Alveolar Bone Grafting - A Summary of History and Current Literature on the Technique

Cleft lip and palate is a common condition affecting thousands of children in India and overseas. With an incidence of 1 in 800 live births, these cleft lip and cleft palate patients face numerous aesthetic as well as functional challenges. The condition goes untreated in many scenarios, or patients do not receive adequate treatment due to various reasons like lack of awareness, lack of specialist dentists etc. leading to permanent facial deformity with significant deterioration of quality of life. There have been many changes in the management of alveolar cleft in the past 100 years. Documentation of the first cleft lip repairs dates back to 400 BC, and was performed by Hippocrates, while the first cleft velum repair was done for the first time by a French dentist, Monnier, in 1764. The treatment protocol for the same has been upgraded with time, with better understanding of the anatomy and pathophysiology of the condition, and for better results to the patients. Alveolar bone grafting (ABG) is now becoming an integral part of managing cleft patients. There still isn’t a fixed and widely accepted protocol for ABG in the management of cleft patients, but there are various opinions of researchers around the world regarding the indications of bone grafting, the type of grafting (primary or secondary) to be employed, timing of grafting, the source of bone graft and use of various bone graft substitutes in the procedure. An increasing value of multidisciplinary approach, including maxillofacial surgeons and orthodontists, towards managing such patients, is helping improve the outcome of such patients, and hence easing the overall treatment duration for the patient and relatives. Hence, through this article, we aim to shed some light over the evolvement and current place of alveolar bone grafting in treating cleft lip and palate patients. The anatomy of involved parts, types and indications of ABG, clinical evidences on the timing of the surgery, future evaluation, results and complications, and orthodontic treatment have been mentioned in this article.

Assessment of Change in SOC of Parents Participating in the Treatment of Their Children Having Cleft Lip & Palate Anomalies

Cleft lip and palate (CLCP) is one of the most common birth defects. The birth of a child with a facial cleft is a tragic incident for the family that the child is born in. Not only is the family devastated by the apparent facial deformity, but also worried about several other issues such as care of the child, the treatment options, and the social impact that the cleft will have for the child and for the family. The purpose of the study was to assess the sense of coherence in parents participating in the treatment of their children with CLCP. Methods50 parents of children with CLCP were evaluated and a questionnaire study was carried out at time intervals of T0, T1 and T2. ResultsMost of the parameters were found to be statistically significant (P<0.05). Overall subjective results were found to be non-significant from T0 - T1. In our study, we found that undergoing orthodontic treatment had positive effects on the parents of patients with CLCP. It was observed that it altered the psychological, financial, emotional and social wellbeing of the parents. ConclusionsIt was concluded that orthodontic treatment should be aimed at both physical and psychological rehabilitation of cleft patients.

A New and Practical Method to Locate Point ANS - A Cephalometric Study.

Diagnosis and treatment planning in skeletal discrepancy and disorders requires radiographic assessment. Disturbance in growth and development alters the morphologic build-up of bony structures, which makes evaluation difficult. Out of these skeletal landmarks Point ANS is seen affected in many conditions like cleft lip and palate, Binders Syndrome, Down’s Syndrome, nasomaxillary hypoplasia, etc., wherein maxilla is mostly affected. Surgical intervention if required needs exact evaluation of point ANS. The purpose of the present study is thus to revisit Point ANS to aid in the cephalometric evaluation in cases where location of Point ANS is difficult; thus, making treatment planning easy. METHODS50 lateral cephalograms were evaluated by taking reference of skeletal landmarks and linear measurements were done. RESULTSLinear measurements from Point Ptm’-Ba’, Ba’-ANS’, ANS’-A were found to be proportionally equal with a ratio of 1:1:1. CONCLUSIONSLinear distance of Point ANS to N perpendicular (ANS’) line was approximately half of the linear distance of Point Ba’-A, while Point ANS is placed approximately 5±2 mm ahead of the line N perpendicular.

Comparison of Bolton s Ratio for Evaluation of Tooth Size Discrepancy between Maxillary and Mandibular Arches in Vidarbha Population

Bolton’s ratio is an indispensable parameter used in orthodontic diagnosis to evaluate the tooth size discrepancy. However, these norms have been established for Caucasian population and population variations necessitate the evaluation of these ratios for Vidarbha population. The objectives of the present study were to determine Bolton’s ratio for Vidarbha population, compare them with original Bolton’s ratios and determine the clinical significance of these differences.METHODSThe study sample consisted of study casts of 300 subjects in the age range of 18-30 years, all belonging to Vidarbha population, having a full complement of teeth. Tooth dimensions were measured using digital vernier caliper and Bolton’s overall ratio and anterior were calculated. The data calculated was statistically analysed for range, mean, standard deviation and coefficient of variation. Unpaired t-test was applied to draw a difference between the results of this study and the results from Bolton’s study.RESULTSBolton’s overall and anterior ratio norms for Vidarbha population sample were found to be 88.15 and 78.50, respectively, with standard deviation of 3.27 and 3.19, respectively. The range of overall ratio noted was 80.36–98.44, and the range of anterior ratio was 67.74–89.70.CONCLUSIONSIn general, the values obtained from this study for the Vidarbha population differ from the data of Caucasian population. So, it can be inferred that the established Bolton’s values for Caucasians cannot be used for the Vidarbha population. Hence, population specific standards are necessary for clinical assessment.

Establishment of Cephalometric Norms for UCLP Cases from Central India Population Falling Under Goslon 1 and 2 Based on Burstone Analysis.

This study was done as there is a need to evaluate separate hard and soft tissue parameters for UCLP as we cannot compare the deformity with normal. A study by Abhilasha Yadav has defined the Burstone norms for class I subjects in Central India as compared to Caucasians. The objective is to derive norms for UCLP itself as the pattern of growth and development of bone, muscle is not normal that can be compared with any population and needs to treated, based on specific norms.METHODS75 cases of UCLP from Central India, with an age range of 18-25 yrs. were selected for the study. The COGS analysis values for Central Indian UCLP cases (falling under GOSLON 1 and 2) was established and compared with class I Caucasians and class I Central Indian subjects. The cephalograms were traced, analysed and interpreted using the landmarks and values established in Burstone analysis (cephalometric analysis for orthognathic surgery). The mean, standard deviation and Z values were calculated to compare the values between three groups.RESULTSThe Central Indian UCLP cases demonstrated decreased anterior cranial base length, upper third height of face, decreased anteroposterior maxillary length, decreased upper and lower incisor height as well as molar height, retroclined upper anterior, significantly decreased facial convexity, nasolabial angle and reduced maxillary prognathism while mandible showed prognathism.CONCLUSIONSThe study reported significant differences in certain cephalometric parameters of UCLP cases from central India population with that of Caucasian and class I central Indian population. The results obtained for central India’s UCLP cases can be used as cephalometric norms for planning orthognathic surgery specifically for cleft cases.

ViVan Formula- A Modified Formula for Estimating the Mesiodistal Width of Maxillary Central and Lateral Incisor

It is a frequent occurrence that teeth especially maxillary incisors are either completely avulsed or fractured due to trauma in facial region. Replacement of these missing teeth always possess a challenge if there are no prior dental records of the patient. Also, maxillary lateral incisors are frequently smaller in size – “Peg shaped” or congenitally absent. Aesthetic correction or/and replacement of this tooth also poses a problem when prior records are missing.METHODSTotally, 300 study casts were taken from the patients and digital vernier caliper was used to measure the mesiodistal width of maxillary central and lateral incisors and mandibular lateral incisors on both the sides. The mean and the standard deviations of the width was assessed. Similarly, the proportion between the widths of the maxillary lateral incisor and mandibular lateral incisor was also assessed and based on the proportions, the ViVan formula was derived.RESULTSBased on the proportions, ViVan Formula for Central Incisor and Lateral Incisor is derived.CONCLUSIONSViVan ratio determined the mesiodistal width of central and lateral incisor with the help of mandibular lateral incisor. This formula provides results accurately and with minimum error. One of the important diagnostic tools is the use of diagnostic model for estimation of tooth size. Tooth size must be proportionate to jaw size so as to avoid tooth size arch length discrepancy.

Association between Genetic Polymorphism in Interferon Regulatory Factor 6 (IRF6) & Non-Syndromic Cleft Lip & Palate Cases in Central Indian Population.

Orofacial clefts can transpire either, as part of complex malformation syndromes, or as an isolated entity, also called non-syndromic cleft. Cleft lip with or without cleft palate (CL/P), collectively termed oral clefts, are the second most commonly observed birth defects among newborns after congenital heart defects. We wanted to investigate the association between genetic polymorphism in Interferon Regulatory Factor 6 (IRF6) & non-syndromic cleft lip and palate (CL/P) cases in Central Indian population.METHODSIn this cross-sectional observational study, the sample comprised of Group 1: 66 individuals and 7 affected families with non-syndromic CL/P; and Group 2: 30 normal individuals and 10 normal families. 5 ml blood sample was collected from each individual following proper surgical protocol using disposable syringes, in blood tubes containing EDTA, with proper labelling and coding for further identification. DNA extraction was done by phenol chloroform extraction protocol and amplification was done using Polymerase Chain Reaction (PCR). Genotyping for the IRF6 polymorphism was completed by restriction digestion of PCR products, also called Restriction Fragment Length Polymorphism (RFLP).RESULTSThe correlative comparison between GG and GA polymorphism in IRF6 gene between affected cases and normal patients shows highly significant value. The comparison between GG & GA polymorphism shows that GG polymorphism is significantly higher in affected cases compared to Group 2. While GA polymorphism is significantly low or decreased in non-syndromic CL/P patients when compared to control group.CONCLUSIONSGG polymorphism is more frequently associated with non-syndromic CL/P as compared to GA polymorphism.

A Review on Evolution and Controversies Regarding Surgical Methods and Timing of Palatoplasty in UCLP Cases

To establish speech, growth and development of maxillofacial region and hearing etc. towards normal is the aim of every professional working for cleft care. With a quest to attain and normalize the growth and development in CLP since ages, researchers and workers have invented and still inventing newer technique to treat them. The procedure of surgeries has evolved over a period of time. Controversies concerning speech and maxillofacial growth have challenged many surgeons who have come up with different views in surgical methods. Studies suggest that the palate repair is the main cause of the maxilla and growth disturbance that later is responsible for speech impairment due to fibrous tissue in anterior palate and constricted tissue in uvula due to repair. Many authors have noted that delayed hard palate repair has more positive effects on maxillary growth than that of early hard palate repair, but studies have also proved that late palate repair impair the speech with due respect. This unsolved controversy whether to opt for late/ early palatoplasty w.r.t to the improvement in speech is still unsolved controversy. The purpose of this article is to review the history of cleft palate surgery, its evolution, various surgical methods and optimal timing of cleft palate repair.

Surgical Orthodontic Correction of Class II Malocclusion with Vertical Maxillary Excess and Gummy Smile- A Case Report.

INTRODUCTION: Achieving functional efficiency, structural balance, and aestheticshasalways been a threefold objective of the correction of dentoskeletal malocclusions. Ortho surgical correction and dentofacial abnormalities has always aimed for facial proportions which are more pleasant and aesthetic alongside normal functional occlusion. One big cosmetic concern for patients and dentists is the Gummy smile, which is the excessive display of gingiva on a full smile.