Influence of early hard palate closure in unilateral and bilateral cleft lip and palate on maxillary transverse growth during the first four years of age.

OBJECTIVE: To evaluate and compare the effects of early primary closure of the hard palate on the anterior and posterior width of the maxillary arch in children with bilateral (BCLP) and unilateral (UCLP) cleft lip and palate during the first 4 years of life. DESIGN: A retrospective, mixed-longitudinal study. SETTING: Cleft Palate Center of the University of Erlangen-Nuremberg. SUBJECTS AND METHODS: The present investigation analyzes longitudinally 42 children with UCLP and 8 children with BCLP between 1996 and 2000 with early simultaneous primary closure of lip and hard palate (4 to 5 months). Palatal arch width was measured on dental casts with a computer-controlled three-dimensional digitizing system, and their growth velocities were calculated from consecutive periods (mean follow-up 39 months). Differences in growth velocities were compared with those of 25 children with UCLP and 15 children with BCLP with delayed closure of hard palate (12 to 14 months). RESULTS AND CONCLUSIONS: There was no significant difference in terms of anterior and posterior maxillary width between early and delayed closure of hard palate within the first 4 years of life.     

Tooth maturation in cleft lip, cleft palate, or both

The relation between chronologic age and the development of permanent teeth in patients with cleft lip, cleft palate, or both was investigated according to the method described by Demirjian et al (1973). The patients were divided into three groups: (1) those with bilateral cleft lip and palate (BCLP), (2) those with unilateral cleft lip and palate (UCLP), and (3) those with cleft palate only (CP). Panoramic radiographs of 107 Caucasian children (66 boys and 41 girls) aged 4 to 12 years were evaluated. The degree of maturation of each of the permanent teeth on the left side of the mandible was determined, and a dental maturation score was computed for each child. The scores were compared with those obtained in a previous study of dental maturation in Caucasian children without cleft from the Chicago area (Loevy, 1983). Evaluation of the data demonstrated that there was no significant difference in dental maturity between girls with cleft lip, cleft palate, or both and with the sample of those free from cleft. There was a significant difference in dental maturity in boys when all cleft groups were evaluated together. There was no significant difference from the normal sample in boys with bilateral cleft lip and cleft palate or with cleft palate alone, but there was a highly significant difference from the normal sample in the group of boys with unilateral cleft lip and palate.     

Long-term outcome of secondary alveolar bone grafting in patients with various types of cleft

OBJECTIVE: To evaluate the results of secondary alveolar bone grafting in patients with various types of cleft. DESIGN: One hundred and seventy patients were classified as cleft lip and alveolar process alone (CLAP), complete unilateral cleft lip and palate (UCLP), and complete bilateral cleft lip and palate (BCLP). The Bergland criteria were used to assess the long-term outcome of alveolar bone grafting. RESULTS: In the UCLP and BCLP groups, the success rate was significantly better (P<0.05) when the cleft was grafted before the eruption of canines. When the operation was done after the eruption of canines, there was a significant difference in the success rate between CLAP and BCLP (P<0.05). CONCLUSION: The timing of the operation was the critical variable that affected the outcome in patients with complete cleft lip and palate. The severity of the deformity influenced the success rate when alveolar bone grafting was done after the eruption of canines.     

唇腭裂患者上颌前部牙槽骨厚度及骨开窗、骨开裂的三维评价研究

目的　利用锥形束CT（cone-beam CT,CBCT）评价不同类型唇腭裂患者上颌前部牙槽骨厚度和形态,以及上前牙骨开窗、骨开裂情况。方法　选择016年8月至019年10月间在南京医科大学附属口腔医院就诊拟行口腔正畸治疗的唇腭裂患者85例（男51例,女34例,平均年龄（14.65±4.95）岁）,其中单侧唇裂伴牙槽突裂（unilateral cleft lip and alveolus,UCLA）患者19例,单侧完全性唇腭裂（unilateral complete cleft lip and palate,UCLP）患者5例,双侧完全性唇腭裂（bilateral complete cleft lip and palate,BCLP）患者14例。在正畸治疗开始前均予以拍摄颌面部CBCT,应用Image J软件测量其上前牙唇腭侧牙槽骨厚度（alveolar bone thickness,ABT）,计算骨开窗、骨开裂发生率,并比较不同唇腭裂类型患者上颌前部ABT及上前牙骨开窗、骨开裂发生率的差异。结果　UCLP、UCLA患侧上前牙骨开裂发生率（34.9%、4.9%）显著高于其健侧（10.7%、11.1%）,但骨开窗发生率无统计学差异。UCLP健侧上中切牙（5.9%）、侧切牙（9.7%）骨开裂发生率低于UCLA。UCLA、UCLP、BCLP三组间患侧上前牙骨开裂及骨开窗发生率均无统计学差异。UCLP、UCLA患侧上前牙ABT在多部位小于其健侧。除UCLP/UCLA患侧侧切牙外,UCLA、UCLP、BCLP各类型上前牙唇侧平均ABT均小于腭侧。UCLA、UCLP、BCLP三组间患侧上前牙唇腭侧平均ABT无统计学差异。UCLP患侧上侧切牙、尖牙分别在唇侧和腭侧根颈处ABT大于UCLA。结论　单侧唇腭裂患者患侧上前牙骨开裂发生率高于健侧,ABT则在多部位小于其健侧;而三种类型患者上前牙唇侧ABT均小于其腭侧。单侧唇裂伴牙槽突裂与单侧完全性唇腭裂患者健侧上中切牙、侧切牙骨开裂发生率及患侧侧切牙、尖牙根颈处牙槽骨厚度存在差异;单侧与双侧完全性唇腭裂间上前牙骨开窗、骨开裂发生率及牙槽骨厚度则无差异。     

Periodontal status and oral hygiene in two populations of cleft patients.

OBJECTIVE: To evaluate and compare the oral hygiene and periodontal status in children with unilateral and bilateral cleft lip and palate treated in ?ód?, Poland, and Erlangen, Germany. DESIGN: Oral health was assessed by the presence of dental plaque, pocket depth, clinical attachment levels, and pathologic teeth mobility. SUBJECTS AND METHODS: Thirty-seven Polish and 63 German patients participated in this study. RESULTS: Poor oral hygiene was found in 57% of all subjects. In Erlangen, 60% of patients had optimal oral hygiene, compared to 19% in ?ód?. The highest scores for dental plaque were noted in both groups in the cleft region. Healthy periodontium was significantly more frequent among German patients, whereas gingival bleeding was significantly more frequent among Polish patients. Pocket depths greater than 6 mm occurred only in German subjects. No statistically significant difference was observed between the amount of tooth areas with gingival recessions and the country of origin. Periodontal pockets deeper than 3.5 mm occurred more frequently during active orthodontic treatment. CONCLUSIONS: The oral hygiene regimens in Germany and Poland were not comparable, as more plaque was found in the Polish than in the German population. Plaque accumulation seems not to be a key factor in causing periodontal destruction in the cleft area. Factors other than oral hygiene should be considered of major importance in relation to the development of gingival recession on teeth in cleft areas.     

Prevalence of intranasal ectopic teeth in children with complete unilateral and bilateral cleft lip and palate.

OBJECTIVE: The objective of this study was to determine the prevalence of ectopic eruption of intranasal teeth. DESIGN: This was a retrospective study, where records of children with repaired cleft lip and palate were analyzed. SETTING: The study was conducted at a large craniofacial center, the Hospital for Rehabilitation of Craniofacial Anomalies, USP, Bauru, S?o Paulo, Brazil. SUBJECTS: The sample consisted of 815 records from patients with bilateral cleft lip and palate (BCLP) and 1,495 records from patients with unilateral cleft lip and palate (UCLP). The age of the subjects was 5 to 10 years old and the groups included both males and females. RESULTS: The results showed that 0.61% of the children with BCLP and 0.40% of those with UCLP had an intranasal tooth. The prevalence of an intranasal tooth for the whole group was 0.48%, and it appeared to be more common in females.     

Palatal growth changes in newborns with unilateral and bilateral cleft lip and palate from birth until 12 months after early neonatal cheiloplasty using morphometric assessment

Clinical Oral Investigations - To compare palatal growth changes in infants with complete unilateral (UCLP) or bilateral (BCLP) cleft lip and palate during the first year of life. Upper dental...     

Changes in soft tissue thickness after Le Fort I osteotomy in different cleft types

The soft tissue thickness before and after Le Fort I osteotomy was evaluated in 46 cleft patients. The sample consisted of 10 patients with isolated cleft palate (CP, mean age 25.5 years); 10 patients with bilateral cleft lip and palate (BCLP, mean age 21.7 years); and 26 patients with unilateral cleft lip and palate (UCLP, mean age 22.9 years). Patients with bimaxillary surgery, simultaneous rhinoplasty, or V-Y plasty of the upper lip were excluded. Soft tissue changes were analyzed by cephalograms taken shortly before surgery and at 6 months postoperatively. Horizontal advancement varied from 4.1 mm in the UCLP group to 5 mm in the BCLP group. The vertical lengthening varied from 3.7 mm in the CP group to 7.2 mm in the BCLP group. In all cleft types, thinning of the subnasal area, superior labial sulcus, and upper lip (anterior nasal spine-subnasale, point A-soft tissue point A, and prosthion-labrale superius) took place. Significant thinning of the upper lip occurred in the UCLP and BCLP patients. Surgical changes of the lower lip and mandibular area were small and insignificant. There were significant differences in soft tissue thicknesses between different types of clefts. The subnasal area and superior labial sulcus were significantly thicker in the CP group than in the BCLP or UCLP groups, both pre- and postoperatively. The upper lip was thickest in the BCLP group preoperatively but thickest in the CP group postoperatively. The upper lip was thinnest in the UCLP group both before and after the operation.     

Transverse changes after surgical closure of complete cleft lip, alveolus and palate

Surgery for patients with unilateral (UCLP) and bilateral (BCLP) complete cleft lip, alveolus and palate has a considerable influence upon craniofacial growth. With respect to this, the cleft team at Hannover Medical School has attempted to reduce necessary surgical interventions to labioplasty, palatoplasty and veloplasty. Still, the effects of these operations influence maxillary growth to an extent which requires orthodontic treatment in all patients. This study focuses upon the transverse alterations of the alveolar arch and the deciduous dentition after lip and palate surgery. Dental casts prior to any surgical intervention and after labioplasty and complete palaotoplasty of the hard and soft palate were measured for transverse changes by using anatomical landmarks. The results indicate a significant occurrence of anterior relative to posterior arch width loss for both UCLP and BCLP patients. Orthodontic treatment should be planned and performed with respect to these findings in order to support craniofacial growth and prevent maxillary dental arch deficiency. Received: 2 November 1998 / Accepted: 15 February 1999     

Maxillary dental anomalies in children with cleft lip and palate: a controlled study

International Journal of Paediatric Dentistry 2010; 20: 442–450 Objective. To evaluate the prevalence of dental abnormalities of the primary and permanent maxillary dentitions in children affected by unilateral (UCLP) and bilateral (BCLP) cleft of the lip and palate. Methods. One hundred and fifty‐six Caucasian patients (64 females and 92 males) affected by non‐syndromic UCLP or BLCP were selected. A control sample of 1000 subjects (482 males and 518 females) without CLP was selected. All comparisons were carried out by means of z‐tests on proportions. Results. The prevalence rate for missing primary lateral incisors in UCLP subjects was 8.1% and it was 27.9% for the permanent lateral incisors. In BLCP subjects, the prevalence rates were 17% for the primary lateral incisors and 60% for the permanent lateral incisors. The second premolar was absent in 5.4% of UCLP subjects and in 8.8% in the BCLP sample. The statistical analysis revealed significant differences for the prevalence rates of all dental anomalies compared with the control group except for second premolar agenesis. Conclusions. In both UCLP and BCLP subjects the most prevalent missing teeth were the lateral incisors. The dental anomalies occurred predominantly in the cleft area, thus suggesting that the effect of the cleft disturbance is more local than general on the dentition.     

Development of the residual cleft in the hard palate after velar repair in a 2-stage palatal repair regimen

Delayed closure of the hard palate is believed to improve maxillary growth and facial appearance in cleft lip and palate patients. However, the cleft opening in the hard palate after velar closure might impair speech development. The aim of this investigation was to study the development of the residual cleft in the hard palate after 2-stage palatal repair (TSPR) in children born with complete cleft lip and palate (bilateral [BCLP]; n=7 or unilateral [UCLP]; n=22) or isolated cleft palate (CP; n=9). Moreover, we aimed to investigate whether any morphologic factors before surgery might predict development of the residual cleft. Dental casts obtained prior to velar repair (mean age 7 months) and postoperatively at 1 1/2, 3, 4, 5 and 7 years were analyzed with a Reflex Microscope regarding the width, length and area of the cleft in the hard palate.The palatal cleft varied in size both pre- and postoperatively in all 3 types of cleft patients. The width of the cleft in the UCLP subgroup showed a marked reduction immediately after velar repair, but then, on average, remained stable until final surgical closure of the hard palate. In the BCLP subgroup the initially rather narrow width of the clefts remained unchanged postoperatively. Clefts in the CP subgroup, especially in those with a complete cleft, remained large after veloplasty. In 4 of the UCLP and 2 of the BCLP patients, the cleft width increased gradually. In some other subjects, both in the UCLP and BCLP subgroups, the residual cleft closed functionally with time, but this development could not be foreseen.     

Nasal airway dimensions of adults with cleft lip and palate: differences among cleft types.

OBJECTIVE: To determine the nasal airway dimensions in adults with repaired cleft lip and palate by rhinomanometry and to analyze the reduction associated with different types of clefts. MODEL: A prospective analysis comparing three types of previously repaired clefts: bilateral cleft lip and palate (BCLP), unilateral cleft lip and palate (UCLP), and isolated cleft palate (CP) at the 5% level of significance. SETTING: Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of S?o Paulo, Bauru, Brazil. PARTICIPANTS: Fifty-three subjects aged 18 to 35 years (17 BCLP, 16 UCLP, 20 CP) and a group of 20 individuals without cleft (N). VARIABLES: Minimum cross-sectional nasal area assessed by posterior (PR) and anterior (AR) rhinomanometry and nasopharyngeal area assessed by modified AR.RESULTS: Mean (+/- 1 SD) nasal areas obtained by PR were: 0.47 +/- 0.16 cm(2) (BCLP), 0.57 +/- 0.19 cm(2) (UCLP), 0.61 +/- 0.13 cm(2) (CP), and 0.60 +/- 0.10 cm(2) (N). The mean value for the BCLP group was significantly smaller than that for the N and CP groups. The remaining values did not differ from one another. The proportion of subjects with subnormal areas obtained by PR was 41%, 19%, and 0% for groups BCLP, UCLP, and CP, respectively. Similar results were obtained by AR. All subjects presented a nasopharyngeal area larger than 0.80 cm(2), denoting absence of obstruction in the nasopharynx. CONCLUSIONS: In adulthood BCLP is the type of cleft associated with a greater reduction of nasal airway, compared with UCLP and CP, suggesting that adults with BCLP are at a greater risk for nasal obstruction.     

A split-mouth study on periodontal and microbial parameters in children with complete unilateral cleft lip and palate

BACKGROUND: Complete unilateral cleft lip and palate (UCLP) is a hereditary or multifactorial malformation that can be corrected successfully with a combined orthodontic, surgical and restorative treatment. Such multidisciplinary treatment takes many years and demands a lot of attention to both patients' teeth and periodontium. OBJECTIVES: This split-mouth study aimed to compare the periodontal health as well as the microbial parameters between cleft and non-cleft region. MATERIAL AND METHODS: 75 patients (52 males, 23 females) between 8 and 20 years with a complete unilateral cleft lip and palate (before (n = 30), during (n = 34) and after (n = 11) the active orthodontic treatment) volunteered for this study. Four regions were defined for the split-mouth comparison: teeth neighbouring cleft (site 1), tooth in cleft (site 2), and the corresponding contra-lateral teeth, respectively, in the unaffected quadrants (sites 3 and 4). At all sites the following periodontal parameters were recorded: plaque and gingivitis indices, pocket depth, attachment loss, bleeding on probing, tooth mobility (visual and Periotest), radiographic bone loss and gingival width. In addition, three pooled subgingival plaque samples were taken (around tooth in cleft, teeth facing the cleft, and contra-lateral teeth of the latter). RESULTS: The differences between the teeth neighbouring the cleft and the corresponding contra-lateral opponents were of borderline significance (P 相似文献   

Maxillary lateral incisors of subjects with cleft lip and/or palate: Part 2.

Maxillary lateral incisors on the alveolar cleft were investigated in 431 cleft children registered in the Department of Orthodontics, Kyushu University Dental Hospital. The majority of primary maxillary lateral incisors were located on the distal side of the alveolar cleft in both unilateral cleft lip and alveolus (UCLA) and unilateral cleft lip and palate (UCLP) subjects. Permanent teeth in UCLA tend to be located distally, but in UCLP they tend to be congenitally absent (p less than .01). The majority of primary teeth had normal shapes; the majority of permanent teeth were of intermediate type or were missing congenitally. One third of the UCLA and one half of the UCLP subjects who had primary maxillary lateral incisors were not followed by permanent replacements. The location of the majority of permanent maxillary lateral incisors tallied with that of the primary ones except in four UCLA, ten UCLP, and two bilateral cleft lip and palate (BCLP) subjects. Four UCLA and ten UCLP subjects who had primary lateral incisors on the distal side were followed by their permanent successors on the mesial side. Three UCLP and one BCLP subjects had permanent maxillary lateral incisors even though they had no temporary predecessors.     

Three-dimensional Evaluation of Mandibular Volume in Patients with Cleft Lip and Palate During the Deciduous Dentition Period

ObjectivesTo examine the relationship between mandibular volume and craniofacial morphology in patients with cleft lip and palate using cone beam computed tomography (CBCT) and to compare these findings with control (noncleft) patients undergoing CBCT for other purposes during the deciduous dentition period.Materials and MethodsEighty-four patients were categorized into the unilateral cleft lip and alveolus (UCLA) group (n = 25; mean age, 4.60 ± 0.40 years), unilateral cleft lip and palate (UCLP) group (n = 23; mean age, 4.52 ± 0.39 years), bilateral cleft lip and palate (BCLP) group (n = 22; mean age, 4.54 ± 0.37 years), and control group without cleft (n = 14; mean age, 5.19 ± 0.52 years). Mandibular volume and craniofacial cephalometric measurements were obtained using CBCT. All measurements were assessed by analysis of covariance (ANCOVA) using Bonferroni post hoc pairwise comparison tests.ResultsANCOVA revealed no statistically significant differences in mandibular volume among the groups. SNA° and ANB° were significantly larger in the UCLA and BCLP groups than in the control group. SN-MP° was smallest in the UCLA group. Co-A in the UCLP group was shorter than in the UCLA and BCLP groups. Go-Gn was shortest in the UCLP and BCLP groups compared with the control group.ConclusionsThree-dimensional evaluation of craniofacial morphology using CBCT can provide valuable information on malocclusion and other dentoskeletal problems among patients with CLP.     

Changes of vertical skeletal morphology in patients with complete unilateral and bilateral cleft lip and palate.

OBJECTIVE: The aim of this retrospective investigation was to qualify and quantify changes of the vertical skeletal morphology during puberty in cleft patients compared with an age-matched noncleft control. METHODS: Patients with unilateral cleft lip and palate (UCLP; n = 12) and bilateral cleft lip and palate (BCLP; n = 11) who fulfilled strict inclusion criteria according to the Hanover treatment protocol were evaluated by means of cephalometric analysis. Lateral cephalograms were analyzed for each cleft patient at age 10 and 15 and compared with corresponding data of a noncleft control (n = 20). RESULTS AND CONCLUSIONS: It was concluded that a vertical growth impairment of the maxilla is found in patients with cleft lip and palate. The maxilla of cleft patients shows a significant clockwise rotation, whereas the inclination of the mandible shows little difference. Consequently, there is a skeletal superposition of the jaws. The posterior height of the maxilla is significantly shorter in patients both with UCLP and BCLP at T(0) and T(1). An increase of the anterior height of the mandible is found in the cleft groups.     

Combined fMRI and MRI movie in the evaluation of articulation in subjects with and without cleft lip and palate.

OBJECTIVE: This study was undertaken to explore the application of functional magnetic resonance imaging (fMRI) and MRI movies in the evaluation of articulatory function in subjects with and without cleft lip and palate (CLP). DESIGN: The authors examined brain activation and the dynamic movement of articulators during bilabial and velar plosives using fMRI and MRI movies. SUBJECTS: Two subjects, one with unilateral cleft lip and palate (UCLP) and one with bilateral cleft lip and palate (BCLP), and 12 non-CLP volunteers. RESULTS: Activation foci were found in the precentral gyrus, thalamus, and cerebellum in non-CLP volunteers. In comparison, similar regions were activated in the UCLP subject during both plosives, whereas the regions activated in the BCLP subject were different, particularly during the velar plosive. The dynamic movement of articulators in the UCLP subject was comparable to that in a non-CLP volunteer but different from that in the BCLP subject. CONCLUSIONS: The results suggest that these two MRI modalities may be a promising evaluation methodology for articulatory function in CLP from central and peripheral perspectives.     

Dental health indices and caries associated microflora in children with unilateral cleft lip and palate.

OBJECTIVE: To investigate the dental health and caries related microflora of children with unilateral cleft lip and palate. STUDY GROUP: Sixty children with unilateral cleft lip and palate and matched controls. OUTCOME MEASURES: The decayed, missing, and filled teeth and surfaces in both the deciduous and permanent dentitions. The presence of developmental defects and plaque and gingivitis scores were also recorded. Plaque was collected from 25 of the children and their matched controls from three different sites, which were (1) the first approximal site distal to the cleft, (2) a contralateral anterior site, and (3) a remote site. It was cultured for Streptococcus mutans and lactobacilli. Plaque was collected from two sites in the matched controls. RESULTS: There was no significant difference in the caries, plaque, and gingivitis scores between the children with cleft palate and the controls. A greater number of enamel opacities were recorded in the control group, and there was a higher prevalence of enamel discoloration in the children with cleft lip and palate. There was no significant difference in the proportion of S. mutans or lactobacilli at the cleft site, compared with the unaffected site in the study group, although there was an anterior-posterior gradient in the proportion of S. mutans. There was no significant association between the stagnation area at the cleft site and the bacteria associated with dental caries.     

Oral disease status of a sample of Jordanian people ages 10 to 28 with cleft lip and palate.

OBJECTIVE: To determine the levels of periodontal disease and dental caries in subjects with cleft lip and palate and to compare them with matched noncleft control subjects. DESIGN: A total of 32 subjects with cleft lip and palate, ages 10 to 28 years, and a similar number of noncleft control subjects were examined for plaque biofilm deposits, gingivitis, periodontitis, and dental caries by using the Silness and L?e plaque index (PI), L?e and Silness gingival index (GI), probing pocket depth (PPD), and the decayed-missing-filled-teeth (DMFT) index, respectively. SETTING: Faculty of Dentistry, Jordan University of Science and Technology, and Prince Rashed Hospital, Royal Medical Services, northern Jordan. RESULTS: Scores for PI, GI, PPD, and DMFT were significantly higher in subjects with cleft lip and palate than in control subjects. CONCLUSION: Subjects with cleft lip and palate are at an increased risk for dental caries and periodontal disease when compared with a noncleft population.