (20 boys, 10 girls; 8 right sided, 22 left sided; mean age, 14.6 ± 3.2 years) and no cleft (control group; 14 boys, 16 girls; mean age, 14.8 ± 2.8 years). Nasopharyngeal, oropharyngeal, and total airway volumes of the subjects in both groups were calculated 3 dimensionally with cone-beam computed tomography. Group differences in relation to cleft side, sex, and cleft presence were statistically tested at P <0.05.

RESULTS

Patients affected by unilateral cleft lip and palate had similar airway volumes regardless of the side of the cleft. In addition, no statistically significant differences were found between the sexes in the 2 groups. Patients affected by unilateral cleft lip and palate had smaller nasopharyngeal, oropharyngeal, and total airway volumes when compared with the control group. The difference for oropharyngeal airway volume (-4036.7 mm(3)) was statistically significant (P <0.05), whereas nasopharyngeal volume (-21.6 mm(3)) and total airway volume (-4057.3 mm(3)) differences were not significant (P >0.05).

CONCLUSIONS

Patients affected by unilateral cleft lip and palate had decreased volumes of oropharyngeal (P <0.05) and total (P >0.05) airways compared with the well-matched control group without unilateral cleft lip and palate.

Assessment of pharyngeal airway volume in adolescent patients affected by bilateral cleft lip and palate using cone beam computed tomography

OBJECTIVE

To test the null hypothesis that there were no significant differences for pharyngeal airway volumes between the adolescent patients affected by bilateral cleft lip and palate (BCLP) and well-matched controls using cone beam computed tomography.

MATERIALS AND METHODS

The study sample consisted of 16 patients (11 female and 5 male; mean [SD] age 14.1 [2.1] years) affected by BCLP and 16 patients (10 female and 6 male; mean [SD] age 13.4 [2.0] years) as age- and sex-matched control group. Craniofacial measurements and pharyngeal airway dimension, area, and volume measurements of patients in both groups were calculated and statistically examined using Student's t-test and multiple linear regression analyses.

RESULTS

Statistically significant differences were found between the BCLP and control groups for SNB (P < .05), SN-GoGn (P < .05), Co-A (P < .05), PAS (P < .01), minAx (P < .01), and oropharyngeal airway volume (P < .05). The most predictive variables for oropharyngeal airway volume were found as PAS (r  =  .655 and P  =  .000) and minAx (r  =  .787 and P  =  .000).

CONCLUSIONS

The null hypothesis was rejected. Oropharyngeal (P < .05) and total (P > .05) airway volumes were found to be less in the BCLP group, and thus the treatment choice in these patients should have positive effects on the pharyngeal airway.