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Sahni V, Grover V, Sood S, Jain A. The Periodontal Status of Orofacial Cleft Patients: A Systematic Review and Meta-Analysis. Cleft Palate Craniofac J 2024; 61:302-318. [PMID: 36130097 DOI: 10.1177/10556656221127549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cleft lip and/or palate is the most commonly documented orofacial anomaly and may impact the status of health and disease of adjacent teeth along with their associated supporting structures. The authors performed a systematic review and meta-analysis to assess whether the presence of clefts altered the periodontal status of patients. The study was registered in PROSPERO (CRD42020210178). A systematic search of literature was performed utilizing unique search strings for PubMed, Scopus, and GoogleScholar as databases including gray literature from April 28, 2020 to October 3, 2020. Cross-sectional and longitudinal human studies published in the English language, providing information about periodontal disease and its association with cleft lip, alveolus, and palate. Periodontal outcome measures such as gingival index (GI), clinical attachment level (CAL), plaque index (PI), periodontal probing depth (PPD), and bleeding on probing (BOP) were utilized as the main outcome measures. Patients with clefts were predisposed to poorer periodontal outcomes. Subgroup analysis revealed compromised periodontal measures for clefts as compared to control sites without cleft which were statistically significant in terms of GI [Z = 2.44, P = .01], CAL [Z = 2.52, P = .01], PI [Z = 2.76, P = .006] and not statistically significant for PPD [Z = 0.27, P = .79] and BOP [Z = 1.47, P = .14]. Within the limitations of the review, the authors conclude that the presence of orofacial clefts may predispose to periodontal compromise when compared to normal controls. The GRADE rating was moderate.
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Affiliation(s)
- Vaibhav Sahni
- Department of Periodontics, Dr. Harvansh Singh Judge Institute of Dental Sciences & Hospital, Panjab University, Chandigarh, India
| | - Vishakha Grover
- Department of Periodontics, Dr. Harvansh Singh Judge Institute of Dental Sciences & Hospital, Panjab University, Chandigarh, India
| | - Shaveta Sood
- Department of Periodontics, Dr. Harvansh Singh Judge Institute of Dental Sciences & Hospital, Panjab University, Chandigarh, India
| | - Ashish Jain
- Department of Periodontics, Dr. Harvansh Singh Judge Institute of Dental Sciences & Hospital, Panjab University, Chandigarh, India
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Molnár B, Würsching T, Sólyom E, Pálvölgyi L, Radóczy-Drajkó Z, Palkovics D, Nagy K. Alveolar cleft reconstruction utilizing a particulate autogenous tooth graft and a novel split-thickness papilla curtain flap - A retrospective study. J Craniomaxillofac Surg 2024; 52:77-84. [PMID: 37926606 DOI: 10.1016/j.jcms.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 09/20/2023] [Accepted: 10/15/2023] [Indexed: 11/07/2023] Open
Abstract
During secondary alveolar cleft grafting, the use of autogenous cancellous bone harvested from the iliac crest is still considered the gold standard. Due to the risk of donor-site morbidity and excessive graft resorption, alternative grafting materials (e.g. intraoral bone, xenografts) have been tested. Autogenous tooth bone graft (ATB) is a novel material derived from extracted teeth. ATB has successfully been used in pre-prosthetic and periodontal surgery for hard-tissue reconstruction. Seven patients with unilateral cleft lip and palate were treated with ATB, using their own deciduous teeth for grafting. Defects were accessed utilizing a novel split-thickness papilla curtain flap. Cone-beam computed tomography scans were taken prior to and 3 months following cleft surgery to assess graft integration, graft stability, and the volume of the newly formed hard tissues. Hard-tissue gain, as measured at the 3-month follow-up, averaged 0.65 cm3 ± 0.26 cm3. Results showed acceptable graft integration and stability at the 3-month follow-up, with no adverse effects or excessive resorption of the graft. The use of ATB might be a feasible alternative for alveolar cleft grafting. However, long-term studies using a large sample size are required to derive further conclusions.
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Affiliation(s)
- Bálint Molnár
- Department of Periodontology, Semmelweis University, Budapest, Hungary
| | - Tamás Würsching
- Centre for Facial Reconstruction, Department of Pediatrics, Semmelweis University Budapest, Hungary; Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University, Budapest, Hungary.
| | - Eleonóra Sólyom
- Department of Periodontology, Semmelweis University, Budapest, Hungary
| | - Laura Pálvölgyi
- Centre for Facial Reconstruction, Department of Pediatrics, Semmelweis University Budapest, Hungary
| | | | - Dániel Palkovics
- Department of Periodontology, Semmelweis University, Budapest, Hungary
| | - Krisztián Nagy
- Centre for Facial Reconstruction, Department of Pediatrics, Semmelweis University Budapest, Hungary; Cleft and Craniofacial Centre, Division of Maxillo-Facial Surgery, General Hospital St. Jan, Bruges, Belgium; OMFS-IMPATH Research Group, Faculty of Medicine, Department of Imaging AndPathology, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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Gillgrass T. The orthodontic management of patients with cleft lip and palate: from the permanent dentition and the adult returning to the service. Br Dent J 2023; 234:892-898. [PMID: 37349437 DOI: 10.1038/s41415-023-5956-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/09/2023] [Accepted: 03/18/2023] [Indexed: 06/24/2023]
Abstract
This is the second of two papers outlining the orthodontic management of patients with cleft lip and palate. The first paper reviewed orthodontic input into children with cleft lip and palate from birth to the late mixed dentition before definitive orthodontics. In this second paper, I will discuss tooth management across the grafted cleft site and its impact on the bone graft itself. I will also discuss the some of the challenges of the adult patient returning to the service.
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Affiliation(s)
- Toby Gillgrass
- Cleft Surgical Service for Scotland & Glasgow Dental Hospital and School, Glasgow, United Kingdom.
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Wu Q, Li Z, Zhang Y, Peng X, Zhou X. Dental caries and periodontitis risk factors in cleft lip and palate patients. Front Pediatr 2022; 10:1092809. [PMID: 36683789 PMCID: PMC9846248 DOI: 10.3389/fped.2022.1092809] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/09/2022] [Indexed: 01/06/2023] Open
Abstract
Cleft lip and palate (CLP) is the most common congenital facial malformation and has a significant developmental, physical, and psychological impact on those with the deformity and their families. Risk factors contributing to CLP may conclude as genetic factors and environmental factors. The anatomical and morphological abnormalities related to CLP are favorable for dental plaque accumulation on the tooth surface. Therefore, patients with CLP undergo poorer oral hygiene and higher susceptibility to dental caries and periodontitis. In this review, we aim to conclude and update probable causes underlying the association between CLP and poor oral health and provide novel ideas of targeted early prevention for such oral diseases.
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Affiliation(s)
- Qinrui Wu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhengyi Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yixin Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xian Peng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.,Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Iurovschi R, Joaquim CR, de Faveri M, de Miranda TS, Feres M, de Figueiredo LC. Evaluation of the Microbiological Profile of Alveolar Residual Screws and Cleft-Adjacent Teeth in Individuals With Complete Unilateral Fissures. Cleft Palate Craniofac J 2020; 57:1182-1189. [PMID: 32748644 DOI: 10.1177/1055665620945568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the microbiota profile of residual alveolar slits and teeth adjacent to the cleft in fissured individuals. DESIGNS This study used a cross-sectional design. PARTICIPANTS Twenty individuals, aged 14 to 24 years, who had a residual fissure in the maxillary alveolar ridge region were selected. MAIN OUTCOME MEASURES Three sites per individual were selected for microbiological collection (the site of the residual cleft and the 2 nearest teeth). The samples were analyzed using the Checkerboard DNA-DNA hybridization technique for 73 species of bacteria. RESULTS All the species analyzed were found in the 2 niches (slits and teeth). The bacterial species present in the largest number in the residual cracks were Prevotella melaninogenica, Prevotella nigrescens, and Streptococcus mitis. With regard to the bacterial profiles in the mesial and distal faces, the most prevalent species were P nigrescens, Veillonella parvula, and Fusobacterium nucleatum sp vicentii. The analysis of all the collected samples demonstrated very similar profiles for the mesial and distal faces, with these 2 sites even presenting the same species in greater frequencies. Higher counts of 20 bacterial species (Wilcoxon test) were observed in the dental niche, in relation to the fissure, particularly, P nigrescens, V parvula, F nucleatum sp vicentii, and Neisseria mucosa. CONCLUSION Some species were significantly more prevalent in the residual alveolar fissures and in adjacent teeth. The comparison between the profiles of the 2 niches demonstrated large differences in the most frequent species in the teeth, and no qualitative differences with regard to specific pathogens.
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Affiliation(s)
- Ronaldo Iurovschi
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - Claudia Regina Joaquim
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - Marcelo de Faveri
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
| | | | - Magda Feres
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
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Jabbari F, Wiklander L, Reiser E, Thor A, Hakelius M, Nowinski D. Secondary Alveolar Bone Grafting in Patients Born With Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2017; 55:173-179. [DOI: 10.1177/1055665617726999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To identify factors of oral health important for the final outcome, after secondary alveolar bone grafting in patients born with unilateral cleft lip and palate and compare occlusal radiographs with cone beam computed tomography (CBCT) in assessment of alveolar bone height. Design: Observational follow-up study. Setting: Cleft Lip and Palate Team, Craniofacial Center, Uppsala University Hospital, Sweden. Patients: 40 nonsyndromic, Caucasian patients with unilateral complete cleft lip and palate. Interventions: Clinical examination, CBCT, and occlusal radiographs. Main Outcome Measurements: Alveolar bone height was evaluated according to Bergland index at a 20-year follow-up. Results: The alveolar bone height in the cleft area was significantly reduced compared to a previously reported 10-year follow-up in the same cohort by total ( P = .045) and by subgroup with dental restoration ( P = .0078). This was positively correlated with the gingival bleeding index (GBI) ( r = 0.51, P = .0008) and presence of dental restorations in the cleft area ( r = 0.45, P = .0170). There was no difference in the Bergland index generated from scoring the alveolar bone height on occlusal radiographs as with the equivalent index on CBCT. Conclusion: Patients rehabilitated with complex dental restoration seems to be at higher risk for progression of bone loss in the cleft area. Supportive periodontal therapy should be implemented after complex dental restorations in cleft patients. Conventional occlusal radiographs provide an adequate image for evaluating postoperative bone height in clinical follow-up.
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Affiliation(s)
- Fatemeh Jabbari
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
- Department of Surgical Sciences, Oral and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden
| | - Laila Wiklander
- Department of Oral and maxillofacial radiology, Specialist Dental Care, Public Dental Health Service, Eastman Institute, Stockholm
| | - Erika Reiser
- Department of Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Andreas Thor
- Department of Orthodontics, Public Dental Health, Uppsala County Council, Uppsala, Sweden
| | - Malin Hakelius
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Daniel Nowinski
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
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Nkenke E, Vairaktaris E, Schlittenbauer T, Eitner S. Masticatory Rehabilitation of a Patient with Cleft Lip and Palate Malformation Using a Maxillary Full-Arch Reconstruction with a Prefabricated Fibula Flap. Cleft Palate Craniofac J 2016; 53:736-740. [DOI: 10.1597/15-051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
For full-arch reconstruction of an atrophied cleft maxilla with missing premaxilla, a prefabricated microvascular free bony flap is a relevant option. A fibula flap was prefabricated in a cleft patient who received six dental implants and an epithelial layer. Six weeks later, maxillary reconstruction was performed. The inpatient period could be confined to 2 weeks. A fixed provisional prosthesis was delivered after an additional 2 weeks. A prefabricated flap allows for the reduction of the interval without a dental prosthesis to only a few weeks, even when a complex full-arch reconstruction of the maxilla is required.
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Affiliation(s)
- Emeka Nkenke
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
| | - Elefterios Vairaktaris
- Department of Oral and Maxillofacial Surgery, University of Athens Medical School, Attikon Hospital, Athens, Greece
| | - Tilo Schlittenbauer
- Department of Oral and Maxillofacial Surgery, Erlangen University Hospital, Erlangen, Germany
| | - Stephan Eitner
- Department of Prosthodontics, Erlangen University Hospital, Erlangen, Germany
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Metgud R, Kumar A, Bhat K. Isolated cleft lip with generalized aggressive periodontitis: A rare entity. J Indian Soc Periodontol 2015; 19:88-92. [PMID: 25810600 PMCID: PMC4365165 DOI: 10.4103/0972-124x.145825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 05/15/2014] [Indexed: 12/03/2022] Open
Abstract
Oro-facial clefts are one of the most common birth defects and may be associated with other genetic anomalies. Aggressive periodontitis is a rare condition that progresses rapidly, but affects only a small percentage of the population. Most of the cases of aggressive periodontitis are familial. Even though, literature has documented the association of various genetic disorders with aggressive periodontitis, the aggressive periodontitis in patients with isolated cleft lip (CL) have never been addressed. Here, we report a rare case of isolated CL with generalized aggressive periodontitis. The concomitant presentation of isolated CL with aggressive periodontitis in an individual has clinical significance for multi-disciplinary care.
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Affiliation(s)
- Renuka Metgud
- Department of Periodontics, KLE University, Belgaum, Karnataka, India
| | - Ajay Kumar
- Department of Periodontics, KLE University, Belgaum, Karnataka, India
| | - Kishore Bhat
- KLE Dr. Prabhakar Kore Basic Science Research Centre, KLE VK Institute of Dental Sciences, KLE University, Belgaum, Karnataka, India
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Ercan E, Celikoglu M, Buyuk SK, Sekerci AE. Assessment of the alveolar bone support of patients with unilateral cleft lip and palate: a cone-beam computed tomography study. Angle Orthod 2015; 85:1003-8. [PMID: 25650761 DOI: 10.2319/092614-691.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Esra Ercan
- a Assistant Professor, Department of Periodontology, Karadeniz Technical University, Trabzon, Turkey
| | - Mevlut Celikoglu
- b Associate Professor, Department of Orthodontics, Akdeniz University, Antalya, Turkey
| | | | - Ahmet Ercan Sekerci
- d Assistant Professor, Department of Oral and Maxillofacial Radiology, Erciyes University, Kayseri, Turkey
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Abstract
This review highlights current issues in the provision of restorative dentistry both in primary and secondary care settings. Current challenges in the provision of restorative procedures are reviewed and methods in improving care and efficiency are proposed. Possible changes to the infrastructure and delivery of care are suggested in order to improve effectiveness and the patient pathway.
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Alani A. Cleft pathways. Br Dent J 2011; 210:463. [DOI: 10.1038/sj.bdj.2011.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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