Rapid and slow palatal expansion in bilateral complete cleft lip and palate cone beam CT evaluation: preliminary results

Introduction: The upper dental arch of patients with complete bilateral cleft lip and palate commonly presents constricted due to the absence of the sutures and the lip and palate surgeries performed at an early age. Objective: The objective of this paper is to evaluate and compare the effects of maxillary expansion between two different appliances: Haas / Hyrax and quad-helix, in patients with bilateral complete cleft lip and palate, using cone-beam computed tomography (CT). Material and methods The study sample will consist of 30 patients with bilateral complete cleft lip and palate with maxilla constriction and that had received primary surgeries in childhood. Patients will be divided into two study groups, treated with Haas or Hyrax expanders (Group I = 30) and quadhelix expanders (Group II = 30). For preliminary results there were 23 patients (Group I = 13 and Group II = 10).The CT examination was performed immediately pre-expansion and six months after the expansion, when the appliance was removed. The following dimensions were performed: the maxillary transverse dimensions, the inclination of the posterior teeth, the buccal bone plates thickness and the buccal and lingual bone crest in the molar anchorage in both phases of the study. Changes interphases were evaluated using the Student \"t\" test (p <0,05). Comparison of baseline characteristics of each study group, as well as the intergroup comparison of the effect of the expansion were conducted by independent t test (p <0,05). Preliminary results: To date, no significant difference between groups was found

Evaluation of facial esthetics in rehabilitated adults with complete unilateral cleft lip and palate

Objectives. The aim of this study was to evaluate the facial esthetics of White-Brazilian adults with complete unilateral cleft lip and palate (UCLP) rehabilitated at a single center. Design. 30 patients (13 females; 17 males; mean age of 24.0 years), rehabilitated at a single center, were photographed and evaluated by 25 examiners, 5 orthodontists, and 5 plastic surgeons dealing with oral clefts, 5 orthodontists and 5 plastic surgeons with no experience in the cleft treatment, and 5 laymen. Their facial profiles were classified into esthetically unpleasant, esthetically acceptable, and esthetically pleasant. Results. Orthodontists dealing with oral clefts classified the majority of the sample as esthetically pleasant. Plastic surgeons dealing with oral cleft, orthodontists, and plastic surgeons without experience with oral clefts classified most of the sample as esthetically acceptable. Laymen evaluation also considered the majority of the sample as esthetically acceptable. Conclusions. The facial profiles of rehabilitated adults with UCLP were classified mostly as esthetically acceptable, with variations among the categories of examiners. The examiners dealing with oral clefts gave higher scores to the facial esthetics when compared to professionals without experience in oral clefts and laypersons, probably due to their knowledge of the limitations involved in the rehabilitation proces

Rapid and slow maxillary expansion in patients with complete bilateral cleft lip and palate: assessment based on cone-beam computerized tomography

Objetivo: O objetivo deste trabalho consistiu em avaliar e comparar os efeitos dentoesqueléticos dos expansores maxilares Haas/Hyrax e quadrihélice, em pacientes com fissura labiopalatina completa e bilateral. Material e Métodos: A amostra do estudo foi composta por 46 pacientes com fissura labiopalatina completa e bilateral, operados na infância, com atresia do arco dentário superior, na fase de dentadura mista tardia. Os pacientes foram aleatoriamente divididos em dois grupos de estudo, tratados com expansão rápida da maxila (ERM), com aparelhos ortopédicos Haas ou Hyrax (Grupo I, n=23) e com expansão lenta da maxila (ELM) por meio de expansores tipo quadrihélice (Grupo II, n=23). O exame de tomografia computadorizada cone-beam (i-Cat, Hartsfield, PA, EUA) foi realizado imediatamente pré-expansão e no mínimo 4 meses após a expansão. Foram mensuradas, por meio do Software Nemoscan (Nemotec, Madri, Espanha) e de modo duplo-cego, as dimensões transversais maxilares, a inclinação dos dentes posteriores, a espessura das tábuas ósseas vestibular e lingual e o nível da crista óssea alveolar vestibular, nas duas fases do estudo. As alterações interfases foram avaliadas por meio do teste t pareado (p<0,05). A comparação das características iniciais de cada grupo de estudo, assim como, a comparação intergrupos do efeito da expansão, foram realizadas por meio do teste t independente (p<0,05). Resultados: Não houve diferença estatisticamente significante entre ERM e ELM para as alterações interfases em nenhuma das variáveis analisadas. A ERM e a ELM apresentaram efeitos ortopédicos semelhantes em pacientes com fissura labiopalatina completa e bilateral, com aumentos transversais decrescentes do nível do arco dentário em direção à cavidade nasal. Ambas as modalidades de expansão ocasionaram inclinação vestibular dos dentes posteriores em magnitudes semelhantes e incitaram suaves reduções da espessura da tábua óssea vestibular (0,57mm) e do nível da crista óssea vestibular (0,54mm), sem significância clínica. Conclusão: Tanto a ERM quanto a ELM foram efetivas para produzir efeitos ortopédicos na maxila em crianças com fissura completa e bilateral, causando movimentos de inclinação vestibular dos molares, porém sem repercussões nas tábuas ósseas vestibulares ou no nível das cristas marginais.Objective: The purpose of this study was to evaluate and to compare the dentoskeletal effects of the Haas/Hyrax and Quadhelix maxillary expanders in patients with complete bilateral cleft lip and palate. Material and Method: The study sample was comprised of 46 patients with complete bilateral cleft lip and palate, operated on during childhood, with constriction of the upper dental arch, in the late mixed dentition. The patients were randomly divided into two groups and treated with a rapid maxillary expansion (RME) with the Haas or Hyrax orthopedic expander (Group I, n=23) and with a slow maxillary expansion (SME) with the Quadhelix expander (Group II, n=23). The cone-beam computerized tomography (i-Cat, Hartsfield, PA, USA) was performed immediately prior to the expansion and at least 4 months post-expansion. Using the multiplanar reconstruction resource, the following measurements were evaluated with Nemoscan Software (Nemotec, Madrid, Spain) in a double-blind manner: maxillary transverse dimensions, inclination of the posterior teeth, thickness of the buccal and lingual bone plate and level of the buccal alveolar bone crest in both phases of the study. The interphase alterations were evaluated with the paired t test (p<0.05). The comparison of the initial characteristics of each study group as well as the intergroup comparison of the expansion effects were performed with the independent t test (p<0.05). The tested null hypothesis is that both expanders present similar dentoskeletal effects. Results: no statistically significant differences were found between RME and SME for the analyzed variables. RME and SME presented similar orthopedic effects in patients with complete bilateral cleft lip and palate, with the transverse increments decreasing from the dental arch level toward the nasal cavity. Both expansion devices produced similar buccal inclination of the posterior teeth and similar and mild reduction of the bone plate thickness (0.57 mm) and of the bucal bone crest (0.54 mm), with no clinical significance. Conclusion: Both RME and SME were effective in producing orthopedic effects on the maxilla, causing inclination and buccal movement of the molars without major consequences to the buccal bone plates or the marginal crests. The null hypothesis tested in the present study was confirmed. Both expanders presented similar dentoskeletal effects