Craniofacial Growth Research Articles

Effect of Beta Thalassemia Major on Anterior Cranial Base in Cephalometric Analysis

Background: Thalassemia is a group of hemolytic diseases caused by genetic disorders resulting from a decrease in the synthesis of the alpha or beta chains of hemoglobin (Hb). A particular craniofacial cephalometric picture is found in the form of mild skeletal class II clinical manifestations. The anterior cranial base becomes a benchmark or reference sector in the measurement of dentofacial structures on cephalometric radiographs because it is considered relatively stable throughout craniofacial growth. Objective: The purpose of this systematic literature review was to determine the effect of beta thalassemia major on the length of the anterior cranial base observed through cephalometric analysis. Methods: References were selected using the PubMed, Science Direct, and Google Scholar databases published from January 2007 to December 2021. The complete articles that met the inclusion and exclusion criteria were then assessed using the Critical Appraisal Skills Program bias assessment and summarized to obtain demographic data and the length of the patient's anterior cranial base in the journal. Results: This systematic literature review succeeded in synthesizing 6 journals consisting of case-control studies with low bias assessment results in 4 journals and moderate bias assessment in 2 journals. All journals in this systematic literature review stated that the length of the anterior cranial base in patients with beta thalassemia major was not much different from the control group seen in cephalometric analysis. Conclusion: There is no effect on the length of the anterior cranial base in patients with beta thalassemia major based on measurements on cephalometric analysis.

Role of growth hormone in orthodontics

Human growth hormone (Somatotropin) is produced by acidophilic growth hormone cells in the anterior pituitary gland, stimulated by hypothalamus. Its production is regulated by several complex feedback mechanisms in response to stress, exercise, diet, sleep and growth hormone itself. Growth hormone plays a major role in linear body growth and craniofacial growth. In Orthodontics, it induces orthodontic tooth movement by activating specific cytokines to regulate osteoclast & osteoblast activity. It mediates STAT signalling in liver & pancreas to produce JAK-IGF-1. IGF-1 has stimulatory effects on osteoblasts and chondrocytes for endochondral ossification to promote bone growth. Growth hormone mediates mitogenic stimulus to odontoblast lineage cells by epidermal growth factor (EGF) to differentiate into odontoblasts. It also stimulates production of alkaline phosphatase and osteocalcin in osteoblasts to improve osteoblast proliferation and differentiation. It also induces osteoclastic activity indirectly by production of IGF-1 and IL- 6 thereby activating RANK-RANKL/OPG phenomenon. It also promotes myofibrillar diameter expansion so it increases muscle mass with strength. Growth Hormone Replacement therapy reduces facial convexity and its main effect appears to be on condylar growth. Since deficiencies of growth hormone can adversely affect orthodontic treatment, effects of growth hormone treatment on craniofacial structures should be considered in order to maximize the effectiveness of orthodontic treatment with appliances and it is more important to understand.

Implant placement in the aesthetic zone: Long-term results.

SUMMARY: Implant placement is considered to be a routine procedure for oral rehabilitation, in cases of tooth agenesia or tooth loss (due to factors such as periodontitis, trauma,caries). Dental implants’ position does not change over time due to the process of “osseointegration”. On the contrary, teeth follow craniofacial growth (in particular, orofacial and dentoalveolar growth) and move. The stomatognathic system undergoes changes in its vertical and horizontal dimensions after adulthood. Implant placement on the anterior maxilla is challenging for clinicians, because of continuous eruption of adjacent teeth, as well as, due to occurrence of occlusal changes. Long-term aesthetic complications, such as differences in incisal edges’ length, position of gingival margins and open contact points between implant restorations and adjacent teeth, should be taken into consideration. The aim of this study is to review literature concerning long-term complications after implant placement in the anterior maxilla. Furthermore, 2 case reports concerning aesthetic problems of implant restorations in the esthetic zone will be presented, together with their treatment procedure. Consequently, with time, implant restorations in the anterior maxilla present aesthetic complications of various degrees, which are in need of personalized treatment plan. In order to avoid such complications, implant placement is recommended to be performed after completion of skeletal growth and maturation.

INFLUENCE OF MASSETER AND TEMPORALISMUSCLE ACTIVITY IN CLASS I HIGH AND LOW ANGLE CASES - AN ELECTROMYOGRAPHIC STUDY

Balanced muscular forces are one of the main factors required to achieve a stabilized environment within the development of the craniofacial complex and a stable occlusion. The normal occlusion is in a state of constant dynamic equilibrium. Thus, there is a balance of forces between muscles, which influences the position and stability of the teeth. Forces exerted during habitual functions such as mastication, swallowing and speech are robust enough to cause tooth movement, yet they do not continue for a long period to move teeth. Both jaw bone and teeth are responsive to this. Light sustained forces created by the tonic contraction of skeletal muscles are needed to retain the posture of mandible. Since the muscle function has substantial effect on craniofacial growth pattern, abnormal muscle function may explain certain abnormalities of facial morphology and forms of malocclusion. To understand the influence of masticatory muscles on craniofacial morphology, surface electromyography is routinely used.

Craniofacial and three-dimensional palatal analysis in cleft lip and palate patients treated in Spain

Growth alterations have been described in patients operated on for oral clefts. The purpose of this work was to analyze the craniofacial and palate morphology and dimensions of young adults operated on for oral clefts in early childhood in Spain. Eighty-three patients from eight different hospitals were divided into four groups based on their type of cleft: cleft lip (CL, n = 6), unilateral cleft lip and palate (UCLP, n = 37), bilateral cleft lip and palate (BCLP, n = 16), and cleft palate only (CPO, n = 24). A control group was formed of 71 individuals. Three-dimensional (3D) digital models were obtained from all groups with an intraoral scanner, together with cephalometries and frontal, lateral, and submental facial photographs. Measurements were obtained and analyzed statistically. Our results showed craniofacial alterations in the BCLP, UCLP, and CPO groups with an influence on the palate, maxilla, and mandible and a direct impact on facial appearance. This effect was more severe in the BCLP group. Measurements in the CL group were similar to those in the control group. Cleft characteristics and cleft type seem to be the main determining factors of long-term craniofacial growth alterations in these patients. Prospective research is needed to clearly delineate the effects of different treatments on the craniofacial appearance of adult cleft patients.

Applications of Biotechnology to the Craniofacial Complex: A Critical Review.

Biotechnology shows a promising future in bridging the gap between biomedical basic sciences and clinical craniofacial practice. The purpose of the present review is to investigate the applications of biotechnology in the craniofacial complex. This critical review was conducted by using the following keywords in the search strategy: "biotechnology", "bioengineering", "craniofacial", "stem cells", "scaffolds", "biomarkers", and "tissue regeneration". The databases used for the electronic search were the Cochrane Library, Medline (PubMed), and Scopus. The search was conducted for studies published before June 2022. The applications of biotechnology are numerous and provide clinicians with the great benefit of understanding the etiology of dentofacial deformities, as well as treating the defected areas. Research has been focused on craniofacial tissue regeneration with the use of stem cells and scaffolds, as well as in bioinformatics with the investigation of growth factors and biomarkers capable of providing evidence for craniofacial growth and development. This review presents the biotechnological opportunities in the fields related to the craniofacial complex and attempts to answer a series of questions that may be of interest to the reader. Biotechnology seems to offer a bright future ahead, improving and modernizing the clinical management of cranio-dento-facial diseases. Extensive research is needed as human studies on this subject are few and have controversial results.

Tongue-and lip-tie beyond breastfeeding difficulties

The diagnosis and treatment of tethered oral tie tissues, such as ankyloglossia (tongue-tie) and lip-tie, have grown substantially. Although robust evidence indicates that these abnormal anatomic variations are associated with breastfeeding difficulties, impaired craniofacial growth, sleep, speech and posture in children, both diagnosis and treatment of oral ties remain controversial. The oral cavity displays considerable morphological variation across individuals. One of these variations includes tight, restrictive connective tissue between oral structures known as tethered oral tie tissues (TOTs). The clinical view regarding these anomalies has evolved with increasing interest not only in tongue-tie (ankyloglossia) but also in lip-tie [1-3]. Ankyloglossia has been considered a risk factor for breastfeeding difficulties [4-16]. Recent evidence indicates that TOTs can be also associated with whole-body consequences, such as reflux, dental malocclusion, and respiratory disorders, ultimately increasing the risk of sleep and speech disorders, and detrimental changes in posture and eating patterns [13, 17-25]. The prevalence of TOTs is highly variable across populations and is still a matter of ample debate. Currently, there is a lack of consensus on diagnosis criteria, best surgical treatment techniques, and pre- and post-surgery care [19, 26, 27]. Yet, the diagnosis and surgical treatment of TOTs have substantially increased in recent years [28-31]. This mini-review will summarize evidence-based data regarding the cascade of consequences of tongue-tie and lip-tie in children and the main signs and symptoms of these anomalies in newborns. It will also discuss the available evidence on treatment options for TOTs, including pre- and post-surgical care that may enable better outcomes and prevention of possible complications. For a better understanding, tongue-tie and lip-tie will be addressed separately.

Skull base flexion and its influence on chewing

Skull base asymmetries can occur in the intrauterine period, manifesting from birth as craniofacial asymmetries and should be investigated both in the maxilla and mandible and in the craniofacial region, as they are related to the base of the skull. The objective of this study was to explain that treatment using Craniofacial Biodynamics (CFBD) enables symmetrical craniofacial growth, being recommended from three to six years of age, when the processes of skull base remodeling cease. This study was based on exploratory bibliographic research, aiming at a better understanding of the concepts presented in this therapeutic approach, to verify the influence that such concepts exert on treatment through CFBD. It was evidenced in this research that these asymmetries may be corrected, or even minimized through the CFBD, which relates the ontogenetic development of the skull base with orofacial development.

Influence of Primary Palatal Surgery on Craniofacial Morphology in Patients with Cleft Palate Only (CPO)-Systematic Review with Meta-Analysis.

Cleft palate only (CPO) is the second most prevalent cleft type. Both the cleft and palatal scarring may affect craniofacial growth. The aim of this systematic review was to summarize scientific evidence on effect of palatal surgery on craniofacial morphology in CPO. A search was conducted in PubMed, PMC, WoS, Scopus, Embase, using the keywords: "cleft palate" AND ("craniofacial morphology" OR "cephalometric analysis") NOT "lip" with inclusion and exclusion criteria ensuring confident, direct comparison between study groups. The quality assessment was performed with Arrive's scale for radiologic examinations. Of 713 potential articles, 19 were subjected to qualitative analysis and 17 to meta-analysis, which confirmed reduced SNA in unoperated CPO versus non-cleft individuals. No scientific evidence was found directly assessing the effect of surgery on craniofacial morphology. The negative effect of palatal surgery was seen indirectly: in treated CPO versus non-cleft, the size effect of SNA is bigger than in untreated CPO versus non-cleft. A high heterogeneity came from a few non-European publications. CPO is associated with sagittal maxillary deficiency resulting both from the cleft and from primary surgery, disregarding cleft severity in operated CPO patients. Ethnic differences influence craniofacial morphology in CPO. This research received no external funding. Study protocol number in PROSPERO database: CRD42021268957.

Accuracy of dental calcification stages for the identification of craniofacial pubertal growth spurt: proposal of referral parameters.

This study primarily aimed to assess the accuracy of radiographic dental calcification parameters for the identification of specific craniofacial growth stages. Permanent mandibular canines, premolars, and second molars of 288 patients, from 6 to 15years old, were analysed on randomly selected panoramic radiographs, and categorised according to two calcification methods. Reproducibility analyses and data derived from panoramic records were correlated with the gold-standard method, as evaluated from lateral cephalometric teleradiographs. Accuracy tests were finally calculated, considering several cutoff points. Dental calcification methods showed "strong" to "almost perfect" intra- and inter-examiner reproducibility. Significant, although weak correlations were observed for all parameters. Canine and first premolar calcification stage 8 and second premolar and second molar stage 7 showed higher sensitivity rates for identifying the pubertal growth spurt period, as well as the stage F for these teeth. Canine and first premolar stages 10 and H obtained higher specificity rates for identifying the absence of post-pubertal period. The dental calcification parameters showed adequate reproducibility, in addition to significant correlations with cervical vertebrae stages. Radiographic dental calcification parameters used for the mandibular first premolar obtained high accuracy rates and were recommended for identifying specific craniofacial growth periods.

The Association of Tonsil Hypertrophy with Pediatric Dentofacial Development: Evidence from a Cross-Sectional Study of Young Children in Shanghai, China.

PurposeThe prevalence of dentofacial deformity was reportedly higher than decades ago, to which upper airway (UA) obstruction-induced sleep-disordered breathing (SDB) might contribute a lot. Tonsil hypertrophy appears relatively common in the population of young children. Given that the association between tonsil hypertrophy and pediatric dentofacial deformity remained controversial, this cross-sectional research was designed to explore the internal relationship of those among young children in Shanghai, China.Patients and MethodsA stratified cluster sampling procedure was adopted, and a representative sample of 715 young children (8–10 years old) was recruited. The OSA-18 quality-of-life questionnaires (OSA-18) were finished by their guardians, and well-trained orthodontists performed the oral examinations. After collecting the valuable information, the descriptions and analyses were run by statistical software (SPSS, version 26.0).Results715 participants (334 boys and 381 girls) were involved in the analyses. As calculated, the current prevalence of malocclusion identified by Angle’s classification was 45.6% in this sample. No evident relation between OSA-18 scores and dentofacial abnormalities (P > 0.05) was found. With the enlargement of tonsil size, the proportion of children with triangular dental arch form (P < 0.05) and high vault palate (P < 0.001) was increasingly higher. More children with protruding profiles and fewer upright profiles were observed as the tonsil size increased, although it did not show a statistical difference (P = 0.103).ConclusionDental and craniofacial growth deficiency has become more prevalent among children, demanding more concerns from health authorities. Tonsil hypertrophy plays an essential role in the direction of dentofacial development. More efforts from local health authorities should be made to enhance public propaganda and education on the prevention and interruption of tonsil hypertrophy and related dentofacial abnormalities.

Craniofacial Growth and Asymmetry in Newborns: A Longitudinal 3D Assessment.

Objective: To evaluate the development of the craniofacial region in healthy infants and analyze the asymmetry pattern in the first year of life. Methods: The participants were grouped by sex and age (1, 2, 4, 6, 9, and 12 months) to receive three-dimensional (3D) photographs. Stereoscopic craniofacial photos were captured and transformed into a series of craniofacial meshes in each group. The growth patterns of the anthropometric indices and the degree of craniofacial asymmetry were measured, and average craniofacial meshes and color-asymmetry maps with craniofacial asymmetry scores were calculated. Results: A total of 373 photographs from 66 infants were obtained. In both genders, the highest and lowest growth rates for all anthropometric indices were noted between 1 and 2 months and between 9 and 12 months, respectively. Overall, male infants had higher anthropometric indices, head volume, and head circumference than female infants. The craniofacial asymmetry score was presented with a descending pattern from 1 to 12 months of age in both sex groups. Both sex groups showed decreased left-sided laterality in the temporal-parietal-occipital region between 1 and 4 months of age and increased right frontal-temporal prominence between 6 and 12 months of age. Conclusions: A longitudinal evaluation of the craniofacial growth of healthy infants during their first year of life was presented.

Auto-segmentation of important centers of growth in the pediatric skeleton to consider during radiation therapy based on deep learning.

Routinely delineating of important skeletal growth centers is imperative to mitigate radiation-induced growth abnormalities for pediatric cancer patients treated with radiotherapy. However, it is hindered by several practical problems, including difficult identification, time consumption, and inter-practitioner variability. The goal of this study was to construct and evaluate a novel Triplet-Attention U-Net (TAU-Net)-based auto-segmentation model for important skeletal growth centers in childhood cancer radiotherapy, concentrating on the accuracy and time efficiency. A total of 107 childhood cancer patients fulfilled the eligibility criteria were enrolled in the training cohort (N=80) and test cohort (N=27). The craniofacial growth plates, shoulder growth centers, and pelvic ossification centers, with a total of 19 structures in the three groups, were manually delineated by two experienced radiation oncologists on axial, coronal, and sagittal computed tomography images. Modified from U-Net, the proposed TAU-Net has one main branch and two bypass branches, receiving semantic information of three adjacent slices to predict the target structure. With supervised deep learning, the skeletal growth centers contouring of each group was generated by three different auto-segmentation models: U-Net, V-Net, and the proposed TAU-Net. Dice similarity coefficient (DSC) and Hausdorff distance 95% (HD95) were used to evaluate the accuracy of three auto-segmentation models. The time spent on performing manual tasks and manually correcting auto-contouring generated by TAU-Net was recorded. The paired t-test was used to compare the statistical differences in delineation quality and time efficiency. Among the three groups, including craniofacial growth plates, shoulder growth centers, and pelvic ossification centers groups, TAU-Net had demonstrated highly acceptable performance (the average DSC=0.77, 0.87, and 0.83 for each group; the average HD95=2.28, 2.07, and 2.86mm for each group). In the overall evaluation of 19 regions of interest (ROIs) in the test cohort, TAU-Net had an overwhelming advantage over U-Net (63.2% ROIs in DSC and 31.6% ROIs in HD95, p=0.001-0.042) and V-Net (94.7% ROIs in DSC and 36.8% ROIs in HD95, p=0.001-0.040). With an average time of 52.2min for manual delineation, the average time saved to adjust TAU-Net-generated contours was 37.6min (p<0.001), a 72% reduction. Deep learning-based models have presented enormous potential for the auto-segmentation of important growth centers in pediatric skeleton, where the proposed TAU-Net outperformed the U-Net and V-Net in geometrical precision for the majority status.

A longitudinal assessment of sex differences in the growth of the mandibular retromolar space

ObjectiveTo assess longitudinal variation in patterns of retromolar space growth, with regard to sex and cervical vertebrae maturation. DesignWe utilized serial lateral cephalograms from three craniofacial growth studies (Denver, Iowa, Oregon), measuring retromolar space and cervical vertebrae maturation in 99 subjects (56% male) from 8 to 18 years of age for each subject. Repeated measures ANOVA and a linear mixed effects model were used to assess retromolar space growth through time. ResultsOur analyses revealed an average increase in retromolar space of 8.73 mm from 8 to 18 years. While t-tests failed to find differences in retromolar space growth between males and females at the measured age points, repeated measures ANOVA and linear mixed effects models revealed modest differences in growth trends between sexes, with females having more growth earlier but a younger age of deceleration of growth (between 12 and 14 years of age). ConclusionsOur results confirm large increases in retromolar space through growth, reaching an average of 1.38 mm/year around puberty. Importantly, we add to the conversation regarding sex differences, showing differences in timing of growth. This highlights the importance of using longitudinal data and analytical approaches to address questions of this nature.

Build and breathing – Is there an association?

Normal breathing is essential for the harmonious craniofacial growth. Narrowing or functional impairment of the airway can lead to obstructive sleep apnoea (OSA). Orthodontists are well positioned to carry out a screening of OSA and refer the patients-at-risk for further diagnostic valuation by the physician. The aim of this research was to evaluate the presence of a correlation between the build of the patient and airway insufficiency to sensitize the eye of the orthodontist for potential at-risk OSA patients and provide a superior quality of treatment for them. Pre-treatment lateral cephalograms of 45 patients were divided into three groups depending on the build of the patient, i.e., endomorphic, mesomorphic and ectomorphic. The BMI was calculated for each individual and all were evaluated for the presence of airway insufficiency using McNamara’s pharyngeal width analysis. The positions of the hyoid bone and the tongue posture was also evaluated. The results of the present study showed that the association between the overall McNamara airway measurements and the build of the patient was statistically insignificant. A statistically significant difference was found between the association of the two sexes with the upper pharyngeal width values and the BMI values with the males showed a higher risk for airway insufficiency. This study suggests that build of the patient cannot be considered as a screening factor for airway insufficiency or OSA. However, a significant correlation exists between the airway insufficiency and the sex of the patient with a higher predilection of upper airway insufficiency in males.

Assessment of Dentofacial Characteristics and Pharyngeal Airway in Children with Class II Malocclusion and Mouth Breathing

Abstract Background In growing patients with skeletal discrepancies, early diagnosis, evidence-based explanation of etiology, and assessment of functional factors can be vital for the restoration of normal craniofacial growth and the stability of treatment needs. Aims The aim of the study was to assess dentofacial characteristics as well as upper and lower pharyngeal airway in children with skeletal class II malocclusion with mouth breathing, and to investigate possible significant relationships and correlations among the studied cephalometric variables and the airway morphology in these children. Materials and Methods Sixty untreated children, aged 9 to 13 years, were divided into three groups according to clinical findings and cephalometric analysis of dentofacial characteristics as well as the presence of mouth breathing habit: Group I (20 children with normal jaw relation/class I), Group II (20 children with skeletal class II), and Group III (20 children with skeletal class II with confirmed mouth breathing habit). Cephalometric variables and upper/lower airway widths were recorded. Intergroup comparison of all measurements was performed by post hoc Tukey test, and Pearson's correlation was used to determine the correlation among the variables. Results Significant changes existed in more than half of the dentofacial measurements among the three groups. Significantly greater skeletal anteroposterior jaw discrepancy and mandibular retrognathism were found in both groups II and III as determined by specific anteroposterior determinants. Children in group III showed significantly increased angle between Sella-Nasion and mandibular plane (SN-MP) angle, y-axis, and a vertical growth pattern. Significant increases in dental measurements, namely upper incisor to Nasion- point A (NA), lower incisor to Nasion - point B (NB), and overjet, were found in group II and group III, while overbite showed a significant decrease. Upper pharyngeal airway width was found to be significantly decreased in group III followed by a smaller though significant decrease in group II. No significant differences were found in lower pharyngeal airway width between the groups. There were statistically significant dentofacial characteristics that showed fair to good correlation with the upper airway width. Conclusion Children with skeletal class II malocclusion with and without mouth breathing showed significant differences in dentofacial measurements and a significantly narrower upper pharyngeal airway as compared with children with normal jaw/class I relation.

Polymorphic Variants across Population of the Growth Hormone Receptor with Mandible Prognathism: A Systematic Review

AbstractGenetic influences are critical for determining mandibular protrusion in class IIImalocclusion cases, and growth hormone receptors (GHRs) are thought to have an essential impact on craniofacial bone growth. This review aimed to assess the association between GHR gene polymorphism variants and mandibular morphology. Studies were extensively searched using PubMed and Google Scholar until December 2020. The study design according to PECOS was: P, class III malocclusion; E, GHR polymorphism; no polymorphism in C, GHR; O, linear dimensional changes in maxillary and mandibular measurements; and S, cross-sectional and case-control studies. Selected studies were of acceptable methodological quality on a 10-point scale. A preliminary search identified 107 studies; after excluding duplicate abstracts, 63 studies were screened. Nine studies were subsequently included in the systematic review. Conclusion Polymorphic variants at rs6180, rs6182, and rs6184 in the GHR gene were associated with condylion-gonion measures in Asians and Turks but not in Colombians and Egyptians.

Evaluation of the Severity of Malocclusion in Children with Osteogenesis Imperfecta.

Occlusion is the way in which the dental arches are related to each other and depends on craniofacial growth and development. It is affected in patients with Osteogenesis Imperfecta (OI) who present altered craniofacial development. The malocclusion present in 49 patients diagnosed with different types of OI aged between 4 and 18 was studied. The control group of healthy people was matched for age, sex, and molar class. To study the mixed and permanent dentition, the American Board of Orthodontics (ABO) discrepancy Index was applied. The primary dentition was evaluated with a Temporary Dentition Occlusion Analysis proposed for this study. The OI group obtained higher scores in the Discrepancy Index than the control group, indicating a high difficulty of treatment. The most significant differences were found in types III and IV of the disease. Regarding the variables studied, the greatest differences were found in the presence of lateral open bite in patients with OI, and in the variable “others” (agenesis and ectopic eruption). The analysis of primary dentition did not show significant differences between the OI and control groups. Patients with OI have more severe malocclusions than their healthy peers. Malocclusion is related to the severity of the disease and may progress with age.

EVALUATION OF THE FACIAL PATTERN AND ORAL FUNCTIONS IN CHILD PATIENTS WITH MICROCEPHALY

<h3>Objectives</h3> The study aimed to evaluate the correlation of facial pattern and oral functions in children with microcephaly. <h3>Study Design</h3> The population consisted of 7 children with complete primary dentition. Data collection consisted of the analysis of clinical records and front and profile facial photography. <h3>Results</h3> There was a predominance of dolichofacial type (100%) and vertical pattern (85.71%). All had unilateral chewing, mouth breathing, bruxism, and atypical swallowing. The proportion of severe microcephaly (-3DP) was higher in males (<i>P</i> = .04). There was no association between the severity of microcephaly and facial type (<i>P</i> > .05), although the vertical pattern predominated in severe microcephaly (100%). There was a moderate association between the dolichofacial type and the presence of orofunctional disorders (<i>P</i> < .05). <h3>Conclusions</h3> Oral health care for these children should include dental development, the stomatognathic system, and craniofacial growth in early childhood to significantly reduce curative procedures.

Craniofacial Growth at Age 6-11 Years after One-Stage Cleft Lip and Palate Repair: A Retrospective Comparative Study with Historical Controls.

Background: Primary alveolar bone grafting inhibits craniofacial growth. However, its effect on craniofacial growth in one-stage cleft lip and palate protocols is unknown. This study investigated whether primary alveolar bone grafting performed during one-stage unilateral cleft lip and palate repair negatively affects growth up to 6–11 years old. Methods: The craniofacial growth, dental arch relationship and palatal morphology at 6–11 years old in children with unilateral cleft lip and palate were compared retrospectively. Two cohorts after a one-stage protocol without (Group A) and with (Group B) primary bone grafting at the same center were compared. Further, cephalometric measurements for growth were compared with an external cohort of a one-stage protocol and a heathy control. Results: Group A comprised 16 patients assessed at 6.8 years (SD 0.83), and Group B comprised 15 patients assessed at 9 years (SD 2.0). Cephalometric measurements indicated similar sagittal maxillary growth deficits and a significant deviation in maxillary inclination in both groups compared to the healthy group. Moderate to severe changes in palatal morphology were observed in 70% of the members in both groups. Conclusion: Omitting primary alveolar bone grafting under the one-stage protocol with two-flap palatoplasty studied did not improve growth at 6–11 years. The results implicate two-flap palatoplasty with secondary healing as having greater adverse effects on growth than primary alveolar bone grafting. Dental and palatal morphology was considerably compromised regardless of primary alveolar bone grafting.