Cleft Lip, Alveolus And Palate Research Articles

Speech Outcomes after Delayed Hard Palate Closure and Synchronous Secondary Alveolar Bone Grafting in Patients with Cleft Lip, Alveolus and Palate.

Background The best timing of closure of the hard palate in individuals with cleft lip, alveolus, and palate (CLAP) to reach the optimal speech outcomes and maxillary growth is still a subject of debate. This study evaluates changes in compensatory articulatory patterns and resonance in patients with unilateral and bilateral CLAP who underwent simultaneous closure of the hard palate and secondary alveolar bone grafting (ABG). Methods A retrospective study of patients with nonsyndromic unilateral and bilateral CLAP who underwent delayed hard palate closure (DHPC) simultaneously with ABG at 9 to 12 years of age from 2013 to 2018. The articulatory patterns, nasality, degree of hypernasality, facial grimacing, and speech intelligibility were assessed pre- and postoperatively. Results Forty-eight patients were included. DHPC and ABG were performed at the mean age of 10.5 years. Postoperatively hypernasal speech was still present in 54% of patients; however, the degree of hypernasality decreased in 67% ( p < 0.001). Grimacing decreased in 27% ( p = 0.015). Articulation disorders remained present in 85% ( p = 0.375). Intelligible speech (grade 1 or 2) was observed in 71 compared with 35% of patients preoperatively ( p < 0.001). Conclusion This study showed an improved resonance and intelligibility following DHPC at the mean age of 10.5 years, however compensatory articulation errors persisted. Sequential treatments such as speech therapy play a key role in improvement of speech and may reduce remaining compensatory mechanisms following DHPC.

Postoperative Daycare as a Safe and Cost-Effective Option for Secondary Alveolar Bone Graft (SABG) Surgery: A Retrospective Comparative Cohort Study.

To evaluate the outcomes of Secondary Alveolar Bone Grafting (SABG) in patients treated either in daycare or with multiple day hospitalization (MDH) in relation to costs and complication rates. Retrospective comparative cohort study. The data was collected from two settings: Postoperative daycare or MDH after oral cleft surgery in an Academic Medical Center in The Netherlands. Data of 137 patients with unilateral Cleft lip, alveolus, and palate (CLAP) treated between 2006-2018 were evaluated. Registered clinical variables: age, gender, cleft subtype, bone donor site, type of hospitalization, length of stay, additional surgery, complications, surgeons, and costs. Closure of the alveolar cleft with/without closure of the anterior palate. Univariate analyses. Of the 137 patients, 46.7% were treated in MDH, and 53.3% in daycare. Total costs for daycare were significantly lower (P < .001). All patients treated in daycare received mandibular symphysis bone, whereas in MDH, 46.9% received iliac crest bone instead. Bone donor site was associated with postoperative care type. Complication rates were slightly but not significantly higher in daycare (26%) vs. MDH (14.1%) (P = .09). Most were Grade I (minor) according to Clavien Dindo classification. Daycare after alveolar cleft surgery is about as safe as MDH, but significantly cheaper.

Decrease in Prevalence of Cleft lip, Alveolus and Palate After Nationwide Introduction of the Second-Trimester Anomaly Scan in the Netherlands.

Some studies have suggested that introducing a second-trimester anomaly scan (SAS) leads to increased rates of termination of pregnancy (TOP) in fetuses with orofacial clefts (OFCs). The aim of this study was to evaluate the impact of a nationwide introduction of SAS on the prevalence of live births with OFCs in the Netherlands. Retrospective cohort study. Tertiary setting. Included in the study were all patients diagnosed with OFCs as recorded in the "Dutch Association for Cleft Palate Anomalies" database between 1997 and 2019. Patients were divided into three categories: cleft lip with or without alveolus (CL/A), cleft lip, alveolus and palate (CLAP) and cleft palate (CP) based on anatomical landmarks at the first consultation. Prevalence rates of OFCs before and after the nationwide introduction of the SAS on January 1, 2007 were compared. Overall, 1899 patients were diagnosed with CL/A, 2586 with CLAP and 2927 with CP. The prevalence of clefts before and after introduction of the SAS did not differ (P = 0.85). The prevalence of CL/A decreased (P = 0.04), and that of CLAP decreased (P = 0.01) and that of CP increased (P = 0.02). This study demonstrates a significant decrease in the prevalence of CL/A and CLAP after introduction of the SAS. However, due to an increase in CP, the prevalence of all patients born with OFCs has not changed in the Netherlands between 1997 and 2019.

Dentition patterns in bilateral cleft lip subphenotypes: multicenter study.

Here, we retrospectively investigated cases of bilateral oral clefts (OCs) to determine the clinical relevance of detailed distinction of incomplete cleft lip subphenotypes, based on morphological severity of the cleft, within the categories cleft lip with or without alveolus (CL ± A) and cleft lip, alveolus, and palate (CLAP). We further assessed possible associations between CL subphenotypes (complete vs different incomplete types) and different dentition patterns of the lateral incisor. Our analysis included 151 non-syndromic Caucasian bilateral OC-patients (8-20 years old) from the Dutch Association for Cleft Palate and Craniofacial Anomalies registry. Six different deciduous and permanent lateral incisor patterns were distinguished: normal position (z/Z), supernumerary lateral incisor (n/N), presence in the anterior (x/X) or posterior (y/Y) segment of the cleft, one in each cleft segment (xy/XY), and agenesis (ab/AB). Logistic regression was performed to show the associations between the CL subphenotypes and dentition patterns of the lateral incisor. One hundred three had complete, while 48 had incomplete CLs. Patterns z/Z and n/N were associated with a submucous/vermillion notch, incomplete CL, and intact alveolus. Patterns x/X, y/Y, and xy/XY were most common in patients with two-thirds to subtotal CL and complete CL. The most severe pattern, ab/AB, was most commonly associated with complete CL. Based on the morphological severity of the CLs, it can be stated that the more severe the CL in bilateral CL ± A and CLAP, the more severe the abnormal pattern of the dentition. Further distinction of incomplete cleft lip subphenotypes (submucous/vermillion notch, one-third to two-thirds CL, two-thirds to subtotal CL) in bilateral CL ± A and CLAP has clinical relevance.

Facial and midfacial symmetry in cleft patients: Comparison to non-cleft children and influence of the primary treatment concept

PurposePatients with cleft lip, alveolus and palate (CLAP) may suffer from marked asymmetry with an impact on attractiveness and psychosocial aspects. The aim of this study was to assess symmetry in CLAP patients compared to non-cleft controls of similar age with regard to cleft type and treatment concept. Materials and methodsIn CLAP patients with different cleft forms and in healthy non-cleft subjects (control group) a three-dimensional stereophotogrammetric face scan was performed and an objective 3D asymmetry index (AI) was calculated for the whole face, the midface, the upper lip and the nose. ResultsIn total, 305 patients were included: 140 CLAP patients (90 male, 50 female, mean age 9.9 ± 3.6 years) and 165 controls (87 male, 78 female, mean age 8.7 ± 2.1 years). In general, CLAP patients showed significantly higher asymmetry than controls, with the most severe asymmetry found in unilateral complete CLAP. Patients treated according to an actual concept considering reconstruction of all affected muscular systems had a significant lower and more favourable AI than patients not treated according to this concept (p < 0.05). ConclusionAn adequate treatment concept is essential to achieve better results concerning symmetry in CLAP, but symmetry values of healthy non-cleft controls are not reached.

Transverse Maxillary Development in Complete Cleft Patients: Comparison of 2 Treatment Strategies by Longitudinal and Cross-Sectional Model Analysis.

This study aimed to compare differences in the maxillary transverse dimension following cleft repair using 2 protocols involving a 2-staged palatal closure with similar timing but different techniques. Retrospective study. Two matched study samples, each containing 10 patients. Cleft center A is a university hospital. Cleft Center B is a general teaching hospital. Patients with cleft lip alveolus and palate (CLAP) were matched by cleft type, gender, age, and palatal morphology at the age of 1 month. Differences in the transverse dimension were measured at 4 ages in 2 matched groups (A and B from center A and B), each including 5 patients with unilateral CLAP (UCLAP) and 5 patients with bilateral CLAP (BCLAP). Orthodontic/orthopedic expansion treatment began at 8 and 5 years of age at centers A and B, respectively. The mean intercanine distance decreased by 8 mm (standard deviation [SD] = 1.6; P = .030) in group A patients with UCLAP between 1 and 5 years (SD = 1.6; P = .030) and by 6.3 mm (SD = 3.2; P = .016) in group B patients with BCLAP. The mean intermolar distance increased by 4 mm (SD = 3.4; P = .076) in patients with BCLAP. A trend toward improved canine positioning was observed in patients with BCLAP by 12 years of age, with improvement occurring between 4 and 12 years. The type of palatal closure (inducing scar tissue at the bony level) and the late installment of orthodontic/orthopedic expansion probably reduced the intercanine width in bilateral complete clefts.

Dentition Patterns in Different Unilateral Cleft Lip Subphenotypes

Oral clefts play an essential role in disturbed odontogenesis of the deciduous and permanent dentition, yet little is known about this relationship. We investigated, within the categories cleft lip with or without alveolus (CL ± A) and cleft lip, alveolus and palate (CLAP), whether different CL subphenotypes based on morphological severity of the cleft show different dentition patterns and whether a more detailed subdivision of the incomplete CL has clinical relevance. In this retrospective study, 345 children with nonsyndromic unilateral CL ± A and CLAP from the Dutch Association for Cleft Palate and Craniofacial Anomalies (NVSCA) registry were included to assess the association between the CL subphenotypes and lateral incisor patterns. Five different deciduous and permanent patterns of the lateral incisor were distinguished: located in normal position (pattern z/Z), in the anterior segment (pattern x/X) or in the posterior segment of the cleft (pattern y/Y), one in each segment of the cleft (pattern xy/XY), and agenesis of the lateral incisor (pattern ab/AB). Analyses were performed by using multinomial logistic regression models. Children born with a vermillion notch or a one-third to two-thirds CL were most likely to have a deciduous pattern x and a permanent pattern X, while children born with a two-thirds to subtotal CL were most likely to have deciduous pattern xy and a permanent pattern X compared to children with a complete CL that predominantly had deciduous pattern y and a permanent pattern AB. Based on the relationship of the CL morphology with the deciduous dentition, subdivision of the CL morphology into vermillion notch to two-thirds CL, two-thirds to subtotal CL, and complete CL appears to be an optimal subdivision. Our results indicate that a more detailed subdivision of the CL has clinical relevance and that critical factors in the pathogenesis of the CL are also critical for the odontogenesis.

Oral hygiene and dental caries status among patients with cleft lip, cleft palate and cleft lip, alveolus and palate in Chennai, India

Background: Long-term health of the stomatognathic system as well as esthetic aspects are the therapeutic goals in patients with orofacial clefts. Aim: The aim of this study is to compare the oral hygiene and dental caries status among patients with cleft lip (CL), cleft palate (CP), and CL alveolus and palate (CLAP) reporting to a hospital in India. Materials and Methods: The study group consisted of 80 cleft patients. Subjects were divided into three groups. Group 1: Patients with CL, Group 2: Subjects with CP and Group 3: Subjects with CLAP. Oral Hygiene Index-Simplified (Greene and Vermillion in 1964), decayed, missing and filled teeth (DMFT) (Klein, Palmer and Knutson in 1938) and deft Index (Grubbel in 1944) were recorded. Results: The maximum number of subjects having fair and poor oral hygiene was found in CLAP groups (42.9% and 7.1%). The mean DMFT was high in CLAP subjects (2.93 ± 2.94) compared to CL (2.73 ± 2.52) and CP subjects (2.58 ± 2.65). The mean deft was high in CP subjects (1.04 ± 2.22) compared to CL (0.28 ± 0.89) and CLAP subjects (0.26 ± 0.76). Conclusion: Oral hygiene status of CLAP patients was found to be fair, and they had moderate risk of dental caries.

Periodontal Status Among Patients With Cleft Lip (CL), Cleft Palate (CP) and Cleft Lip, Alveolus and Palate (CLAP) In Chennai, India. A Comparative Study.

Long term health of the stomatognathic system as well as esthetic aspects is the therapeutic goals in patients with oro facial clefts. The aim of this study was to assess and compare the periodontal status of patients with cleft lip (CL), cleft palate (CP) and cleft lip, alveolus and palate (CLAP) reporting to a hospital in Chennai, India. The study group consisted of 80 cleft patients. Subjects were divided into three groups. Group 1: patients with cleft lip (CL), Group 2: subjects with cleft palate (CP) and Group 3: subjects with cleft lip alveolus and palate (CLAP). Community Periodontal Index for Treatment needs CPITN Index was recorded. Among the 80 study subjects, 51 (63.8%) were males and 29 (36.2%) were females. Among the 26 study subjects with cleft lip, 10 (38.5%) had healthy periodontium, 4 (15.4%) had bleeding on probing and 12 (46.1%) had calculus. Mean number of sextants coded for healthy and bleeding was maximum among the subjects with cleft palate. Mean number of sextants coded for calculus was maximum among the subjects with cleft lip alveolus and palate. Prevalence of periodontal disease is high among patients with cleft lip, alveolus and palate (35%) than in Cleft lip (32.5%) and Cleft Palate (32.5%). Gingivitis and Calculus is predominantly high in patients with Cleft Palate and Cleft Lip respectively.

Sociodemographic profile of orofacial cleft patients in India: A hospital-based study

Aim: Long-term health of the stomatognathic system as well as esthetic aspects is the therapeutic goals in patients with orofacial clefts (OFCs). The aim of this study was to assess the sociodemographic profile of patients with OFCs in India. Materials and Methods: The study group consisted of 108 cleft patients. Subjects were divided into three groups. Group 1: Patients with cleft lip (CL), Group 2: Subjects with cleft palate and Group 3: Subjects with CL alveolus and palate (CLAP). A pretested interviewer administered questionnaire was used. Socioeconomic status (SES) was assessed using Pareek's scale for the rural population and Kuppuswamy's scale for the urban population. Results: Among the 108 study subjects, 69 (63.9%) were males, and 39 (36.1%) were females. 64 (59.2%) study subjects were residing in rural areas, and 44 (40.8%) were residing in urban areas. 29 (26.80%) from rural areas and 21 (19.50%) from the urban areas had a family income below Rs. 5001-10000. In rural areas, 47 (73.40%) study subjects belonged to the middle class and 17 (26.60%) study subjects belonged to the lower middle class. In urban areas, 20 (45.50%) study subjects belonged to the middle class and 24 (54.50%) study subjects belonged to the lower class. Conclusion: Most of the study subjects in rural areas belonged to middle SES, whereas in urban areas belonged to lower SES.

Announcements

Using the Dutch Oral Cleft Registration, which records the morphology and topography of common oral clefts, a new classification based on the (patho)embryology of the primary and secondary palates was tested. Prospective observational study. The fifteen cleft palate teams in the Netherlands register patients to the national registry. All unoperated patients with common oral clefts reported between 1997 and 2006 inclusive were included. The classification is based on the pathoembryological events that ultimately result in various subphenotypes of common oral clefts. PATIENTS within the three categories cleft lip/alveolus (CL/A), cleft lip/alveolus and palate (CL/AP), and cleft palate (CP) were divided into three subgroups: fusion defects, differentiation defects, and fusion and differentiation defects. A timetable was constructed to relate the type of clefting to the time of derailment during embryonic development. 3512 patients were included. PATIENTS with CL/A showed 22% fusion defects, 75% differentiation defects, and 3% fusion and differentiation defects. CL/AP patients and CP patients mostly showed fusion defects (70% and 89%, respectively). We were able to relate almost all (over 90%) cleft subphenotypes to specific weeks in embryonic development. This classification provides new cleft subgroups that may be used for clinical and fundamental research. The subphenotypes of these subgroups originate from different time frames during embryonic development and different cell biological mechanisms, thereby enabling more accurate data for, e.g., gene identification and/or environmental factors.

Classifying Common Oral Clefts: A New Approach after Descriptive Registration

Objective Using the Dutch Oral Cleft Registration, which records the morphology and topography of common oral clefts, a new classification based on the (patho)embryology of the primary and secondary palates was tested. Design Prospective observational study. Setting The fifteen cleft palate teams in the Netherlands register patients to the national registry. Patients All unoperated patients with common oral clefts reported between 1997 and 2006 inclusive were included. Main Outcome Measures The classification is based on the pathoembryological events that ultimately result in various subphenotypes of common oral clefts. Patients within the three categories cleft lip/alveolus (CL/A), cleft lip/alveolus and palate (CL/AP), and cleft palate (CP) were divided into three subgroups: fusion defects, differentiation defects, and fusion and differentiation defects. A timetable was constructed to relate the type of clefting to the time of derailment during embryonic development. Results 3512 patients were included. Patients with CL/A showed 22% fusion defects, 75% differentiation defects, and 3% fusion and differentiation defects. CL/AP patients and CP patients mostly showed fusion defects (70% and 89%, respectively). We were able to relate almost all (over 90%) cleft subphenotypes to specific weeks in embryonic development. Conclusions This classification provides new cleft subgroups that may be used for clinical and fundamental research. The subphenotypes of these subgroups originate from different time frames during embryonic development and different cell biological mechanisms, thereby enabling more accurate data for, e.g., gene identification and/or environmental factors.

Prevalencia de anomalías dentarias en pacientes con fisura labio alveolo palatina atendidos en el Instituto Especializado de Salud del Niño Lima Perú

Se estudió las anomalías en número de las piezas dentarias en pacientes con fisura labio alveolo palatina (FLAP) utilizando radiografías panorámicas e historias clínicas de 129 niños (79 niños y 50 niñas) de 6 a 12 años, del Instituto Especializado de Salud del Niño, Lima, Perú, correspondiente a los años 2005 a 2008. La prevalencia de agenesia dentaria fue de 86.8% y de dientes supernumerarios de 49.6% de la población total, mientras que 43.4% presentó ambas anomalías a la vez. 78 pacientes mostraron FLAP unilateral (60.5%); y 51, FLAP bilateral (39.5%). Con respecto a la distribución de agenesia dentaria según género se apreció que 68 casos (60,7%) fueron del género masculino y 44 del género femenino (39,3%); mientras que en los dientes supernumerarios 42 casos (65.6%) de género masculino y 22 casos (34.4%) del género femenino. Comparando la frecuencia de agenesia y dientes supernumerarios con el tipo de fisura, el grupo más afectado fue el de FLAP bilateral con 48 casos (42.9%) y 27 (42.2%) respectivamente, en cuanto al grupo de FLAP unilateral el del lado izquierdo presentó mayor afectación en ambas anomalías dentarias. La agenesia dentaria se presentó mayormente en el lado opuesto a la fisura (96.4%) mientras que los dientes supernumerarios se observan generalmente en el lado de la fisura (92.2%). Según la cantidad de piezas afectadas 41 niños presentaron una agenesia (36,6%) y 34 niños con dos agenesias (30,4%), siendo las piezas más afectadas el incisivo lateral (92.9%), segunda premolar (38.4%). En el caso de dientes supernumerarios, 39 casos (60.9%) presentaron sólo una pieza y 23 casos (35.9%) presentaron dos piezas supernumerarias; ubicados frecuentemente en el espacio entre el incisivo lateral y canino superior, presentándose por lo general no eruptivo (79.7%). Los dientes supernumerarios heteromórficos fueron los más comunes en este estudio.

Assessment of Deformities of the Lip and Nose in Cleft Lip Alveolus and Palate Patients by a Rating Scale

Labial and nasal deformities have always been a fundamental problem in the treatment of cleft lip, alveolus and palate patients. The primary surgical treatment of nasolabial area is of paramount importance in order to obtain both an esthetical correction of the deformity and a progressive and a balanced development of mid-face. In this study the nasal deformities in patients with cleft lip, alveolus and palate (CLAP) were analyzed and the relevant role of the perinasal, perioral muscular balance and the inborn dislocation of the alar cartilages are presented. 50 CLAP patients were analyzed, 40 UCLP and 10BCLP. The lip repair was done by modification of Millard's technique. The severity of the cleft appearance was evaluated pre and post operatively, according to a pre-agreed visual rating scale. There are 4° of severity of the deformity pre operatively (mild, moderate, severe and very severe) and post operatively 5 categories of outcome (excellent,very good, good, satisfactory and poor), depending on the scores obtained by summing up the points corresponding to different types of deformity. This scale is closely related to the American Cleft Palate classification of clefts. In the 40 UCLP patients, 8 excellent, 10 very good, 16 good and 6 satisfactory results were obtained following primary cheiloplasty. In 10 BCLP patients 1 very good, 7 good, 1 satisfactory and 1 poor result were obtained. During the primary repair, it is important to correct the abnormal position of ala nasi, the nasal floor and the base of the columella. Abnormalities in the insertion of the nasolabial muscles with their abnormal function contribute to the cleft nose deformities. Therefore the reconstruction not only the orbicularis muscle but also of the paranasal muscles is therefore important for a symmetrical growth of the nose. Separate suture of intrinsic orbicularis oris provide a better shape to the vermillion. The position of the alar cartilage plays an important role for the symmetry of the nose. It is necessary to place the alar base symmetrically in three dimensions.

Comparison of periodontal status among patients with cleft lip, cleft palate, and cleft lip along with a cleft in palate and alveolus.

Background and Objectives:A healthy periodontium is an important prerequisite for unhindered dentition and long-term oral health. In cleft subjects, especially in those with cleft lip, alveolus and palate (CLAP), maintenance of oral hygiene is a difficult task for the patients because of the patent oro-nasal communication. Crowding of teeth in cleft patients is a common finding, especially in those with CLAP and those with cleft palate (CP). In the case of multiple tooth-malpositions, transverse deficiency, arch length deficiency and primary cross-bite; periodontal trauma increases and is detrimental to periodontal health. According to literature, a critical periodontal situation was found in patients with CLAP. Hence a study was conducted to analyze the periodontal status of patients with cleft lip (CL); those with cleft palate; and those with cleft lip, alveolus and palate.Materials and Methods:The present study consisted of 60 cleft subjects divided into 3 groups: those with cleft lip; those with cleft palate; and those with cleft lip, alveolus and palate. Subjects with permanent dentition were selected, and the clinical examination included determination of oral hygiene status using Oral Hygiene Index — Simplified (OHI-S) index and periodontal status using community periodontal index (CPI).Results:Statistically significant increase in the periodontal disease in the CLAP group as compared with the other 2 groups, and the oral hygiene was seen to be generally poor with the CLAP group.Interpretation and Conclusion:Individuals with clefts are more prone to periodontal disease due to the presence of cleft, which causes retention of food in the defect sites and inability to maintain good oral hygiene; but the severity of periodontal disease is more if the defect is large and involving the lip, alveolus and palate.

Associated syndromes and other genetic variations at a South African cleft lip and palate clinic

A retrospective study was done of data on all patients registered at one of the largest cleft lip and palate clinics in South Africa (n = 3174). The associated syndromes and other genetic variations [(abbreviation:) ASGV] found in the population of persons suffering from facial cleft deformities (FCD) were analysed. 832 (26.2%) cleft lip and/ or palate patients presented with ASGV. Fifty-seven different types of syndromes were recorded of which the Fairbaim-Robin appearance (FRA) (or Pierre Robin sequence) 169 (5.3%), the Demarque-van der Woude syndrome 40 (1.3%), and the holoprosencephaly sequence cases 32 (1.0%) were the three most common ones. The three most common genetic variations found in the non-syndromic patients, were heart involvement 53(1.7%), club foot 42 (1.3%) and various eye problems 39 (1.2%). The main facial cleft deformity, namely the cleft lip, alveolus and palate (CLAP), was found in 26.2% of the ASGV-group. This particular cleft deformity was recorded at 39.7% in the FCD clinic. On the other hand, the hard and soft palate cleft (hPsP) group was found in 32.9% of patients who also had ASGV; in the total group of patients registered at the clinic, it accounted for only 16.6%. This means that ASGV occur less commonly in the CLAP group of patients, than in the hPsP group of patients.

Periodontal disease progression in subjects with orofacial clefts over a 25‐year follow‐up period

To assess rates of periodontal disease progression in subjects with cleft lip, alveolus and palate (CLAP) over a 25-year period without regular maintenance care in a specialist setting and to compare those with those of subjects without alveolar clefts, i.e. cleft lip (CL) or cleft palate (CP). Ten subjects with CLAP and 10 subjects with CL/CP were examined in 1979, 1987, 1993 and 2004. Probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BoP) and plaque control record (PCR) scores were recorded in all 20 subjects. High plaque and BoP scores were recorded at all examinations in both groups. Over 25 years, a statistically significant loss of mean full-mouth CAL of 1.52 +/- 0.12 mm (SD) and 1.66 +/- 0.15 mm occurred in the CLAP and CL/CP group respectively (p<0.05). A statistically significant increase (p<0.05) in mean full-mouth PPD of 0.35 +/- 0.12 mm was observed in the CL/CP group, whereas only a trend for a mean full-mouth increase in PPD of 0.09 +/- 0.11 mm was observed in the CLAP group. In subjects with CLAP, a statistically significant increase (p<0.05) in PPD of 0.92 +/- 1.13 mm at cleft sites was observed compared with that of 0.17 +/- 0.76 mm at control sites. With respect to CAL, the loss at the corresponding sites amounted to 2.71 +/- 1.46 and to 2.27 +/- 1.62 mm, respectively (p=0.36). When stringent and well-defined supportive periodontal therapy was not provided, subjects with orofacial clefts were at high risk for periodontal disease progression. Over 25 years, alveolar cleft sites tended to have more periodontal tissue destruction compared with control sites.

Failures and complications in patients with birth defects restored with fixed dental prostheses and single crowns on teeth and/or implants

To assess retrospectively, over at least 5 years, the incidences of technical and biological complications and failures in young adult patients with birth defects affecting the formation of teeth. All insurance cases with a birth defect that had crowns and fixed dental prostheses (FDPs) inserted more than 5 years ago were contacted and asked to participate in a reexamination. The median age of the patients was 19.3 years (range 16.6-24.7 years) when prosthetic treatment was initiated. Over the median observation period of 15.7 years (range 7.4-24.9 years) and considering the treatment needs at the reexamination, 19 out of 33 patients (58%) with reconstructions on teeth remained free from all failures or complications. From the patients with FDPs and single unit crowns (SCs) on implants followed over a median observation period of 8 years (range 4.6-15.3 years), eight out of 17% or 47% needed a retreatment or repair at some point due to a failure or a complication. From the three groups of patients, the cases with amelogenesis/dentinogenesis imperfecta demonstrated the highest failure and complication rates. In the cases with cleft lip, alveolus and palate (CLAP) or hypodontia/oligodontia, 71% of the SCs and 73% of the FDPs on teeth (FDP T) remained complication free over a median observation period of about 16 years. Sixty-two percent of the SCs and 64% of the FDPs on implants remained complication free over 8 years. Complications occurred earlier with implant-supported reconstructions. Because healthy, pristine teeth can be left unprepared, implant-supported SCs and FDPs are the treatment choice in young adults with birth defects resulting in tooth agenesis and in whom the edentulous spaces cannot be closed by means of orthodontic therapy. However, the trend for earlier and more frequent complications with implant-supported reconstructions in young adults, expecting many years of function with the reconstructions, has to be weighed against the benefits of keeping teeth unprepared. In cases with CLAP in which anatomical conditions render implant placement difficult and in which teeth adjacent to the cleft require esthetic corrections, the conventional FDP T still remains the treatment of choice.

Evaluation of patient satisfaction after therapy of unilateral clefts of lip, alveolus and palate

Cleft lip, alveolus and palate (CLAP) is a craniofacial abnormality and is one of the most frequent human developmental anomalies. Therapy of clefts does not only comprise surgical closure of the cleft, but rather aims at an aesthetically and functionally optimal result at adult age. Thirty-three cleft patients with total clefts of lip, alveolus and palate were enrolled in this study. Osseous bridging of the alveolar cleft (osteoplasty) was performed in all patients followed by different types of subsequent treatment. All patients answered a questionnaire to assess their satisfaction with the treatment result and their facial appearance. Patient satisfaction was correlated to the type of alveolar cleft repair. The returned questionnaires revealed varying patient satisfaction with their appearance, occlusal conditions, and dental aesthetics depending on the type of dental treatment in the alveolar cleft area. Questionnaire analysis by gender revealed clear gender-dependent differences in self-rated satisfaction. Aesthetics gain increasing importance for self-perception. Therefore, patient satisfaction with her facial appearance should move even more into focus of therapy of clefts.

Analysis of nasal and labial deformities in cleft lip, alveolus and palate patients by a new rating scale: preliminary report

Introduction: In this study the nasal deformities in patients with cleft lip, alveolus and palate (CLAP) were analysed and the relevant role of the perinasal-perioral muscular balance, and the inborn dislocation of the alar cartilages is presented. Patients and methods: 50 CLAP patients were analysed in whom 29 primary cheiloplasties, 12 lip revisions and 9 rhinoplasties were performed. The lip repair was done by a modification of Millard's technique, the nose by either a closed or open-sky rhinoplasty. The severity of the cleft appearance was evaluated pre- and postoperatively, according to a pre-agreed visual rating scale. There were 4 degrees of severity of the deformity preoperatively (mild, moderate, severe and very severe), and postoperatively 5 categories of outcome (excellent, very good, good, satisfactory and poor) depending on the scores obtained by summing up the points corresponding to different types of deformity. This scale is closely related to the American Cleft Palate classification of clefts. Results: 17 excellent, 4 very good, 2 good, 5 satisfactory and 1 poor result were obtained in the group of primary cheiloplasty. Eight excellent, 4 very good results were obtained by the lip revisions. Seven excellent and 2 satisfactory results were obtained following rhinoplasty. Conclusions: During the primary lip repair, it is important to correct the abnormal position of ala nasi, the nasal floor and the base of the columella. When correct insertion of m. transversus nasi to the nasal spine is achieved and a good repair of m. orbicularis oris, symmetry of the alae and normal growth of lip and columella was obtained even in most severe bilateral cases. In cases of diastasis of the orbicularis and transversus nasi muscles, in combination with other soft tissue deformities or scars, a secondary musculo-periosteal revision is recommended. The defect of the soft tissue triangle of the nose is best corrected via an open rhinoplasty.