Abstract
ObjectivesTo assess treatment outcome (transversal and sagittal dental arch relationships) and its determinants in complete bilateral cleft lip and palate (BCLP) evaluated with the modified Huddart-Bodenham scoring system and the BCLP Yardstick.Materials and methodsMultiple electronic databases were searched without time limitation. Randomized clinical trials, cohort and case control studies using BCLP Yardstick and/or modified Huddart-Bodenham system to judge treatment outcome of patients with BCLP were included. The Risk of Bias in Nonrandomized Studies of Interventions tool and Grading of Recommendations, Assessment, Development, and Evaluation was used.ResultsOf the 528 studies identified by the electronic search, only eight retrospective studies met the inclusion criteria and were included. A total of 12 cleft centers were represented. All treatment protocols differed and background information was underreported. The results for the BCLP yardstick showed that all except the centers in New Zealand had a mean score lower than 3, indicating good treatment results. However, these studies had a moderate to high risk of bias. The modified Huddart-Bodenham scores were negative in all studies. No further meta-analysis was done due to heterogeneity and high risk of bias. The quality of evidence was graded as very low.ConclusionResults for the dental arch relationship of studies in complete BCLP and possible determinants were not synthesized due to very low quality of evidence. Clinical research for patients with BCLP should focus on sound methodological designs to enable evidence-based decision making to improve treatment for patients with BCLP and thereby hopefully their quality of life.
Highlights
Maxillofacial growth in patients with an orofacial cleft is influenced by intrinsic, functional, and extrinsic factors
The modified Huddart/Bodenham system (Huddart)-Bodenham scores were negative in all studies
Randomized clinical trials, cohort studies and case control studies using the bilateral cleft lip and palate (BCLP) Yardstick and/or the modified Huddart/Bodenham system (Huddart) to judge the treatment outcome of patients with BCLP were included in this review study
Summary
Maxillofacial growth in patients with an orofacial cleft is influenced by intrinsic, functional, and extrinsic factors. The latter, in particular surgical interventions, may have a profound effect on maxillofacial growth. Different determinants may play a role like the surgeon, surgical technique, timing of the surgery and other possible factors (Shaw et al, 1992). To achieve an acceptable jaw relationship, good functional occlusion, and satisfactory dental and facial aesthetics, orthodontic and orthopedic treatments are indispensable (Kuijpers-Jagtman, 2012). There is still no agreement on the ideal treatment protocol leading to a wide diversity of treatment approaches (Shaw and Semb, 2017). Outcome studies are important to help clinicians to differentiate amongst protocols and select the optimal treatment for their patients
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