medical and dental considerations

Patients with an orofacial cleft (OFC) need complex treatment and require long-term and collective decisions from the multidisciplinary team. These patients may have an associated congenital malformation or syndrome. Some conditions like learning or psychiatric disorders or heart diseases can be diagnosed later in life. Therefore, the team members should examine the patients in different developmental stages to diagnose early an associated condition. Nevertheless, deep phenotyping of the dental and craniofacial affecting structures is only possible after 14 and 18 years of age, respectively, at the end of these structures’ development. Moreover, the genetic basis of OFC is multifactorial and, so far, not well understood. In our study, almost 25% of the examined patients with OFC had a positive family history (Bartzela et al., 2021). Patients with CPO have an associated anomaly or syndrome (66,7%) more often than patients with other cleft types. Skeletal (27,7%) and eye malformations (22,9%) were more common than malformations in other organs or systems. Sex predominance has been registered according to the cleft type. Males were more often observed in CL/P (71,4%) and females (59,7%) in CPO cleft types. Phenotyping CL/P pedigrees make understanding etiopathogenesis even more complicated (Bartzela et al., 2021). The increased prevalence of TA in these patients inside and outside the cleft region of the maxilla but also in the mandible suggests a common genetic pathway between OFC and TA. Patients with OFC require long-lasting, multidisciplinary orthodontic treatment with an MBA. Expansion and symmetry of the collapsed dental arches, followed by a secondary bone graft to correct the interrupted arch continuity, are required before the orthodontic tooth movement in the cleft region. The severe form of EARR related to orthodontic treatment is rare, and the most commonly affected teeth are the central incisors of the cleft side (Bartzela et al., 2020). Severe rotation of the central incisors on the cleft side, pre-existing EARR, atypical root form, specific bone anatomical aspects, oral habits (e.g., lip or tongue posture or dysfunction), and associated medical conditions have been considered as predisposing factors for EARR during the orthodontic treatment (Bartzela et al., 2020). Intercenter studies for evaluating treatment outcomes of patients with CLP can be carried out with e-mail transfer or CDs of images of the dental casts or digital models. The images could be protected by a password, allowing the participant raters from their computers to access and score the dental models. This method facilitates intercenter studies or remote clinical audits. Clinical trials, intercenter studies, and epidemiological data may help evaluate treatment results and identify the role of genetic variation bias and confounding factors on clinical phenotypes. Documentation and meticulous record collection of these patients for the quality assessment of the treatment outcome are mandatory. Early identification of associated syndromes or malformations is of vital importance, especially in life-threatening complications. The type and timing of orthodontic treatment and maxillofacial surgery are critical and often complicated by disrupting dental and craniofacial structures’ development. The team’s goal is to improve function and aesthetic outcomes and ascertain a better quality of life for these patients and their families. Patients’ and parents’ considerations, satisfaction, and psychosocial aspects need research evaluation. Further research is required for clinical recommendations and treatment consensus

Rapid Maxillary Expansion Treatment in Patients with Cleft Lip and Palate: A Survey on Clinical Experience in the European Cleft Centers

Cleft lip and palate patients require complex interdisciplinary treatment, including maxillary expansion and secondary alveolar bone grafting. However, the evidence on these treatment procedures and outcomes is lacking. Therefore, this study aimed to survey the subjective observations of European maxillofacial surgeons and orthodontists on the maxillary expansion and bone grafting treatment protocols and the associated complications. An online questionnaire was sent to 131 centers. The questions assessed the participants' demographic data, maxillary expansion and alveolar bone grafting protocols, and the associated complications. Descriptive statistics and a t-test were used to analyze the data. The response rate was 40.5%. The average age for maxillary expansion was 9-10 years. The secondary alveolar bone grafting was planned 5-10 months after the expansion. The most common complications were asymmetric expansion, relapse, and fistula formation. The protocols and materials used vary widely among centers. Anatomical alterations and developmental processes, like tooth eruption adjacent to the cleft, should be seriously considered for treatment planning. This survey showed that there is still a lack of consensus on these treatment procedures. Further clinical trials should focus on long-term outcome evaluation to identify treatment components for optimal alveolar bone substitution and transversal maxillary expansion treatment in patients with clefts

Clinical characterization of 266 patients and family members with cleft lip and/or palate with associated malformations and syndromes

Objectives: To clinically characterize patients and family members with cleft lip and/or palate (CL/P) and associated congenital malformations or syndromes and propose possible inheritance patterns. Materials and methods: An observational study of patients with CL/P, including medical and family history and intra- and extra-oral examination of their family members, was performed. Results: Two hundred sixty-six patients, 1257 family members, and 42 pedigrees were included in the study. The distribution of patients according to the cleft type was 57.9% with CLP, 25.2% with cleft palate (CPO), and 12.8% with cleft lip with/without alveolus (CL/A). Seventy-four (27.8%) patients had associated malformations, and 24 (9.2%) a syndrome. The skeletal (27.7%), cardiovascular (19.3%) systems, and eyes (22.9%) were most commonly affected. Pierre Robin Sequence (7 patients) and van der Woude (4) were the most common syndromes. The majority of patients with CPO (19/24) had an associate syndrome. The families had an average of 2.45 affected members. Conclusion: Individual and interfamilial phenotypic variability in patients with CL/P makes the understanding of etiopathogenesis challenging. Clinical relevance: The overall prevalence of individuals with CL/P and their pedigrees with associated malformations and syndromes emphasize the need for early identification, interdisciplinary, and long-term planning

Longitudinal Three-Dimensional Stereophotogrammetric Growth Analysis in Infants with Unilateral Cleft Lip and Palate from 3 to 12 Months of Age.

This longitudinal study aimed to evaluate facial growth and soft tissue changes in infants with complete unilateral cleft lip, alveolus, and palate (CUCLAP) at ages 3, 9, and 12 months. Using 3D images of 22 CUCLAP infants, average faces and distance maps for the entire face and specific regions were created. Color-coded maps highlighted more significant soft tissue changes from 3 to 9 months than from 9 to 12 months. The first interval showed substantial growth in the entire face, particularly in the forehead, eyes, lower lip, chin, and cheeks (p < 0.001), while the second interval exhibited no significant growth. This study provides insights into facial soft tissue growth in CUCLAP infants during critical developmental stages, emphasizing substantial improvements between 3 and 9 months, mainly in the chin, lower lip, and forehead. However, uneven growth occurred in the upper lip, philtrum, and nostrils throughout both intervals, with an overall decline in growth from 9 to 12 months. These findings underscore the dynamic nature of soft tissue growth in CUCLAP patients, highlighting the need to consider these patterns in treatment planning. Future research should explore the underlying factors and develop customized treatment interventions for enhanced facial aesthetics and function in this population

[Orthodontics in general practice. 4. Eruption guidance appliances in orthodontics]

Contains fulltext : 69284.pdf (publisher's version ) (Open Access)Eruption guidance appliances are recommended for early orthodontic treatment or prevention of malocclusions. The treatment effect of eruption guidance appliances and functional appliances is similar. In addition to dentoalveolar and skeletal effects, eruption guidance appliances would also have myofunctional effects for treating open mouth behaviour and swallowing problems. However, there is no solid evidence for the myofunctional effect claimed. The position of erution guidance appliances in the orthodontic treatment arsenal is limited: early treatment of Angle Class II malocclusion in 2 phases has no advantage over a 2 phase treatment. When eruption guidance is needed, preference is given to an individually produced appliance

Load-deflection characteristics of superelastic nickel-titanium wires.

Contains fulltext : 53413.pdf (publisher's version ) (Open Access)OBJECTIVE: To determine the mechanical properties of commercially available thermodynamic wires and to classify these wires mathematically into different groups. MATERIALS AND METHODS: The samples examined were 48 nickel-titanium (NiTi) alloy orthodontic wires commercially available from five manufacturers. These samples included 0.016-inch, 0.016- x 0.022-inch, 0.017- x 0.025-inch, and 0.018- x 0.025-inch wires. The superelastic properties of the NiTi wires were evaluated by conducting the three-point bending test under uniform testing conditions. The group classification was made under mathematically restricted parameters, and the final classification was according to their clinical plateau length. RESULTS: The orthodontic wires tested are classified as follows: (1) true superelastic wires, which presented a clinical plateau length of >/=0.5 mm; (2) borderline superelastic with a clinical plateau length of 0.05 mm; and (3) nonsuperelastic, with a clinical plateau length of </=0.05 mm. The results showed that the range of products displays big variations in quantitative and qualitative behavior. A fraction of the tested wires showed weak superelasticity, and others showed no superelasticity. Some of the products showed permanent deformation after the three-point bending test. CONCLUSION: A significant fraction of the tested wires showed no or only weak superelasticity. The practitioner should be informed for the load-deflection characteristics of the NiTi orthodontic wires to choose the proper products for the given treatment needs