Assessment modalities of non-ionizing three-dimensional images for the quantification of facial morphology, symmetry, and appearance in cleft lip and palate: a systematic review.

The use non-ionizing three-dimensional (3D) imaging in cleft lip and palate is an emerging field, but properly designed methods for the assessment of these images are not well established. Therefore, the aim of this study was to review the current literature on the modalities of assessment of non-ionizing 3D images for the quantification of facial morphology, symmetry, and appearance in cleft lip and palate, and to assess the method error of these modalities. A systematic literature search was conducted using MEDLINE (PubMed), Cochrane Central Register of Controlled Trials, Web of Science, and Embase. Cross-sectional studies with prospective or retrospective data collection, using non-ionizing 3D imaging, with a subjective or objective outcome assessment and including at least 10 cleft lip and/or palate patients were considered eligible. Overall, 1767 unique studies were identified and 33 met the inclusion criteria. The images were objectively assessed using elementary measurements and comprehensive statistical methods for superimposition, shape description, and structuring. Subjective assessment was performed using a Likert-type scale or visual analogue scale. It can be concluded that non-ionizing 3D images are widely used in cleft research, but 3D analysis of the images is often methodologically suboptimal. Researchers must fully utilize the content of 3D images to quantify morphology, symmetry, and appearance.

[Orthodontics based on a new scientific method of evaluating results: "evidence-based"]. / L'orthodontie basé sur une nouvelle méthode scientifique d'evaluation des résultats: l'"evidence-based".

In the orthodontic literature, randomized clinical trials are used to establish standards for the comparison of different clinical approaches. The balancing effect produced in a randomized study makes it possible to attribute the differences in results achieved clearly to treatment and not to variations in the biological characteristics of the patients involved. Recently, most randomized studies in orthodontics have been devoted to testing the hypothesis that some orthodontic appliances exert orthopedic effects that modify dento-facial growth. The authors propose definitions of "orthopedic effects" and of "dento-alveolar changes" and discuss the difficulties encountered in measuring them. They also review clinical studies published over the past 10 years on the correction of Class II malocclusions, on the problems of expansion and also report on Class IIl disorders. In addition they assess the problems associated with these clinical studies such as the ethical requirement of assuring that control groups receive treatment as appropriate for their maladies as that delivered to patients under study, the high cost of carrying them out, the relatively long delay before results can be evaluated, the difficulties of measuring all the different parameters involved, and the need to assemble large enough samples. To sum up, one can conclude that, because of all these impediments, randomized clinical studies have not as yet delivered the hope for benefit of collecting enough "evidence based" information for the orthodontic profession to deliver better treatment to its patients.

[Tooth transplantation: an extra dimension in orthodontics]. / Tandtransplantaties: een extra-dimensie in de orthodontie.

In the first part of the presentation, the content of orthodontics has been briefly explained by means of some clinical cases. The main part of the presentation consisted of discussing patient treatment by means of autogenous tooth transplantation with special emphasis on its indications and contra-indications. When a tooth transplantation is carried out properly, a success percentage of 90%, even forty years after treatment, can be expected. This high percentage has been reported in a recent study. The success of tooth transplantation is mainly due to the timing of the transplantation and the non-traumatic handling during surgery. According to the literature, the ideal moment for tooth transplantation is when half to three quarters of the root has been formed. One of the indications for tooth transplantation is the transplantation of a tooth in the cleft of a cleft palate patient. Two cleft palate patients have been presented in which tooth transplantation was carried out after bone grafting in the alveolar cleft. Finally some findings of a recent study, carried out at our department, dealing with cryopreservation of teeth before transplantation, has been presented. According to the findings of this study, cryopreservation, after removal of the pulp tissue does not inhibit the normal ingrowth of new pulp tissue after transplantation.