Cleft Size and Success of Secondary Alveolar Bone Grafting-A Systematic Review.

OBJECTIVE: This study aimed to review all research evidence of presurgical cleft size and related factors to success of secondary alveolar bone grafting (SABG). DESIGN AND SETTING: The systematic review searched the OVID-Medline®, PubMed®, Embase®, and Cochrane Central Register of Controlled Trials (CENTRAL) up to August 2020. Two reviewers independently selected potential abstracts for full review. Disagreeements were resolved by consensus. The first author extracted data and assessed the risk of bias using Risk of Bias in Non-randomized studies-of Interventions tool. PATIENTS AND INTERVENTIONS: Patients with non-syndromic clefts who received SABG were selected. Presurgical cleft size/volume and treatment results must be available. MAIN OUTCOME MEASURES: Level of the grafted bone, achievement of orthodontic tooth movement into the grafted area, need for re-operation. RESULTS: From 962 abstracts, 23 publications were included. Mean cleft width was 6.80 ± 1.98 mm, cleft area 20-240 mm2, and mean volume 0.89 ± 0.33 cm3. No definite conclusion was achieved on whether a narrow or wide cleft showed better treatment outcomes, but other potentially related factors were good oral hygiene and eruptive force of the maxillary canines. Lack of a standard definition of cleft size, a small sample size, varying outcome parameters, and moderate-to-high risk of bias contributed to the summary. A meta-analysis could not be performed because of the heterogeneity. CONCLUSION: Due to insufficient evidence, cleft width/volume could not be specified leading to more successful SABG. Care of patients could be improved in both research by following rigorous methodology, and practice by clear communication.

Esthetic views on facial and dental appearance in young adults with treated bilateral cleft lip and palate (BCLP). A comparison between professional and non-professional evaluators.

The aim of the present study was to make a comparison between the professional and non-professional evaluations concerning the esthetic outcome after the completion of patients who have been treated for bilateral cleft lip and palate. A web-based questionnaire, with 12 photo sets, was answered by 25 orthodontists and 20 young adults who had been treated with orthodontic fixed appliances. They ranked the three first features they noticed when looking at each photo set, and then rated specific variables as being bad, fairly good, good, or excellent. At the end of each set, they had an opportunity to add any additional comments. The three features first noticed by the orthodontists were 'the upper lip', 'the nose' and 'the scar'. The young adults reported first 'the teeth', 'the upper lip' and 'occlusion/alignment of the teeth'. The specific variables similarly rated by orthodontists and young adults were 'the profile of the face', 'the form of the upper lip' and 'the entire facial appearance'. The orthodontists were less critical than the young adults concerning 'the upper teeth alignment', 'the lower teeth alignment', 'shape of the upper teeth', and 'color of the upper teeth'. The individual opinion on each separate set of photos was additionally important in explaining the rating, regardless the category of being either orthodontists or young adults.

Dental appearance, with focus on the anterior maxillary dentition, in young adults with bilateral cleft lip and palate (CLP). A follow up study.

Bilateral CLP interferes with both facial and dental development. Surgical and orthodontic treatments help in optimizing facial and dental appearance. In order to improve the quality of treatment one of the keys is to evaluate the physical outcome. The aim of the present study was to evaluate the longitudinal treatment results in young adults born with a bilateral CLP during 1975-1991 in the south-west region of Sweden. Records and casts (13, 16 and 19 years) were evaluated for 35 persons with total bilateral CLP:s. They all belonged to the CLP team of Gothenburg. Occlusion, congenitally missing laterals, peg shaped laterals, impacted canines, midline, implants, prosthetic treatment and maxillofacial surgery were among the recorded variables. Unilateral or bilateral missing laterals were common (40%) as were peg shaped laterals (40%). Six children had impacted canines. A good symmetry and a straight midline between jaws were found after treatment for 60% of the young adults. It was more common to have canines positioned in the region for a missing or extracted lateral compared to having the lateral replaced with an implant or other prosthetic treatment. Asymmetrical maxillary frontal appearance and an acceptable occlusion are not always achieved. Awareness of and effort to solve this problem are important in reducing factors that are likely to negatively affect the harmony of the face.

Cleft extension and risks of other birth defects in children with isolated cleft palate.

OBJECTIVE: To study the risks of having other birth defects in children born with an isolated cleft palate (iCP) when the length of the cleft was taken into account. The hypothesis was that a newborn with an extensive cleft lesion may have an increased risk of other birth defects compared to a child with a less extensive cleft of the palate. MATERIAL AND METHODS: All Caucasian children with iCP born between 1975 and 2005 in the southwestern region of Sweden were included. Data were collected from standardized medical records and the length of the cleft was checked on the pre-surgical dental cast for each child. RESULTS: A total of 343 children were born with an iCP. The incidence was 0.64/1000 live births. Thirty-four percent of children with either a total or partial iCP had other birth defects. The risk was 1.7 times higher for a total compared to a partial iCP. The two most common birth defects were congenital heart disease and intellectual disability. Ear problems related to infections were registered in 43% of cases. Fifteen percent of the children had the Pierre Robin sequence, which was analyzed as a separate variable and not included as a birth defect. CONCLUSIONS: The length of the iCP was found to influence the risk of having another birth defect as the total palatal clefts were more often combined with other birth defects compared to partial clefts. Careful medical check-ups are important for newborns with iCP since they have increased risks of other birth defects.

Social life aspects of young adults with cleft lip and palate: grounded theory approach.

OBJECTIVES: The findings of many questionnaire and inventory studies suggest that people with cleft lip and/or palate report a decreased quality of life. Common problems include dissatisfaction with the external appearance of the lips and nose, speech problems, depression, and anxiety. This qualitative study aimed to explore the subjective perceptions and values of young adults with clefts, particularly with regard to their social lives. MATERIAL AND METHODS: Twelve persons participated in an in-depth interview. Among those, seven had a repaired isolated cleft palate involving only the hard/soft palate. Five had a repaired bilateral cleft lip and palate that had been a continuous lesion of the lip, the alveolar process, and the palate. A grounded theory approach was used to conduct and analyze the interviews. RESULTS: The study revealed seven important categories--hoping to be like other people, being treated differently from others, experiencing deviation from others, regarding oneself as being different from others, lack of recognition, low self-esteem, and receiving recognition from significant others--with hoping to be like other people as the core category. CONCLUSION: Young adults with either cleft lip and palate or isolated cleft palate who received recognition from significant others reported increased self-esteem and greater ability to cope with their social lives.