Dental arch dimensions in patients with unilateral cleft lip and palate

In this investigation, dental arch dimensions during different ages were studied in 72 children with unilateral cleft of the lip, alveolar process, and palate and were compared with those of normal children. All the children with clefts were treated surgically by surgeons of the Lancaster Cleft Palate Clinic. The dental arch dimensions were studied with the use of dental casts during the time of full deciduous dentition (3 to 4 years of age), mixed dentition (8 to 9 years of age), and permanent dentition (12 years of age). The major findings were: (1) all maxillary interdental widths and lengths were significantly smaller than the normal dimensions at all ages, except for intermolar width at age 12 years; and (2) the mandibular arch dimensions seemed to be related to changes in the maxillary arch; however, the influence of surgical procedures in the maxillary arch is not reflected severely in mandibular arch dental position.     

The influence of unilateral cleft lip and palate on maxillary dental arch morphology.

A sample of 97 untreated cleft lip and palate adult patients, with and without Simonart's band, was analyzed. The dimensions and form of the maxillary dental arches were analyzed. Comparison of this sample with a "normal" group indicated maxillary dental arch size and shape are distorted by the presence of a cleft which is characterized by a constriction that becomes more severe in the medial and anterior regions. The presence of Simonart's band affects the cleft arch form, redirecting the anterior extremity of the major segment towards the minor segment.     

Quantitative 3D maxillary arch evaluation of two different infant managements for unilateral cleft lip and palate.

OBJECTIVE: A two-institution retrospective study was undertaken to determine whether two different prepalatoplasty protocols quantitatively affect maxillary arch morphology in infants with complete unilateral cleft lip and palate (UCLP). DESIGN: Serial maxillary dental casts, obtained at regular intervals through the first 18 months of life from preintervention until palatoplasty were evaluated quantitatively using computer-assisted three-dimensional digitization and analysis for three populations: institution 1 (protocol 1), institution 2 (protocol 2), and unaffected individuals (neither cleft nor treatment). Sequential UCLP patients from institution 1 were matched for age and initial alveolar cleft width, sex and cleft side having been demonstrated to be nonsignificant, with UCLP patients from institution 2 and to unaffected individuals for age for the analysis. SETTING: Both treatment institutions are well-established regional interdisciplinary cleft centers. Institution 1 is located in a tertiary, academic children's hospital in a metropolis within a primarily agrarian region of the Midwest; institution 2 is a freestanding private clinic located in a small city within a primarily agrarian region of an eastern state; the unaffected population is a historic archive acquired in the 1930s. Data acquisition (model digitization) and computer processing were performed at institution 1. PATIENTS: Eighty-five casts of 28 infants from institution 1, 106 casts of 31 infants from institution 2, and 68 casts of 29 unaffected infants were analyzed. All infants had alginate impressions taken prior to intervention and at several additional 6-month intervals after that, consistent with each institution's treatment protocol. INTERVENTIONS: At institution 1, patients with UCLP underwent lip adhesion and placement of a passive alveolar molding plate at 7 weeks of age, definitive cheiloplasty at 7 months of age, and one-stage palatoplasty at 14 months of age. At institution 2, patients with UCLP underwent definitive cheiloplasty at 3 months of age, had no maxillary orthopedics, and had vomer flap hard palate repair at 12 months of age and soft palate repair at 18 months of age. MAIN OUTCOME MEASURES: The outcome measures included directly digitized (cleft segment and hemialveolar ridge lengths) and derived (alveolar base width, alveolar cleft gap, maxillary frenum-alveolar base perpendicular angle, and rates of change over time of digitized cleft segment and hemialveolar ridge lengths) features. The data were assessed by comparing simple linear regression lines and an unpaired, two-tailed t test. RESULTS: Prior to initiating therapy, there were no statistically significant differences between the two populations with clefts. However, both populations with clefts differed significantly from unaffected individuals (p < .001), with increased maxillary base widths and larger perpendicular/frenum angles. At the time of palatoplasty, the two populations with clefts had statistically significant differences between them in the maxillary base width (p < .01) and the cleft gap distance (p < .05). The base width of institution 1 did not differ significantly from that of widths of unaffected children, and that of institution 2 was significantly less, although the latter had already received first-stage palate repair. Alveolar segment growth rates were similar for the greater and lesser segments, respectively, and the left side hemialveolus of both groups. The growth rate for the noncleft side hemialveolus of institution 2 exceeded (p < .05) that of both institution 1 and unaffected patients. CONCLUSION: Two different regimens for the initial management of UCLP can significantly affect maxillary alveolar arch growth with respect to the treatment used and in comparison with unaffected controls.     

前方牵引治疗单侧完全性唇腭裂患者术后前牙反(牙合)畸形的研究

Objective To investigate the effects of maxillary protraction on anterior crossbite in repaired pre-pubertal patients with complete unilateral cleft lip and palate(UCLP).Methods Prospective controlled clinical trial was carried out.Eighteen UCLP patients with anterior crossbite,aged 9.63±1.24 years,were the experimental subjects.Fourteen UCLP patients with similar malocclusion,aged 8.71±1.92 years,were selected as controls.All patients were before puberty according to the evaluation of the hand wrist radiograms.A Hyrax appliance and reverse headgear were applied.Lateral cephalometric radiographs were taken before and after the treatment.Computerized cephalometric analysis was carried out.Results After treatment in experimental group.the maxilla moved forward more significantly.The mandible rotated downward and backward.The intermaxillary relationship and soft tissue profile improved significantly.The rate of maxillary and mandibular Contribution was 1:1.7. ConelusionsMaxillary protraction could improve the imermaxillary relationship and soft tissue profile in UCLP patients with mild or moderate skeletal deformity before puberty.     

前方牵引治疗单侧完全性唇腭裂患者术后前牙反[牙合]畸形的研究

目的探讨前方牵引治疗单侧完全性唇腭裂（UCLP）患者术后前牙反[牙合]畸形的效果。方法进行前瞻性临床研究设计,UCLP术后骨性前牙反[牙合]患者治疗组18例,年龄9．63±1．24岁,观察对照组14例,平均8．71±1．92岁,均处于生长发育高峰前期。使用前方牵引进行治疗,治疗或观察前后拍摄头颅侧位片并测量,进行成组设计和配对设计t检验。结果UCLP治疗组前方牵引后,上颌骨前移;下颌后移合并后下旋转;上下颌间关系和面型改善明显,上颌与下颌改变的比值为1：1．7。对照组上下颌不调、前牙反覆盖、凹面型加重。结论UCLP术后轻中度骨性前牙反[牙合]畸形,前方牵引能够促进上颌骨向前,改善上下颌骨关系和软组织面型,应该早期矫形治疗。     

Skeletal relapse of maxillary osteotomies in unilateral cleft lip and palate patients

The outcomes of a consecutive series of 10 adults who had unilateral cleft lip and palate and who had undergone Le Fort I advancement fixed with miniplates were investigated. The amount and timing of horizontal and vertical relapse, the correlation between advancement and relapse, and the effectiveness of various methods of internal fixation were analyzed with respect to the authors' clinical experience and the data from the international literature. Tracings of the preoperative and serial postoperative lateral cephalograms--taken immediately and during the 1 1/2 to 2 postoperative years--were analyzed to calculate horizontal and vertical maxillary change. We found that the use of rigid fixation is associated with a significantly more stable postoperative result, as described by other authors. Our study suggests that this useful technique does not eliminate but reduces and controls the problem of relapse in a series of unilateral cleft lip and palate adult patients undergoing Le Fort I osteotomy.     

Assessment of dental arch relationships in Japanese patients with unilateral cleft lip and palate.

OBJECTIVE: Evaluation of the dental arch relationships of Japanese patients with unilateral cleft lip and palate (UCLP) from the orthodontic clinic of the University of Tokyo Hospital (UTH) compared with patients treated by the Oslo Cleft Team, Norway. DESIGN: Retrospective study and comparison with previous reports. MATERIALS: Dental models of 24 patients with UCLP in UTH taken before orthodontic treatment and before alveolar bone grafting were included. Surgeons in many hospitals performed primary surgeries. These models were matched for age and gender with 24 models from a consecutive series of patients treated by the Oslo Cleft Team as part of the Eurocran Good Practice Archive. A total of 48 models were evaluated. MAIN OUTCOME MEASURE: Dental arch relationship was rated with the Goslon Yardstick. The strength of agreement of rating was assessed with weighted kappa statistics. RESULTS: Intra- and interexaminer agreements evaluated by weighted kappa statistics were high, indicating good reproducibility. Almost 60% of the patients in UTH were classified into poor or very poor categories, and the mean Goslon score was 3.50. These results show a contrast to those in Oslo and were the poorest in comparison with previous reports. CONCLUSION: Dental arch relationships in patients with UCLP in UTH were poor. This seemed to be attributable to surgical procedures, but a factor of racial difference in the craniofacial morphology was also considered. Further intercenter research is required to clarify this point.     

Effects of cheiloplasty on maxillary dental arch development in infants with unilateral complete cleft lip and palate.

OBJECTIVE: To identify and analyze quantitatively the development of the maxillary dental arch before and after cheiloplasty. DESIGN: Prospective, longitudinal study of maxillary dental arch development at age of 1, 3, 6, and 12 months. SETTING: All patients were treated at a university hospital craniofacial center. PATIENTS: Twenty-seven infants with nonsyndromic, unilateral complete cleft lip and palate. INTERVENTION: Millard's rotation-advancement cheiloplasty was performed between the ages of 3 and 4 months. RESULTS: The anterior portion of the nonclefted segment (I-G), anterior ridge length of the nonclefted segment (I-C), and anterior ridge length of the clefted segment (L-C') continuously increased from 1 to 12 months of age. The anterior cleft width (G-L), anterior arch depth (I perpendicular to CC'), anterior basal angle (angle GC-CC'), and anterior arch curature angle (angle GIC) continuously decreased after the cheiloplasty. CONCLUSIONS: Cheiloplasty could mold the anterior portion of the maxillary dental arch palatally by exerting continuous pressure.     

单侧完全性唇腭裂患者上颌骨扩弓稳定性的研究进展

唇腭裂患者在生长发育期,常可观察到上颌骨矢状向、横向和垂直向等三维方向的发育障碍,其牙弓形态往往表现为上牙弓狭窄等,尤以完全性唇腭裂患者为严重。上颌骨扩弓成为唇腭裂患者正畸治疗的重要步骤,扩弓方法根据不同需要进行选择。本文分别从各类扩弓方式、年龄和牙弓形态等方面,讨论其对单侧完全性唇腭裂患者扩弓稳定性的影响。     

Dental arch relationships in Yorkshire children with unilateral cleft lip and palate.

OBJECTIVE: To assess the dental arch relationships of children with a complete unilateral cleft lip and palate (UCLP), born consecutively between 1983 and 1987, who had undergone primary cleft repair in the West Yorkshire region of the United Kingdom. The treatment outcome of this UCLP sample was then compared with the results of a previously published intercenter European study. DESIGN: A retrospective study with standardized record collection and blind assessment. SETTING: Regional dental hospital providing secondary and tertiary health care to the local population. PATIENTS: 35 UCLP patients whose primary repair had been performed within West Yorkshire. INTERVENTIONS: Dental casts obtained for each subject within 12 months of their 10th birthday. MAIN OUTCOME MEASURES: The West Yorkshire models were randomly mixed with an anonymous sample of 115 UCLP cases from other cleft centers in the U.K. The dental arch relationships of the 10-year-old models were assessed by applying the Goslon Yardstick. RESULTS: One-third of the West Yorkshire cleft sample were rated as belonging to Goslon group 2 (good result), another third to group 3 (fair result), and the remaining third to groups 4 and 5 (poor/very poor result). Numerically, the results were of a slightly higher standard than that previously published for other U.K. and European cleft centers but were inferior to the treatment outcome of two European centers. No statistically significant differences were found between the outcome results of the West Yorkshire group and the other cleft centers. CONCLUSIONS: These results provide useful baseline data against which progress in achieving improved treatment outcome for West Yorkshire UCLP children can be determined by future research.     

Growth in the width and length of the dental arch in children with unilateral cleft lip and cleft palate]

A study of casts of the dentitions of children with cheilognathopalatoschisis made over an extended period emphasizes that the development and the growth of the maxillary dental arch in width and length are considerably reduced as compared to children without clefts. Consequently, therapeutical measures must be taken to maintain the length and width of the maxillary dental arch.     

唇腭裂手术对上颌骨矢状向生长发育影响的研究

目的：研究唇腭裂手术对单侧完全性唇腭裂患者上颌骨矢状向生长发育的影响。方法：混合牙列期单侧完全性唇腭裂仅修复唇裂患者15例,唇腭裂术后患者18例;16岁以上恒牙列期单侧完全性唇腭裂仅修复唇裂患者15例,唇腭裂术后患者15例。所有患者均拍摄头颅定位侧位片,测量分析矢状方向的线距和角度;分别以相应年龄段的非唇腭裂正常者作为对照,采用SPSS11.0软件包对数据进行单因素方差分析（ANOVA）。结果：混合牙列期单侧完全性唇腭裂仅修复唇裂患者表现为上颌长度缩短,而唇腭裂术后患者除上颌长度的缩短外,还存在上颌位置后缩;16岁以上恒牙列单侧完全性唇腭裂仅修复唇裂患者主要表现为上颌位置后缩,存在明显Ⅲ类倾向,术后患者上颌位置后缩外,上颌长度也缩短。结论：唇裂手术及早期腭裂手术对上颌骨矢状向生长可能有干扰作用。     

Dental arch width stability after quadhelix and edgewise treatment in complete unilateral cleft lip and palate

OBJECTIVE: To evaluate the transverse stability of the dental arch in unilateral cleft lip and palate (UCLP) patients after orthodontic treatment with quadhelix and edgewise appliances. MATERIALS AND METHODS: Twenty repaired complete UCLP patients with posterior crossbites were chosen as the study subjects. All had ceased retention at least 15 months previously. Measurements were carried out directly on the pretreatment, posttreatment, and postretention study models using a three-dimensional dental cast analyzer. The interdental widths were measured for the canines, first premolars, second premolars, first molars, basal bone, and the alveolar arch. Two-way analysis of variance and Fisher's LSD was performed in comparing the difference between intervals. RESULTS: Lower inter-first-premolar width and upper arch widths of each region increased significantly (P < .05) after orthodontic treatment. The expansion was greater in the anterior than the posterior region in the upper arch, and the greatest increase was in the upper first premolar region. The upper arch width decreased after retention, with the decrease of the arch width in the upper canine (1.3 +/- 0.8 mm) and first premolar (1.5 +/- 0.8 mm) regions being statistically significant. The increased upper arch width in each region and the lower inter-first-premolar width maintained significant expansion after retention. CONCLUSIONS: The widths of the dental arch increased significantly after expansion with a quadhelix followed by preadjusted edgewise treatment. Relapse occurred, especially in the upper canine and first premolar region, but most of the treatment effect on the upper arch remained after retention.     

Factors influencing changes in maxillary arch dimensions in unilateral cleft lip and palate patients until six months of age.

OBJECTIVE: The objectives of the present study were (1) to investigate whether growth increments until 6 months of age are influenced by particular factors, (2) to analyze whether anterior cleft reduction is dependent on the extent of the cleft width at birth, and (3) to examine the correlation between maxillary measurements at birth and the anterior cleft width at 6 months of age. DESIGN: The study design was prospective and longitudinal. SETTING: Heidelberg University Hospital Interdisciplinary Cleft/Craniofacial Center. PATIENTS AND METHOD: The longitudinal records of 34 patients (24 male and 10 female) with complete unilateral cleft lip, alveolar ridge, and hard and soft palate were included in this study. All patients were treated with the same protocol. All participants were assessed at 0 and 6 months of age. Maxillary plaster casts of the patients were analyzed using a computer-controlled three-dimensional digitizing system. MAIN OUTCOME MEASURE: Maxillary models were measured and compared to putative factors influencing growth. RESULTS: No statistically significant differences were found between maxillary growth changes and increases in weight and length. Similarly, there was no significant interaction between the extent of the alveolar cleft width at birth and its reduction prior to lip closure. In contrast, significant differences of maxillary growth increments could be found between male and female patients. Stepwise regression analysis demonstrated a correlation between maxillary measurements at birth and growth increments. CONCLUSION: The results of the study indicate that gender plays a certain role in growth changes within the first 6 months of age.     

Effects of maxillary protraction combined with chin-cap therapy in unilateral cleft lip and palate patients.

OBJECTIVE: This study investigated the treatment effects of maxillary protraction combined with chin-cap therapy in complete unilateral cleft lip and palate patients at the deciduous and early mixed dentition stages. METHOD: Twenty-six Japanese children (10 boys and 16 girls) with complete unilateral cleft lip and palate were examined. All had undergone pushback operations for palatal repair at approximately 18 months of age. Maxillary protraction began between 5 and 7 years of age and continued for 10 to 38 months. Lateral cephalograms were used to analyze skeletal changes during the first and second years of treatment, and the relationship between pretreatment midfacial morphology and forward displacement of the maxilla during the first year was investigated. RESULTS AND CONCLUSIONS: During the first year of treatment, the mean increase in the ANB angle for all cases was 2.37 degrees. The forward displacement of the maxilla varied considerably, from 0.23 mm to 3.03 mm. The treatment response was significantly smaller in the second year, and no benefit from treatment longer than 1 year was established. The amount of maxillary forward displacement was significantly correlated with the pretreatment posterior upper facial height. Patients with smaller posterior upper facial height showed a poorer treatment response, whereas patients with a greater posterior upper facial height responded better to treatment. Individual differences in maxillary growth acceleration may be related to growth inhibition associated with postsurgical scar tissue on the palates.     

Outcome of bone grafting in relation to cleft width in unilateral cleft lip and palate patients

OBJECTIVE: The purpose of this study was to determine the relationship between cleft width and the residual amount of bone after bone grafting in 53 unilateral cleft lip and palate patients. STUDY DESIGN: The fate of the bone graft was determined by the residual amount of bone calculated from computed tomography scans taken immediately after surgery and 1 year postoperatively. Initial cleft width was measured on the computed tomography scans taken immediately after bone grafting. RESULTS: An average cleft width of 6.4 mm (range 3.0-12.2 mm) was found. The average amount of residual bone in the cleft area after 1 year was 64% of the initial bone graft. Linear regression analysis showed that a significant correlation (r = -0.29, P =.04) was found for cleft width in relation to the percentage of residual bone after 1 year. CONCLUSION: The regression analysis indicates that a relation between cleft width and the fate of the bone graft exists. Bone grafts in wider clefts are more prone to resorption than those in more narrow ones.     

Early assessment of dental arch development in repaired unilateral cleft lip and unilateral cleft lip and palate versus controls.

OBJECTIVE: To evaluate dental arch relationships and dimensions, relative to an age matched noncleft sample, in Caucasian 3-year-old children with repaired unilateral cleft lip (UCL) or unilateral cleft lip and palate (UCLP). DESIGN: Prospective, cross-sectional, case-control study performed in Scotland, U.K. PARTICIPANTS: Eleven children with repaired unilateral cleft lip, 16 children with repaired unilateral cleft lip and palate, and 78 children as controls. MAIN OUTCOME MEASURES: Dental arch relationships and linear arch dimensions. RESULTS: Prevalence of Class III incisor relationship was 31.3% in children with unilateral cleft lip and palate compared with 9.1% in children with unilateral cleft lip. A buccal crossbite was present in 36% of children with unilateral cleft lip, compared with 75.6% of children with unilateral cleft lip and palate.Mean linear maxillary arch dimensions did not differ significantly between children with unilateral cleft lip and the controls. Except for second intermolar width, statistically significant differences existed in mean linear maxillary arch dimensions between the unilateral cleft lip and the unilateral cleft lip and palate groups; the mean linear maxillary arch dimensions were significantly greater in the control group than in the unilateral cleft lip and palate group. The mean cleft-affected anterior quadrant length appeared to be the arch dimension with the greatest power of discrimination among the three groups. There were no significant differences in mean linear mandibular arch dimensions among the three groups. CONCLUSIONS: Anterior crossbite was almost three times more common in the unilateral cleft lip and palate group than in the unilateral cleft lip group. Mean linear maxillary arch dimensions differed significantly between the unilateral cleft lip and palate group and the control group. There were no significant differences in mean linear maxillary arch dimensions between unilateral cleft lip and controls or between mean linear mandibular arch dimensions for unilateral cleft lip, unilateral cleft lip and palate, and controls.