Dental Arch Relationships In Patients Research Articles

Evaluating Dental Arch Relationships in Indonesian Patients with Operated Bilateral Cleft Lip and Palate Using Modified Huddart/Bodenham Index and Bauru-bilateral cleft lip and palate (BCLP) Yardstick.

Patients with complete bilateral cleft lip and palate (CBCLP) have the most complex orofacial abnormalities despite its lowest incidence among cleft lip and palate (CLP) types. Impaired maxillary growth can result from surgical procedures in patients with CBCLP. This study evaluates dental arch relationships in Indonesian patients with CBCLP after undergoing CLP repair at Harapan Kita Children and Mother Hospital in Jakarta. Using the modified Huddart and Bodenham (MHB) index and Bauru bilateral cleft lip and palate (BCLP) yardstick, three examiners assessed 17 study models in the 9-year age group and 13 study models in the 12-year age group, as well as two intraoral clinical photographs of two patients with CBCLP. The assessments were repeated three times within two weeks of each assessment time. Patients with operated CBCLP (aged 9 and 12 years) had edge-to-edge tooth relations, which were categorized as a mild crossbite or mild deviation, and only required orthodontic treatment according to the two specified indicators. The CLP repair protocol used at the Harapan Kita Hospital effectively manages CBCLP cases with satisfactory results, suggesting the effectiveness of the MHB index and Bauru-BCLP yardstick in assessing dental arch relationships in patients with operated CBCLP. Key words:Bilateral, cleft lip and palate, dental arch relationship, lip repair, palate repair.

Maxillary Development and Dental Arch Relationships Following Early Two-Stage Palatoplasty: A Comparative Study.

To examine skeletal morphology and dental arch relationships at 8 years of age following early 2-stage palatoplasty, which consists of soft palate plasty at 1 year of age and hard palate closure at 1.5 years of age, and to compare the results with those of conventional pushback palatoplasty. Retrospective. Single institutional study. Eighty-six patients with nonsyndromic complete unilateral cleft lip and palate (UCLP) were selected. The subjects were divided into 2 groups according to the palatoplasty protocols, as follows: 45 patients, who underwent early 2-stage palatoplasty (ETS group), and 41 patients, who underwent 1-stage pushback palatoplasty (PB group). Skeletal morphology was assessed using lateral cephalometric analysis, and dental arch relationships were examined using the GOSLON yardstick. Cephalometric analysis revealed that the anterior-posterior length of the maxilla, measured by PTM-A and PTM-ANS, both projected to the nasal floor (NF) plane, was longer in the ETS group than in the PB group (PTM-A/NF, p = .04; PTM-ANS/NF, p = .03, unpaired t-test), although no significant difference was observed in SNA (p = .09, unpaired t-test). Upper posterior facial height was shorter in the ETS group than in the PB group (p = .02, unpaired t). Assessments with the GOSLON yardstick showed that the ETS group presented better dental arch relationships than the PB group (p = 0.04, Mann-Whitney's U-test). The present results suggested that the ETS protocol reduced the negative effects of palatal surgery on facial development and dental arch relationships in patients with complete UCLP at 8 years of age.

Primary surgery effect on dental arch relationships of patients born with unilateral cleft lip and palate using the GOSLON yardstick index

To score dental arch development using the Great Ormond Street, London, and Oslo (GOSLON) yardstick index, following primary surgery in patients with a complete unilateral cleft lip and palate (UCLP), and to compare the outcome score with the GOSLON score of Cleft Care UK (CCUK) as well as with the Clinical Standards Advisory Group (CSAG), United Kingdom.Study models of patients (average age 12 years) with a non-syndromic complete UCLP, who had been surgically treated at the University of Pretoria Facial Cleft Deformity (UPFCD) clinic. They were assessed using the GOSLON yardstick index by certified raters from the Dental School in Dundee, Scotland. The mean outcome ratings were calculated from the scoring of 27 sets of plaster models. The other scoring rounds were used to calculate intraand inter-observer agreement using Cohen's weighted kappa and Fleiss's multi-rater kappa. There were strong intra- and inter-observer agreement, with a weighted kappa of 0.92. The Facial Cleft Deformity (FCD) clinic data showed a good treatment outcome with a mean GOSLON rating of 2.85 compared to a rating of 3.2 for the CSAG and 2.62 for the CCUK cohort studies. The UPFCD clinic primary surgical protocol displayed a good treatment outcome rating, in line with that of the CCUK cohort and better than the CSAG results.

The Slavcleft: A three-center study of the outcome of treatment of cleft lip and palate. Part 2: Dental arch relationships

PurposeOur aim was to evaluate the dental arch relationship in a preadolescent Slavic population with unilateral cleft lip and palate (UCLP) by using the Goslon Yardstick. Materials and methodsPatients treated in Warsaw, Poland (n = 32), Prague, Czech Republic (n = 33) and Bratislava, Slovakia (n = 30) were included in this retrospective study. Each cleft center used a unique surgical protocol. Three raters scored blindly the dental arch relationship on plaster models. Intra- and inter-rater agreement were assessed with kappa statistics, and differences between the groups were evaluated with one-way analysis of variance. Intra-rater agreement was very good (k > 0.825), while inter-rater agreement was either good or very good (kappa >0.703). ResultsWe found that patients treated in Warsaw showed a more favorable dental arch relationship (Goslon score = 2.58, SD = 0.77) than patients treated in Prague (Goslon score = 3.21, SD = 1.04). Patients treated in Bratislava showed an intermediate Goslon score (3.07; SD = 0.99). ConclusionThis study showed that the dental arch relationships in patients treated in Warsaw with a one-stage repair were more favorable than in patients treated in Prague and Bratislava with a two-stage protocol and comparable to the best results obtained in the Eurocleft and Americleft studies.

Dental arch relationship outcomes for children with complete unilateral and complete bilateral cleft lip and palate in New Zealand

To evaluate dental arch relationships of patients with complete unilateral and complete bilateral cleft lip and palate (CUCLP/CBCLP) in New Zealand. Retrospective nationwide observational outcomes study involving 100 CUCLP and 32 CBCLP non-syndromic patients. Four calibrated assessors, blinded to the origin of the randomized digital models, used the GOSLON (UCLP) and the Bauru-BCLP (BCLP) Yardsticks and a 100mm visual analogue scale (VAS) (UCLP&BCLP) to assess dental arch relationships. Weighted Kappa statistics were used to determine the intra- and inter-rater reliability for the GOSLON/Bauru-BCLP Yardsticks and correlations for the VAS. Intra-rater reliability ranged from 0.57 to 0.88 (GOSLON), 0.62-0.84 (Bauru-BCLP) and 0.45-0.93 (VAS). Inter-rater reliability ranged from 0.62 to 0.86, (GOSLON), 0.48-0.75 (Bauru-BCLP) and 0.64-0.93 (VAS). Of the 100 CUCLP models, 46% had poor/very poor, 28% fair and 26% had good/very good dental arch relationships. Of the 32 CBCLP models, 37.5% were poor/very poor, 40.6% fair and 21.9% had good/very good dental arch relationships. The mean CUCLP VAS score was 50.5mm (SD 19.9mm) whilst the mean CBCLP VAS score was 40.0mm (SD 22.0mm) and both showed a strong relationship with their respective Yardstick scorings. The dental arch relationships of children in New Zealand with CUCLP are similar to those centres in the Eurocleft and Americleft studies which had less favourable outcomes. Those with CBCLP are inferior to those reported elsewhere. Continued monitoring will allow for tracking of improvement in outcomes.

Midfacial growth and dental arch relationships in bilateral cleft palate following secondary alveolar bone grafting and orthodontic intervention: Factors predicting a Le Fort I osteotomy at age 18

ObjectiveTo evaluate midfacial growth and dental arch relationships in patients treated for bilateral cleft lip and palate (BCLP). Materials and MethodsData were collected from all patients with BCLP treated at our hospital between 2004 and 2014, with or without premaxillary osteotomy (PO). Dental casts for pre-secondary alveolar bone grafting with PO (SABG + PO) and end-point dental casts were analyzed using the BAURU yardstick scoring system. Pre-SABG + PO, post-SABG + PO, and end-point SABG + PO lateral cephalograms were analyzed. The correlation between both scoring systems was calculated. ResultsThere were no significant differences between the BAURU scores for centers in a previous study and those collected here. A negative correlation was found between the pre-SABG + PO ANB (Angle between A-point, Nasion and B-point) angle and pre-SABG + PO BAURU scores (R = −0.58; p = 0.000), the long-term post-SABG + PO ANB and mean end-point BAURU (R = −0.50; p = 0.000), and the pre-SABG + PO ANB and mean end-point BAURU (R = −0.51; p = 0.000). ConclusionWe found no significant difference between pre-SABG + PO and end-point BAURU scores. There was a decrease in the SNA (Angle between Sella, Nasion and A-point) and ANB angle over time, indicating delayed growth of the maxilla. We found a negative correlation between the pre-SABG ANB and end-point BAURU scores. Pre-SABG ANB can be used to predict the need for Le Fort I osteotomy at age 18.

Evaluation of dental arch relationship of patients with unilateral cleft lip and palate

Background: Several classifications have previously been described to assess dental arch relationships of cleft patients and therefore the surgical outcome. The most commonly used method for evaluation of surgical outcome is Goslon Yardstick. Another scoring system that can be used is the modified Huddart/Bodenham scoring system. Aim: The objective of this study was to evaluate the dental arch relationships of subjects with repaired unilateral and cleft lip and palate who come at an orthodontic center by means of Goslon and modified Huddart/Bodenham scoring system and to find a correlation between the two systems. Methodology: The study models of 16 patients (9 males, 7 females) with an average age of 14.2 years (range 11–23 years) were evaluated for arch constriction by four observers which included two orthodontists and two postgraduate students. Results: The analysis of dental arch relationship using Goslon Yardstick revealed that 63% of patients ranked between Goslon 3 and 5. The mean modified Huddart/Bodenham score was −16.13. Conclusion: The study revealed that modified Huddart/Bodenham scoring system provided better interobserver agreement than Goslon Yardstick by untrained observers. There was a good inverse correlation between two scoring systems.

Presurgical cleft lip anthropometrics and dental arch relationships in patients with complete unilateral cleft lip and palate.

To investigate associations between anthropometric lip measurements and dental arch relationships in patients with complete unilateral cleft lip and palate (CUCLP). Retrospective cross-sectional study. Children with CUCLP. Anthropometric lip measurements, made immediately prior to lip repair, were available for each patient. The dental arch relationships were evaluated on dental study casts (8.6 ± 0.9 years) taken prior to any orthodontic treatment and prior to alveolar bone graft, using the modified Huddart and Bodenham (MHB) scoring system. The presence of associations between anthropometric lip measurements and dental arch relationships was determined using linear regression analysis. In the 63 patients included in the study, the cleft lateral lip element was deficient in height in 87% and in transverse width in 86% of patients. Patients with more deficient cleft-side lateral lip height were more likely to present with more negative MHB scores (r = .443; P < .001). Conversely, patients with more deficient cleft-side lateral lip transverse width more often presented with more positive MHB scores (r = .281; P = .025). In patients with CUCLP, there is a wide variability in the degree of deficiency of the cleft-side lateral lip element, both in the vertical and in the transverse dimension. The extent of this deficiency may, in part, predict the resulting dental arch relationships.

Three-Dimensional Digital Models for Rating Dental Arch Relationships in Unilateral Cleft Lip and Palate

Objective : To determine the reliability and reproducibility of using three-dimensional digital models as an alternative to plaster models for rating dental arch relationships in patients born with unilateral cleft lip and palate. Design : Reliability and reproducibility study. Methods : Study models of 45 patients born with unilateral cleft lip and palate were made available in plaster and three-dimensional digital models. Records were scored a week apart by three examiners using the 5-year-olds' index reference models in the same two formats as the patient models. To assess reproducibility the study was repeated 4weeks later under similar conditions to minimize the influence of memory bias on the results. The reliability of using the three-dimensional digital models was determined by comparing the scores for each examiner with the plaster model scores. Results : Weighted kappa statistics indicated repeatability for the plaster models was very good (.83 to .87). For the three-dimensional digital models it was good to very good (.74 to .83). Overall, the use of the three-dimensional digital models showed good agreement with the plaster model scores on both occasions. Conclusion : Three-dimensional digital models appear to be a good alternative to plaster models for assessing dental arch relationships using the 5-year-olds' index.

Dental Arch Relationships on Three-Dimensional Digital Study Models and Conventional Plaster Study Models for Patients with Unilateral Cleft Lip and Palate

To determine if three-dimensional (3D) digital study models could replace plaster study models for the evaluation of dental arch relationships for patients with unilateral cleft lip and palate. Observational study involving plaster study models from a records archive. U.K. National Health Service. Thirty sets of study models of 5-year-old patients with unilateral cleft lip and palate were identified and scanned to produce 3D digital study models by ESM Digital Solutions Ltd. (Swords, Co. Dublin, Ireland) using an R250 Orthodontic Study Model Scanner (3Shape A/S, Copenhagen, Denmark). None. The plaster and 3D digital study models were scored using the 5-year-olds' and modified Huddart Bodenham indices and analyzed using the Friedman test (p < .05) and two-way ANOVA, respectively. Intra-observer and interobserver reproducibility were calculated from the 5-year-olds' index data using the weighted kappa statistic for both the plaster and 3D digital models. Intra-observer and interobserver reproducibility were good (0.62 to 0.83 and 0.64 to 0.78, respectively). There were no statistically significant differences between the scores for the 3D digital study models when compared to the plaster study models for either the 5-year-olds' index (p = .12) or for the modified Huddart Bodenham index (p = .506). Three-dimensional digital models are a valid alternative to traditional plaster study models for the evaluation of dental arch relationships in patients with unilateral cleft lip and palate.

Photographs of dental casts or digital models: rating dental arch relationships in bilateral cleft lip and palate

Yardsticks have been developed to measure dental arch relations in cleft lip and palate (CLP) patients as diagnostic proxies for the underlying skeletal relationship. Travelling with plaster casts to compare results between CLP centres is inefficient so the aim of this study was to investigate the reliability of using digital models or photographs of dental casts instead of plaster casts for rating dental arch relationships in children with complete bilateral cleft lip and palate (CBCLP). Dental casts of children with CBCLP (n=20) were included. Plaster casts, digital models and photographs of the plaster casts were available for all the children at 6, 9, and 12 years of age. All three record formats were scored using the bilateral cleft lip and palate (BCLP) yardstick by four observers in random order. No significant differences were found for the BCLP yardstick scores among the three formats. The interobserver weighted kappa scores were between 0.672 and 0.934. Comparison between the formats per observer resulted in weighted kappa scores between 0.692 and 0.885. It is concluded that digital models and photographs of dental casts can be used for rating dental arch relationships in patients with CBCLP. These formats are a reliable alternative for BCLP yardstick assessments on conventional plaster casts.

Comparison of Two Scoring Systems for Evaluation of Treatment Outcome in Patients with Complete Bilateral Cleft Lip and Palate

To compare two scoring systems: the Huddart/Bodenham system (HB system) and the Bauru-BCLP yardstick (BCLP yardstick), which classify treatment outcome in terms of dental arch relationships in patients with complete bilateral cleft lip and palate (CBCLP). The predictive value of these scoring systems for treatment outcome was also evaluated. Retrospective longitudinal study. Dental arch relationships of 43 CBCLP patients were evaluated at 6, 9, and 12 years. Setting : Treatment outcome in BCLP patients using two scoring systems. For each age group, the HB scores were correlated with the BCLP yardstick scores using Spearman's correlation coefficient. The predictive value of the two scoring systems was evaluated by backward regression analysis. Intraobserver Kappa values for the BCLP yardstick scoring for the two observers were .506 and .627, respectively, and the interobserver reliability ranged from .427 and .581. The intraobserver reliability for the HB system ranged from .92 to .97 and the interobserver reliability from .88 to .96. The BCLP yardstick scores of 6 and 9 years together were predictors for the outcome at 12 years (explained variance 41.3%). Adding the incisor and lateral HB scores in the regression model increased the explained variance to 67%. The BCLP yardstick and the HB system are reliable scoring systems for evaluation of dental arch relationships of CBCLP patients. The HB system categorizes treatment outcome into similar categories as the BCLP yardstick. In case a more sensitive measure of treatment outcome is needed, selectively both scoring systems should be used.

Dental arch relationships after two-flap palatoplasty in Taiwanese patients with unilateral cleft lip and palate

The authors evaluated the dental arch relationships of patients with unilateral cleft lip and palate treated with two-flap palatoplasty at the Chang Gung Craniofacial Center, Taipei, Taiwan, and compared them with the 6 centers from the Eurocleft study. Intraoral dental photographs of 60 consecutively treated Taiwanese patients with complete unilateral cleft lip and palate were used. The dental arch relationships were rated with the Goslon yardstick and compared with the Goslon outcome of the 6 center Eurocleft study. The strength of agreement of rating was assessed with quadratic-weighted kappa statistics. Inter- and intra-examiner agreements were high. 75% of patients were classified into poor or very poor categories, and the mean Goslon score was 3.92. These results showed no significant difference with Eurocleft center D, which had relatively poor treatment outcome. These data suggest that intraoral dental photographs provide a reliable method for rating dental arch relationships. Dental arch relationships in patients with unilateral cleft lip and palate at Chang Gung Craniofacial Center were unfavorable. This seemed to be attributable to the surgical procedures and racial differences in craniofacial morphology.

Intraoral Photographs for Rating Dental Arch Relationships in Unilateral Cleft Lip and Palate

The Goslon Yardstick is one of the most commonly used methods to assess dental arch relationships of patients with unilateral cleft lip and palate. This system was originally applied to dental casts. For reasons of economy and convenience, we aimed to determine whether intraoral photographs could substitute for dental casts for rating dental arch relationships. Records of 58 patients with nonsyndromic complete unilateral cleft lip and palate from the Chang Gung Craniofacial Center, Taipei, Taiwan, were used in this study. A set of dental casts and digital intraoral photographs taken at around 9 years of age were available for all patients. An experienced examiner rated the dental casts using the Goslon Yardstick to provide the reference scores. The other three examiners rated the intraoral photographs and repeated the rating 1 week later to calculate inter- and intraexaminer reliability. The photographic scores for each examiner were then compared with the reference scores to determine the validity of the photographs. The results showed no significant difference between the rating of dental casts and photographs using the Goslon Yardstick. Reliability was also high for rating on photographs. Intraoral photographs appear to be a viable alternative to the application of the Goslon Yardstick on dental casts.

A Multicenter Outcomes Assessment of Five-Year-Old Patients with Unilateral Cleft Lip and Palate

Compare 5-year-old dental arch relationships of patients from three centers with differing primary protocols. Retrospective study of treatment outcomes using blinded evaluation of dental study casts. Three major cleft-craniofacial centers; one (center A) is a free-standing institution, and two (centers B and C) are university hospitals. 118 (A = 41; B = 33; C = 44) consecutively treated 5-year-old patients with complete, nonsyndromic unilateral cleft lip and palate. Centers A and C completed primary repair without presurgical orthopedics by 18 months (center A in three surgeries and center C in two surgeries). Center B used passive presurgical orthopedics with lip/soft palate repair at 6 months and gingivo-alveoloplasty/hard palate repair at 18 to 36 months. Averaged ratings of dental casts using the 5-year yardstick were computed for each patient. The Wilcoxon two-sample test was used to compare means; a chi-square test was used to compare distributions. Intra- and interexaminer reliability tests showed excellent reliability (>.90). Mean scores were not significantly different. Distribution of scores differed significantly. Center A had the highest percentage of good scores and the lowest percentage of poor scores (72% versus 6.5%), followed by center B (63% versus 6.6%) and center C (59% versus 16.3%). Centers A and B had comparable scores and completely different protocols in surgical technique, timing, sequencing, and nonuse/use of appliances. Center C's results were slightly lower than those of 1 and 3, but the center had the protocol with the least burden of treatment (only two surgeries, without use of appliances).

Assessment of Dental Arch Relationships in Japanese Patients with Unilateral Cleft Lip and Palate

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

Treatment Outcome after Two-Stage Palatal Closure in Unilateral Cleft Lip and Palate: A Comparison with Eurocleft

To evaluate dental arch relationships of patients with unilateral cleft lip and palate (UCLP) treated with a two-stage palatal closure and to compare them with the six centers from the Eurocleft study that used various treatment protocols. Repeated-measures study. Cleft Palate Craniofacial Unit of Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands. Records of 9-year-old children with complete unilateral cleft lip and palate (n = 43) were included. The dental arch relationships of these patients were assessed by applying the Goslon Yardstick and subsequently compared with the Goslon outcome of the six-center Eurocleft study. Statistics of intra- and interexaminer agreement. For the Nijmegen UCLP group, 9% of dental arch relationships had a Goslon score of 1, 52% had a score of 2, 30% has a score of 3, 9% had a score of 4, and none had a score of 5. The mean Nijmegen Goslon score showed no significant differences with Eurocleft centers A, B, and E, which achieved the best treatment results, but did significantly differ from Goslon outcomes of Eurocleft centers D (p < .001), C, and F (p < .01), which had relatively poor treatment outcome. Treatment outcome of the patients in the Nijmegen UCLP group treated with two-stage palatal closure was comparable with the results of the Eurocleft centers with the best outcome. Treatment protocol could not explain differences in the quality of treatment results.

Photographs of Study Casts: An Alternative Medium for Rating Dental Arch Relationships in Unilateral Cleft Lip and Palate

To investigate the reliability of using photographs of study casts as an alternative to casts for rating dental arch relationships. Repeated-measures study. Cleft Palate Center of the University Medical Center Nijmegen, Nijmegen, The Netherlands. Records of children with complete unilateral cleft lip and palate (UCLP) (n = 49) at the age of 9 years were included. Statistics of intra- and interexaminer agreement. No significant differences were found between the rating of dental casts and photographs of dental casts, using the Goslon Yardstick. Photographs of dental casts provide a consistent, reproducible method for rating dental arch relationships in patients with UCLP at the age of 9 years and provide a reliable alternative to the application of the Goslon Yardstick on dental casts.

Index may show outcome differences in unilateral cleft lip and palate patients at 5-years of age

Objective To examine whether differences in dental arch relationships of 5-year-old children born with a unilateral cleft lip and palate could be detected. Materials and Methods 40 sets of study models from each of two surgical units (Bristol & Oslo) were assessed using the 5-year old index. Models from each unit were assessed twice on one day at least 1 week apart by two examiners. Positions of the models in the series were reallocated using randomly generated numbers to minimise the influence of memory. Inter and intra-examiner variability was assessed using weighted kappa statistic. Results Intra-examiner variability was good to very good while inter-examiner variability was moderate to good. Both initial and subsequent examinations of the models by the examiners showed that the Oslo sample had a greater number of patients categories 1 and 2 which are considered to indicate better long term growth outcomes. Other differences were also detected between the two modelled samples suggesting that it is possible to detect differences in surgical outcomes at 5-years of age. Conclusions Differences in dental arch relationships in patients with unilateral CLP are apparent at 5 years of age and the use of this index appears to show difference in outcomes by which it may be feasible to compare outcomes from different surgeons. Atack N E, Hathorn I, Dowell T, Sandy J, Semb G, Leach A. Early detection of differences in surgical outcome for cleft lip and palate. Br J Ortho. 1998; 25; 181–185.