Three-dimensional morphometric analysis of dental arches of children with cleft lip and palate: longitudinal study / Análise morfométrica tridimensional dos arcos dentários de crianças com fissura labiopalatina: estudo longitudinal

This study aimed to present two papers that show the alterations in the dental arch dimensions of children with cleft lip and palate before and after the primary surgeries. The first study aimed to evaluate the dimensional alterations of the dental arches of neonates with unilateral complete cleft lip and palate before and after two different primary plastic surgeries. The sample was composed of 114 dental casts of 57 children, divided into two groups: Group 1 ­ 26 neonates whose lip closure was accomplished at 3 months of life by Millard´s technique and the anterior and posterior palate closure by von Langenback's technique (VL); Group 2 ­ 31 neonates whose lip closure, nose's ala correction, and anterior palate closure were accomplished of life by Millard´s technique, Mcomb's or Skoog's technique, and vomer's flap, respectively at 3 months of life; posterior palate closure was accomplished by VL at 12 months of life. The dental casts were analyzed at two phases: (T1) pre-cheiloplasty and (T2) one year after palatoplasty. The second study aimed to evaluate morphometrically and longitudinally the alterations of the dental arch dimensions of children with cleft lip and palate. The sample was composed by digital dental casts of children with complete cleft lip (Group 1), complete cleft lip and palate (Group 2), and complete cleft palate (Group 3), obtained at pre-cheiloplasty (T1), pre-palatoplasty (T2), and one year after palatoplasty (T3). The measurements of the dental arch dimensions of both studies were performed directly on the digitized models and analyzed by Appliance Designer software. The following dimensions were obtained: intercanine distance, inter-tuberosity distance, anterior arch length, and total arch length. A previously trained and calibrated examiner performed the assessments of both studies. To verify the alterations among groups, t test and ANOVA followed by Tukey was applied. In the first study, no statistically significant differences occurred at pre-cheiloplasty. At one year after palatoplasty, Group 1 had statistically significant greater anterior-posterior arch length (P=0.002) than Group 2. This suggested that the outcomes of the different surgical techniques may cause alterations in the dental arch growth and development of neonates with cleft lip and palate. In the second study, in Group 1, the distances C-C', T-T', and I-TT' were statistically greater at T2 than at T1. In Group 2, the distances C-C' and I-CC' were smaller at T3. T-T' distance decreased and I-TT' distance increased at all phases. In Group 3, the C-C', T-T', and I-TT' distances were statistically greater at T3. The intergroup comparisons showed that C-C' and T-T' distances were statistically greater in Group 1; C-C' and I-CC' distances were statistically smaller in Group 2; and I-TT' distance was statistically greater in Group 3. The longitudinal evaluation of the changes occurred in the dental arches of children with different oral cleft types showed that cheiloplasty and palatoplasty caused the most alterations in the growth and development of the maxillary dimensions of children with complete cleft lip and palate.(AU)

O propósito deste estudo foi apresentar dois artigos que mostram as alterações das dimensões dos arcos dentários de crianças com fissura labiopalatina antes e depois das cirurgias primárias. O primeiro estudo foi proposto para avaliar as alterações dimensionais dos arcos dentários de neonatos com fissura labiopalatina antes e após a realização de duas técnicas distintas de cirurgias plásticas primárias. A amostra foi composta de 114 modelos dentários em gesso de 57 crianças, divididos em dois grupos: Grupo I ­ 26 neonatos, fechamento do lábio realizado aos 3 meses de vida pela técnica de Millard e palato total aos 12 meses, pela técnica de von Langenback (VL); Grupo II ­ 31 neonatos, fechamento do lábio pela técnica de Millard aos 3 meses de vida, correção de asa nasal (técnicas de Mcomb ou Skoog) e palatoplastia anterior com retalho de vômer aos 3 meses. A palatoplastia posterior foi realizada aos 12 meses pela técnica VL. Os modelos foram analisados em 2 fases: (F1) pré-queiloplastia e (F2) 1 ano pós-palatoplastia. No segundo estudo o objetivo foi realizar uma avaliação longitudinal das alterações das dimensões dos arcos dentários de crianças com fissura labiopalatina. A amostra foi composta de modelos digitais de crianças com fissura completa de lábio (Grupo 1), completa de lábio e palato (Grupo 2), e completa de palato (Grupo 3), obtidos nas fases de pré-queiloplastia (Fase 1), pré-palatoplastia (Fase 2), 1 ano póspalatoplastia (Fase 3). As medidas das dimensões dos arcos dentários nos dois estudos foram realizadas nos modelos digitalizados e analisados utilizando software Appliance Designer. As seguintes dimensões foram obtidas: distância intercaninos, distância intertuberosidade, comprimento anterior do arco dentário e comprimento total do arco. Um avaliador previamente calibrado e treinado realizou as avaliações para os dois estudos. Foi aplicado o Teste t e a Análise de Variância, seguida do Teste de Tukey. Para o primeiro estudo não houve diferença estatisticamente significante na fase pré-queiloplastia entre os grupos. Na fase 1 ano pós-palatoplastia houve diferença para o comprimento anteroposterior do arco dentário (p=0,002), entre os grupos, com valores maiores para o grupo I. Para o segundo estudo, no Grupo 1, as distâncias C-C', T-T' e I-TT' apresentaram diferença estatisticamente significante entre a F1 e F2, com aumento na F2. Para o Grupo 2, houve diferença estatisticamente significante em todas as fases avaliadas. As distâncias C-C' e I-CC' apresentaram menor valor na F3, T-T' diminuiu em todas as fases, e I-TT' aumentou em todas as fases. No Grupo 3, as distâncias C-C', T-T' e I-TT' mostraram diferença estatisticamente significante com aumento na F3. Quando avaliadas as medidas entre os grupos e fases, C-C' e T-T' mostraram um valor maior para o Grupo 1. A comparação entre F2 e F3 mostraram para as distâncias C-C' e I-CC' valor menor para o Grupo 2, e I-TT' foi maior para o Grupo 3. As avaliações longitudinais nos arcos dentários mostraram que a queiloplastia e palatoplastia causam maiores alterações de crescimento e desenvolvimento maxilares de pacientes com fissura completa de lábio e palato.(AU)

Mini-implants: Alternative for Oral Rehabilitation of a Child with Ectodermal Dysplasia

Ectodermal dysplasia is a rare congenital disease that affects several structures of ectodermal origin. The most commonly related oral characteristics are hypodontia, malformed teeth and underdeveloped alveolar ridges. New alternative treatments are needed due to the failure of the conventional prosthesis retention. This case report outlines the oral rehabilitation treatment of a 9-year-old girl with ectodermal dysplasia. The treatment was performed with conventional prosthesis upon mini-implants. The mini-implants provided prosthetic retention. The patient reported a good adaptation of the dental prosthesis and satisfaction with the treatment. The increased self-esteem improved the socialization skills of the girl. In this case report, use of prosthesis with mini-implants was satisfactory for prosthetic retention. However, clinical studies with long-term follow-up are needed to test the mini-implants as an alternative for oral rehabilitation of children with ectodermal dysplasia.

A displasia ectodérmica é uma doença congênita rara, que afeta várias estruturas de origem ectodérmica. As principais características na cavidade oral são hipodontia, má formação dentária e subdesenvolvimento do rebordo alveolar. Devido às falhas de retenção das próteses convencionais, novas alternativas de tratamento são necessárias. Este relato de caso descreve o tratamento de reabilitação oral em uma menina de 9 anos de idade com displasia ectodérmica. O tratamento foi realizado com próteses dentárias convencionais sobre mini-implantes. Os mini-implantes promoveram a retenção da prótese. A paciente relatou uma boa adaptação das próteses e satisfação com o tratamento. O aumento da autoestima melhorou as atividades de socialização da criança. Neste estudo de caso, o uso de prótese com mini-implantes foi satisfatória para a retenção da prótese. No entanto, estudos clínicos longitudinais são necessários para testar os mini-implantes como uma alternativa para a reabilitação oral de crianças com displasia ectodérmica.

Evaluation of the intercanine distance in newborns with cleft lip and palate using 3D digital casts

OBJECTIVE: The purpose of this present study was to compare, by means of 3D digital casts, the anterior transverse dimension of the dental arch of newborns with and without cleft lip and palate. MATERIAL AND METHODS: The sample was composed of ninety-four children aged from 3 to 9 months divided into three study groups: Group I - children without craniofacial deformities (control group); Group II - children with unilateral cleft lip and palate; Group III - children with bilateral cleft lip and palate. Impressions were executed before lip and palate repair in patients with clefts. Dental casts were digitized using a 3D scanner linked to a computer. Measurements of the intercanine distance were measured on the digital casts. Intergroup comparisons were performed using ANOVA (p<0.05). RESULTS: The results showed a mean of 36.5 mm for unilateral cleft lip and palate group, 34.8 mm for bilateral cleft lip and palate group and 27.52 mm for the control group. There was a statistically significant difference between the control group and both groups of patients with cleft lip and palate. There was no statistically significant difference between complete unilateral and bilateral cleft lip and palate groups. CONCLUSIONS: Patients with complete cleft lip and palate were born with an increased anterior dimension of the maxillary dental arch compared to non cleft patients. .