ABSTRACT
The aim of this study was to assess whether the initial cleft width in patients born with complete unilateral cleft lip and palate (UCLP), is correlated to final treatment outcome regarding maxillary growth. This report is a retrospective longitudinal cohort study of 45 consecutive non-syndromic individuals with UCLP, 19 from the Stockholm Cleft Team, and 26 from the Oslo Cleft Team. The treatment protocols in the two teams differed. The initial transversal width in infants was measured at three levels on study casts. The width was correlated to variables obtained from lateral cephalograms at 17 years of age, from rating of dental arch relationship and to treatment variables obtained from the medical records: existence of Simonart's band, missing maxillary teeth, duration of orthopaedic/orthodontic treatment, and the need for orthognathic surgery. The initial width of the middle part of the cleft and final maxillary inclination (NSL/NL) showed a weak correlation (P < 0.05); the wider the cleft, the less the inclination. No further correlations were found between the initial width and final outcome measurements studied. In the Oslo group where Simonart's band was present, the anterior and middle widths of the cleft were significantly smaller (P < 0.001). Additionally, the existence of Simonart's band had a significant effect on final maxillary inclination (P < 0.05), i.e. the maxillary inclination increased. Treatment outcome seems mainly to depend on the treatment protocol performed rather than the severity of the cleft. The width of the middle part of cleft may be associated with the final maxillary inclination.
Subject(s)
Cephalometry/methods , Cleft Lip/surgery , Cleft Palate/surgery , Maxilla/growth & development , Adolescent , Cleft Lip/complications , Cleft Lip/pathology , Cleft Lip/therapy , Cleft Palate/complications , Cleft Palate/pathology , Cleft Palate/therapy , Cohort Studies , Dental Arch/growth & development , Dental Arch/pathology , Female , Humans , Longitudinal Studies , Male , Retrospective Studies , Sweden , Tooth , Treatment OutcomeABSTRACT
UNLABELLED: To obtain high quality in orthodontics; it is important to evaluate the treatment. There are many indices for evaluation of treatment outcome however all of them compare treatment outcome with ideal occlusion. Therefore Stockholm Eastman Index of Treatment Outcome (SEITO) was invented. This index relates the treatment outcome to the treatment goal. SEITO is a morphological index based on criteria from the records including study casts, and/or intra oral photos. METHOD: The outcome of treatment is related to the treatment goal as stated in the records. Pre-treatment goals are divided into subgroups; overjet, vertical relation anterior/lateral), anterior cross bite, transverse relations, impacted teeth and space crowding/ spacing. Each subgroup is scored; the points are 0, 1, 3 or 5 depending on the severity of the malocclusion. The points for each subgroup are added to give a total sum of treatment goal points. Each post-treatment subgroup above is evaluated. If the treatment goal is fulfilled, the treatment outcome points are equal to the treatment goal points. If not - there is a reduction in the outcome points. Finally the outcome points are expressed as a percentage of the treatment goal points and form a measure of the success of treatment. CONCLUSION: SEITO index is a simple and quick way to obtain a picture of the quality of treatment outcome, and the only orthodontic index that relates the treatment outcome to the treatment goal.
Subject(s)
Orthodontics, Corrective , Outcome Assessment, Health Care , Goals , Humans , Malocclusion/diagnosis , Malocclusion/therapy , Orthodontics, Corrective/standards , Outcome Assessment, Health Care/methods , Quality Control , Tooth, Impacted/diagnosis , Tooth, Impacted/therapy , Treatment OutcomeABSTRACT
OBJECTIVE: The aim of this systematic literature review was to evaluate associations between different malocclusions, orthodontic treatment, and signs and symptoms of temporomandibular disorders (TMD). MATERIALS AND METHODS: This review was part of a project at the Swedish Council on Technology Assessment in Health Care focusing on malocclusion and orthodontic treatment from a health perspective. As a first step, the literature was searched in the Medline and Cochrane Library databases from 1966 to May 2003. A later update was made in January 2005. Human studies in English or in Scandinavian languages were included. RESULTS: Associations between certain malocclusions and TMD were found in some studies, whereas the majority of the reviewed articles failed to identify significant and clinically important associations. TMD could not be correlated to any specific type of malocclusion, and there was no support for the belief that orthodontic treatment may cause TMD. Obvious individual variations in signs and symptoms of TMD over time according to some longitudinal studies further emphasized the difficulty in establishing malocclusion as a significant risk factor for TMD. A considerable reduction in signs and symptoms of TMD between the teenage period and young adulthood has been shown in some recent longitudinal studies. CONCLUSIONS: Associations between specific types of malocclusions and development of significant signs and symptoms of TMD could not be verified. There is still a need for longitudinal studies.
Subject(s)
Malocclusion/complications , Orthodontics, Corrective/adverse effects , Temporomandibular Joint Disorders/etiology , Humans , Malocclusion/therapyABSTRACT
OBJECTIVE: To calculate the amount of treatment and associated travel experienced by five groups of patients treated at different centers. (This data is related to outcomes and patient/parent satisfaction in subsequent papers in this series). DESIGN: A longitudinal cohort study where results were previously reported at 9 years and follow-up measurements were obtained for 12 and 17 years. SETTING: Multidisciplinary cleft services in Northern Europe. SUBJECTS: 127 consecutively treated individuals with repaired unilateral complete cleft lip and palate. MAIN OUTCOME MEASURES: Numbers of surgeries and outpatient visits, number of visits, and treatment duration for early orthopedics and orthodontic treatment, associated travel time and difficulties. RESULTS: The mean number of operations per center ranged from 3.5 to 6; length of orthodontic treatment from 3.3 to 8.5 years, and attendance from 49 to 94 visits; and for early orthopedics, 0 to 15 months of treatment, 0 to 17 visits, and 0 to 146 days in hospital. CONCLUSION: Protocols for the management of complete unilateral cleft lip and palate can vary dramatically in the burden of treatment imposed.
Subject(s)
Cleft Lip/surgery , Cleft Palate/surgery , Oral Surgical Procedures/methods , Outcome Assessment, Health Care/methods , Adolescent , Child , Child, Preschool , Clinical Protocols , Episode of Care , Europe , Female , Follow-Up Studies , Humans , Infant , Longitudinal Studies , Male , Office Visits , Orthodontics, Corrective , Transportation of Patients , TravelABSTRACT
OBJECTIVE: To compare craniofacial morphology and nasolabial appearance up to age 17 in individuals with repaired complete unilateral cleft lip and palate (UCLP) treated at five European centers. DESIGN: Longitudinal cohort study. SETTING: Multidisciplinary cleft services in Northern Europe. SUBJECTS: 127 consecutively treated individuals with repaired complete UCLP. MAIN OUTCOME MEASURES: Cephalometric variables, 14 angular and 2 ratio variables, and panel ratings of nasolabial appearance, 4 variables. RESULTS: The results revealed that at ages 12 and 17, two centers had a flatter profile (gs-sn-pgs) and retrognathic maxilla (sss-ns-sms). Additionally, one of the two centers had increased lower face height. Ratings of nasolabial appearance showed more similarity between the centers. CONCLUSION: The results confirm that systematic differences in craniofacial morphology and nasolabial appearance may occur between different cleft centers, but do not allow specific caused factors to be identified.
Subject(s)
Cleft Lip/surgery , Cleft Palate/surgery , Maxillofacial Development , Oral Surgical Procedures/methods , Outcome Assessment, Health Care/methods , Adolescent , Cephalometry , Child , Dental Occlusion , Europe , Follow-Up Studies , Humans , Lip/anatomy & histology , Longitudinal Studies , Nose/anatomy & histology , Odds Ratio , Regression Analysis , Statistics, NonparametricABSTRACT
OBJECTIVE: To compare dental arch relationships up to age 17 in individuals with complete unilateral cleft lip and palate (UCLP) treated at five European centers. DESIGN: Longitudinal cohort study, where results were previously reported at 9 years and follow-up measurements were obtained for 12 and 17 years. SETTING: Multidisciplinary cleft services in Northern Europe. SUBJECTS: 127 consecutively treated individuals with repaired UCLP. MAIN OUTCOME MEASURE: Panel rating of dental arch relationship. RESULTS: The results revealed that at 17 years of age three of the centers had better ratings in dental arch relationship (means scores: 1.7, 1.9, and 2.2, respectively) than the other two centers (3.3, 3.4) at statistically significant levels ( p < .01 to p < .001). CONCLUSION: The results confirm that systematic differences in dental arch relationships may occur between different cleft centers, but do not allow specific causal factors to be identified.
Subject(s)
Cleft Lip/surgery , Cleft Palate/surgery , Dental Occlusion , Oral Surgical Procedures/methods , Outcome Assessment, Health Care/methods , Adolescent , Analysis of Variance , Cephalometry , Europe , Follow-Up Studies , Humans , Jaw Relation Record , Longitudinal Studies , Malocclusion/etiology , Maxillofacial Development , Models, Dental , Oral Surgical Procedures/adverse effectsABSTRACT
OBJECTIVE: To assess patient/parent satisfaction with the treatment they had received from their respective teams, and to explore interrelationships between satisfaction, objectively rated outcome, and the burden of care. DESIGN: This study reports cross-sectional data as part of the overall longitudinal cohort study reported in the other four papers of this series. SETTING: Multidisciplinary cleft services in Northern Europe. SUBJECTS: 127 consecutively treated 17-year-olds with repaired complete unilateral cleft lip and palate and their parents. MAIN OUTCOME MEASURE: Patient/parent satisfaction. RESULTS: Generally, there was a high level of patient/parent satisfaction. There were no relationships among satisfaction, objectively rated outcomes, and the amount of care. CONCLUSIONS: This study highlights various challenges involved in questionnaire surveys into patient/parent satisfaction, and underlines the need for collective efforts to improve our understanding of this issue.
Subject(s)
Cleft Lip/surgery , Cleft Palate/surgery , Oral Surgical Procedures/psychology , Outcome Assessment, Health Care/methods , Patient Satisfaction , Adolescent , Cross-Sectional Studies , Europe , Female , Humans , Male , Social Behavior , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To review the lessons learned from a longitudinal intercenter comparison study. DESIGN: Longitudinal cohort study. SETTING: Multidisciplinary cleft services in Northern Europe. SUBJECTS: Individuals with repaired complete unilateral cleft lip and palate. MAIN OUTCOMES MEASURES: The first four papers in this series report amount of treatment, cephalometric form, nasolabial appearance, dental arch relationship, patient/parent satisfaction. This paper considers the consistency of outcome at the five centers over time, and other relationships between outcomes. RESULTS: Some outcomes measured in childhood can be predictive over time. The amount of treatment does not correlate with the quality of clinical outcome. CONCLUSIONS: Measurement of clinical outcome in childhood is an important and valid form of clinical audit. Intercenter studies are more informative than single center reports, and will have an important future role in cleft care.
