A survey of South African Maxillofacial & Oral Surgeon opinions regarding the academic education in the field of cleft lip/palate and craniofacial deformities

Maxillofacial and oral surgeons (MFOS) are trained to manage hard and soft tissue conditions affecting the orofacial region. They, therefore, play an essential role in the health care of  cleft lip/palate (CLP) and craniofacial deformities (CFD) patients. The complex and lengthy nature of CLP and CFD management requires collaboration between different disciplines. Consequently, it becomes increasingly important that the academic education available to MFOS provides in-depth knowledge, multidisciplinary participation and adequate clinical exposure provided by field experts. This study aimed to investigate the exposure and knowledge level of MFOS regarding the management of CLP and CFD. A second objective was to obtain an opinion from practising MFOS about the academic educational needs of those working with CLP and CFD. An online survey and telephone interviews (using a structured questionnaire) were used to investigate the level and scope of the MFOS academic education and to determine their academic needs. The questionnaire was completed by 53 (of 121)  of practising MFOS on the Medpages health care provider database, 64.8% of whom had more than 10 years of professional experience. Of the respondents, 60% showed a good general knowledge of CLP and CFD. However, 66.5% acknowledged that they had received only limited clinical training and exposure, which prevented them from providing adequate services to CLP/CFD patients. Only 41% of the respondents offered primary and/or only secondary treatment for both CLP and CFD patients, and 53.8% of them had participated in multidisciplinary teams. All the respondents agreed on the need for a dedicated training programme(s) in CLP and CFD management, and the majority recommended a subspecialty training either by degree courses or clinical fellowship and / or certification. This study demonstrates that postgraduate academic training and clinical exposure are limited in the CLP and CFD fields. All the respondents agreed that an educational strategy to meet the needs of MFOS providing CLP and CFD care should be established. Participants suggested that part-time clinical and/or degree courses should be developed

The orthodontist's views regarding academic education in cleft lip and palate as well as craniofacial deformities in South Africa

Orthodontists are essential members of a craniofacial team (American Cleft Palate-Craniofacial Association Team Standards Committee).1 Because cleft lip/palate (CLP) and craniofacial deformities (CFD) vary in severity and facial growth patterns, treatment is complex and lengthy and requires collaboration among different disciplines. Consequently, orthodontists need specialised training in this field to reach the treatment goals of good facial growth, aesthetically acceptable appearance, and dental occlusion. Therefore, it becomes increasingly important to provide adequate training for orthodontists, so they can not only provide efficient treatment but can also undertake a leadership role in the field. To obtain information regarding:• the CLP and CFD academic education of orthodontists the professional services that orthodontists offer to CLP and CFD patients• the educational and training needs of orthodontists in this field A 54-item online survey to collect quantitative data was conducted by means of an interview, using a randomised sample of orthodontists attending the annual scientific conference of the South African Society of Orthodontics. The questionnaire was completed by 53 orthodontists, 54.6% of whom had more than 10 years of professional experience. Of the respondents, 84.8% experienced some clinical exposure in this field during their postgraduate education. Treatment for CLP and CFD patients was offered by 92% of the professionals, but only 21.7% had high confidence in their expertise in treating CLP/CFD patients. Of the respondents, 88% agreed there was a need to improve CLP and CFD education, and the majority recommended fellowship training and certified courses. The rest suggested continuing-education workshops. Most of the orthodontists provided treatment for both CLP and CFD patients despite some of them lacking confidence in treating such cases. The majority agreed that there is a strong need to establish an educational strategy to meet the needs of orthodontists who treat CLP and CFD patients. The respondents suggested that programmes such as fellowship training, degree couses, certified courses, and continuing education workshops could be used

Assessment of the educational needs and services available in cleft /lip palate and craniofacial anomalies management in South Africa.

Doctoral Degree. University of KwaZulu-Natal, Durban.ABSTRACT Background Since the 1960s, South Africa has been providing multidisciplinary treatment for children with cleft lip and/or palate (CLP) and craniofacial anomalies (CFA) (Marks, 1960). Currently, the standard for best practice (ACPA, 2017) regarding cleft lip/palate and craniofacial anomalies focuses on oral function, improved appearance, and normal speech. Therefore, American cleft palate association recognize the core of the cleft palate team comprises maxillofacial and oral surgeons (MFOS), orthodontists (Orthod), plastic surgeons (PS), and speech-language therapists (SLT). Cleft lip/palate and craniofacial anomalies vary in severity and facial growth patterns, and treatment is complex and lengthy. Therefore, it requires collaboration among different disciplines, with the aim of reaching the treatment goals of good facial growth, aesthetically acceptable appearance, and dental occlusion. Consequently, it becomes increasingly important to provide adequate training for these professionals, to empower them not only to provide efficient treatment, but also to assume leadership roles in this field. This is the first study ever to include all four disciplines. Objectives To obtain information regarding the CLP/CFA academic education of MFOS, Orthod, PS and SLT; the services that those practitioners offer to CLP/CFA patients; and the educational and training needs in this field. Methods A 51-item online survey questionnaire was used to collect quantitative data of a randomised sample of professionals from the four disciplines: MFOS, Orthod, PS and SLT. The study was introduced to the participants by means of a telephone call and they were given the option to record their responses or to send the online questionnaire by email. For the orthodontists, the data was collected during their annual scientific congress by two students using an iPad. Results The questionnaire was completed by 46,3% of MFOS, 41% of Orthod, 46,5% of PS and 18,83% of SLT who are registered on the Medpages database. Although 42,6% of the participating MFOS, 92% of Orthod, 41,6% of PS, and 42,7% of SLT indicated that they provide treatment and intervention for CLP/CFA patients, only a few felt confident to provide such services. The study shows that professionals are treating patients beyond their competence, which could result in poor outcomes and services. Most of the respondents agreed that there is a need to improve CLP/CFA education, and the majority recommended fellowship, sub-speciality training and/or certified courses. The minority suggested continuing-education workshops. Conclusion Most of the professionals who participated in this study provide treatment for both CLP and CFA patients, despite some of them lacking in confidence when treating such cases. The majority agreed that there is a strong need to establish an educational strategy to meet the needs of professionals who treat CLP/CFA patients. The respondents suggested dedicated programmes in the CLP/CFA field. The professionals recommended fellowship, sub-speciality training, certified courses, and continuing-education workshops

In-vitro comparison of bonding time and strength of adhesive pre-coated and standard metal orthodontic brackets

To compare the shear bond strength and bond time of 3M Unitek's APC (Adehesive Pre-Coated) Flash-Free™system applied to metal brackets. An in vitro study was performed on 40 extracted sound human premolar teeth randomly divided into two groups (20 per group) bonded either with Adhesive Pre-Coated Flash-Free metal brackets or metal brackets coated manually with Transbond XT™ light-cure adhesive. Bonding time was measured using a stopwatch. Thermoycling was performed on the samples (500 cycles) to simulate the oral environment between baths of 5°C and 55°C distilled water. Debonding shear bond strength measurements were performed in an Instron universal testing machine. The APC Flash-Free group bonded in significantly (p<0.001) less time (mean 34.06s/tooth) than the manually coated group (mean 55.14s/tooth). Shear bond strength of the manually coated group was significantly (p<0.001) higher (mean 13.32 MPa) than the APC Flash-Free group (mean 10.95 MPa). The APC Flash-Free free system is efficient and allows for reduced chair time during the bonding appointment while attaining a mean shear bond strength of 10.95MPa, which is higher than the minimum shear bond strength of between 4MPa and 7MPa

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

South African speech-language therapists’ opinion of their training in cleft lip and palate and craniofacial deformities

BACKGROUND : Speech care of cleft lip and/or palate (CLP) and craniofacial deformities (CFD) is complex and lengthy and requires collaboration amongst different disciplines. Consequently, it is important to provide academic educational models that include didactics, online learning and clinical exposure in CLP and CFD treatment, and participation in established cleft palate multidisciplinary team management. OBJECTIVES : To obtain information regarding: (1) the perceived adequacy of CLP and CFD academic education of speech-language therapists (SLTs); (2) the professional services that SLTs offer to CLP and CFD patients; and (3) the educational needs of SLTs in this field. METHOD : A 54-item online survey to collect quantitative data was conducted by telephone and email using a randomised sample of SLTs in different areas of South Africa. RESULTS : The questionnaire was completed by 123 SLTs, 70% of whom had more than 10 years of professional experience. Of the respondents, 81% acknowledged their limited clinical exposure during their academic education. Only 42% of the professionals offer treatment for CLP and CFD patients. Of the respondents, 96% agreed on the need to improve CLP and CFD academic education, and the majority recommended certified courses, continued-education workshops and online resources. CONCLUSION : The findings indicate that SLTs academic training is perceived to be significantly limited in the cleft palate and craniofacial fields. Thus, there is a strong need at the undergraduate level for clinical training and exposure to multidisciplinary management. At post-graduate level there is a need to establish an educational strategy to meet the needs of SLTs providing CLP and CFD care. Participants suggested that programmes for continuing professional education, degree courses and online resources be designed to provide practising clinicians with updated information and guidance in management of CLP and CFD patients.The Gerald Gavron Research Fund of the South African Society of Orthodonticshttp://www.sajcd.org.zaam2021Orthodontic

The orthodontist's views regarding academic education in cleft lip and palate as well as craniofacial deformities in South Africa

BACKGROUND : Orthodontists are essential members of a craniofacial team (American Cleft Palate-Craniofacial Association Team Standards Committee)1. Because cleft lip/palate (CLP) and craniofacial deformities (CFD) vary in severity and facial growth patterns, treatment is complex and lengthy and requires collaboration among different disciplines. Consequently, orthodontists need specialised training in this field to reach the treatment goals of good facial growth, aesthetically acceptable appearance, and dental occlusion. Therefore, it becomes increasingly important to provide adequate training for orthodontists, so they can not only provide efficient treatment but can also undertake a leadership role in the field. OBJECTIVES : To obtain information regarding: the CLP and CFD academic education of orthodontists the professional services that orthodontists offer to CLP and CFD patients the educational and training needs of orthodontists in this field METHOD : A 54-item online survey to collect quantitative data was conducted by means of an interview, using a randomised sample of orthodontists attending the annual scientific conference of the South African Society of Orthodontics. RESULTS : The questionnaire was completed by 53 orthodontists, 54.6% of whom had more than 10 years of professional experience. Of the respondents, 84.8% experienced some clinical exposure in this field during their postgraduate education. Treatment for CLP and CFD patients was offered by 92% of the professionals, but only 21.7% had high confidence in their expertise in treating CLP/CFD patients. Of the respondents, 88% agreed there was a need to improve CLP and CFD education, and the majority recommended fellowship training and certified courses. The rest suggested continuing-education workshops. CONCLUSION : Most of the orthodontists provided treatment for both CLP and CFD patients despite some of them lacking confidence in treating such cases. The majority agreed that there is a strong need to establish an educational strategy to meet the needs of orthodontists who treat CLP and CFD patients. The respondents suggested that programmes such as fellowship training, degree couses, certified courses, and continuing education workshops could be used.The research paper is a part of fulfilment PhD degree at Discipline of Dentistry, School of Health Sciences, University of KwaZulu-Natal.https://www.sada.co.za/the-sadjhj2022Orthodontic

The epidemiology of malocclusion in Zambian urban school children

This survey was undertaken to determine the occlusal status of a selected group of urban Zambian Black 9-12 year old children at 5 different schools in the same geographical area in order to determine their need for orthodontic treatment. The examination criteria of the Occlusal Index of Summers (1966) were used. Six hundred and one children who had not previously received orthodontic treatment were examined. The data were analysed statistically by using the calculated Summers Index. The results showed that 83 per cent of the subjects required no orthodontic treatment. Of the 17 per cent who did require orthodontic treatment, 5.2 per cent needed specialized treatment. The malocclusion status of Black Zambian children is very similar to that recorded in epidemiological studies on South African and Swazi Black children. This study indicates that only a small need exists for orthodontic treatment amongst Black Zambian children.https://www.sada.co.za/the-sadjhj2022Orthodontic

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

OBJECTIVES : 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. METHODS : 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 intra- and inter-observer agreement using Cohen's weighted kappa and Fleiss's multi-rater kappa. RESULTS : 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. CONCLUSION : 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.https://www.sada.co.za/the-sadjhj2022Maxillo-Facial and Oral SurgeryOrthodontic