Incisor and molar overjet, arch contraction, and molar relationship in the mixed dentition in repaired complete unilateral cleft lip and palate: A qualitative and quantitative appraisal

The Impact of Fan-Type Rapid Palatal Expanders on Speech in Patients With Unilateral Cleft Lip and Palate

Rapid palatal expanders (RPEs) are commonly used in patients with cleft lip and palate (CLP) prior to secondary alveolar bone grafting (SABG). Their position and size can impede tongue movement and affect speech. This study assessed changes in perception and production of speech over the course of RPE treatment.

Prospective longitudinal.

Tertiary university-affiliated hospital.

Twenty-five patients with unilateral CLP treated with Fan-type RPEs, and their parents.

Patient and parent speech questionnaires and patient speech recordings were collected at baseline before RPE insertion (T1), directly after RPE insertion (T2), during RPE expansion (T3), during RPE retention (T4), directly after RPE removal but before SABG (T5), and at short-term follow-up after RPE removal and SABG (T6).

Ratings for patient and parent questionnaires, first (F1) and second (F2) formants for vowels /a/, /i/, and /u/, and nasalance scores for non-nasal and nasal sentences, were obtained and analyzed using mixed model analyses of variance.

Ratings worsened at T2. For the vowel /a/, F1 and F2 were unchanged at T2. For the vowel /i/, F1 increased and F2 decreased at T2. For the vowel /u/, F1 was unchanged and F2 decreased at T2. Nasalance was unchanged at T2. All outcome measures returned to T1 levels by T4.

RPE insertion resulted in initial adverse effects on speech perception and production, which decreased to baseline prior to removal. Information regarding transient speech dysfunction and distress may help prepare patients for treatment.

Two-Dimensional Analysis of Digital Images through Vector Graphic Editors in Dentistry: New Calibration and Analysis Protocol Based on a Scoping Review

This review was carried out to analyse the functions of three Vector Graphic Editor applications (VGEs) applicable to clinical or research practice, and through this we propose a two-dimensional image analysis protocol in a VGE. We adapted the review method from the PRISMA-ScR protocol. Pubmed, Embase, Web of Science, and Scopus were searched until June 2020 with the following keywords: Vector Graphics Editor, Vector Graphics Editor Dentistry, Adobe Illustrator, Adobe Illustrator Dentistry, Coreldraw, Coreldraw Dentistry, Inkscape, Inkscape Dentistry. The publications found described the functions of the following VGEs: Adobe Illustrator, CorelDRAW, and Inkscape. The possibility of replicating the procedures to perform the VGE functions was analysed using each study’s data. The search yielded 1032 publications. After the selection, 21 articles met the eligibility criteria. They described eight VGE functions: line tracing, landmarks tracing, linear measurement recording, angular measurement recording, image calibration, image overlay, file transfer, and vector graphics development. The features offered by the VGEs bring great precision and objectivity to two-dimensional image analysis. The image analysis and editing procedures are currently not protocolised. Thus, a protocol for image calibration and measurement recording is proposed in order to guarantee the protocol’s replication.

Association between speech and dental occlusion changes in children with cleft lip and palate and time of primary plastic surgeries

ABSTRACT Purpose: to describe the changes in speech and dental occlusion in children with cleft lip and palate and verify their association with each other and with the time of primary plastic surgeries. Methods: a cross-sectional study with collected data on the subjects’ identification, age at the time of primary surgeries, and clinical assessment of speech and dental occlusion. The chi-square test, Fisher's exact test, and t-test were used to verify the associations between the variables at the 5% significance level (p < 0.05). Results: the sample comprised 11 children aged 6 to 10 years, most of whom were males, self-reported white, with trans-incisive foramen cleft, predominantly on the left side. The mean age at lip repair surgery was 6 months, and 13 months at palatoplasty. Among the main dental occlusion changes, posterior and anterior crossbite stood out. All the subjects presented changed speech, with a prevalence of cases with dentoalveolar and palatine deformities, followed by passive and active changes. Subjects with anterior crossbite tended to have undergone primary lip repair surgery at a mean of four months earlier than the subjects without anterior crossbite. Conclusions: the associations between speech and dental occlusion changes, and between these and the time of primary plastic surgeries were not statistically significant. Even though it is known that early lip repair surgery is ideal to favor oral functions and aesthetics, the results revealed a tendency towards anterior crossbite, in these subjects.

Frontal and Axial Evaluation of Craniofacial Morphology in Repaired Unilateral Cleft Lip and Palate Patients Utilizing Cone Beam Computed Tomography; An Observational Study

The current study was conducted to assess the extent of maxillary arch collapse on the cleft vis-a-vis non-cleft sides in the same individual presenting withunilateral cleft lip and palate (UCLP), using cone-beam computed tomography (CBCT). Thirty-one children (eighteen boys andthirteen girls) with surgically repaired UCLP, who met the inclusion criteria, were selected. Following the acquisition of CBCT scans, fourteen bilateral landmarks were selected. The distance of the bilateral landmark was calculated from the midsagittal plane on the cleft and non-cleft sides for both frontal and axial views. Tracings were done;the data obtained was subjected to statistical analysis;and intra-observer variability was checked with intraclass correlation coefficient (ICC) and two-way ANOVA. Subsequently, the measurements were subjected to paired t-tests at the 95% level of significance with Bonferroni correction. A significant reduction of pyriforme and an alveolar crest above the maxillary 1st molar were discerned in frontal analysis on the cleft side. In the axial view, the zygomatic arch, malar, porion and alveolar crest at the molar region were non-significant, but the alveolar crest at the premolar region (p < 0.004)) was significantly decreased. In the frontal analysis, pyriforme and the alveolar crest above the maxillary 1st molar, and, in the axial view, premolar widths, showed significant reduction when comparing the cleft vis-a-vis non-cleft sides.

Predictive factors for canine position in patients with unilateral cleft lip and palate

OBJECTIVES

The aims were to compare cleft and non-cleft canine position, to find predictive factors for canine position and to assess surgically exposed canines.

MATERIALS/METHODS

One hundred forty-eight individuals, born 1978-2005, with total unilateral cleft lip and palate (including Simonart's band <5 mm) treated in Gothenburg, were included. Canine angulation as well as vertical and horizontal position were assessed on panoramic radiographs (PAN) taken at the age of 10. Plausible predictive factors were registered from PAN, cast models and medical records. Data on spontaneous eruption or surgical exposure were available for 88 patients. Cleft- and non-cleft side was compared using paired t-test and Fisher's exact test. Multiple stepwise regression analysis and logistic regression analysis were used to detect possible predictors for cleft canine position.

RESULTS

The cleft canine angulation was 29.3 ± 13.1 degrees (mean ± standard deviation) versus 7.6 ± 8.2 degrees on the non-cleft side (p < 0.001). Cleft canines were higher positioned and located closer to the midline compared to non-cleft canines (p < 0.001). Age for both hard palate closure and bone grafting, cleft lateral agenesis as well as transposition were associated with canine position. Cleft canines that required surgical exposure (28%) had an increased angulation and were higher positioned than spontaneously erupted canines (p < 0.001).

LIMITATIONS

The shortcomings were the retrospective design and incomplete assessment of the buccal-palatal canine position on 2D images.

CONCLUSIONS/IMPLICATIONS

With increased age for bone grafting, decreased age for hard palate closure and transposition, an association with abnormal canine position was found. A rigorous monitoring of cleft canine eruption is, therefore, advocated.

Craniofacial Analysis May Indicate Co-Occurrence of Skeletal Malocclusions and Associated Risks in Development of Cleft Lip and Palate

Non-syndromic orofacial clefts encompass a range of morphological changes affecting the oral cavity and the craniofacial skeleton, of which the genetic and epigenetic etiologic factors remain largely unknown. The objective of this study is to explore the contribution of underlying dentofacial deformities (also known as skeletal malocclusions) in the craniofacial morphology of non-syndromic cleft lip and palate patients (nsCLP). For that purpose, geometric morphometric analysis was performed using full skull cone beam computed tomography (CBCT) images of patients with nsCLP (n = 30), normocephalic controls (n = 60), as well as to sex- and ethnicity- matched patients with an equivalent dentofacial deformity (n = 30). Our outcome measures were shape differences among the groups quantified via principal component analysis and associated principal component loadings, as well as mean shape differences quantified via a Procrustes distance among groups. According to our results, despite the shape differences among all three groups, the nsCLP group shares many morphological similarities in the maxilla and mandible with the dentofacial deformity group. Therefore, the dentoskeletal phenotype in nsCLP could be the result of the cleft and the coexisting dentofacial deformity and not simply the impact of the cleft.

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

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.