Long-term mid-facial growth of patients with a unilateral complete cleft of lip, alveolus and palate treated by two-stage palatoplasty: cephalometric analysis.

OBJECTIVES: The aim of this study is to evaluate long-term facial growth in adults previously treated for an isolated unilateral complete cleft lip, alveolus and palate by two-stage palatoplasty. MATERIALS AND METHODS: Unilateral cleft lip and palate (UCLP) patients of 17 years and older treated by two-stage palatoplasty were invited for long-term follow-up. During follow-up, lateral cephalograms were obtained (n = 52). Medical history was acquired from their medical files. Outcome was compared to previously published normal values and the Eurocleft study. RESULTS: Soft and hard palate closure were performed at the age of 8 (SD 5.9) months and 3 (SD 2.2) years, respectively. The mean maxillary and mandibular angle (SNA, SNB) were 74.9° (SD 4.2) and 75.8° (SD 3.8). Maxillary and maxillomandibular relationships (SNA, ANB) were comparable to all Eurocleft Centres, except for Centre D. We observed a significantly steeper upper interincisor angle compared to the Eurocleft Centres. CONCLUSIONS: This study describes the long-term craniofacial morphology in adults treated for a UCLP with hard palate closure at a mean age of 3 years. The mean maxillary angle SNA and mandibular angle SNPg were comparable to previous studies both applying early and delayed hard palate closure. The observed upper incisor proclination is likely caused by orthodontic overcorrection in response to the unfavourable jaw relationships. No clear growth benefit of this protocol could be demonstrated. CLINICAL RELEVANCE: The present study shows the long-term craniofacial morphology of UCLP adults after the Utrecht treatment protocol which includes two-stage palate closure.

Dental age in Dutch children.

Dental age was studied in a sample of 451 Dutch children (226 boys and 225 girls) according to the method of Demirjian. They were born between 1972 and 1993 and were between 3 and 17 years of age at the time a dental pantomogram (DPT) was obtained. All children were placed in the age group closest to their chronological age. All 451 DPTs were scored by one examiner. A subset of 52 DPTs was scored by a second examiner and the intra-class correlation coefficient (ICC) and Cohen's kappa were calculated. The ICC was 0.99 and Cohen's kappa 0.68. Boys and girls were analysed separately.A significant difference was found between chronological age and dental age. On average, the Dutch boys were 0.4 years and the girls 0.6 years ahead of the French-Canadian children analysed by Demirjian. Therefore, the French-Canadian standards were not considered suitable for Dutch children. New graphs for the Dutch population were constructed using a logistic curve with the equation Y = 100*{1/(1 + e(-alpha(x - x0)))} as a basis. The 90 per cent confidence interval was calculated. To determine whether the logistic curve was correct, a residual analysis was carried out and scatter plots of the differences were made. The explained variance was 93.9 per cent for the boys and 94.8 per cent for the girls. Both the residual analysis and the scatter plots indicated that the logistic curve was appropriate for use with Dutch children. In addition to the graphs, tables were produced which transfer the maturity scores calculated by the method of Demirjian into Dutch dental age.

Influence of fluoride in saliva during the early cariogenic changes in the enamel of boys and girls.

In boys and girls cariogenic changes in the dental enamel in relation to fluoride (F-) concentrations in stimulated and unstimulated saliva were studied in a six-month period. Also the use of various types of applications of F- was assessed. No difference in the use of F- between boys and girls before and after the interval was observed. Also no clear differences were found between boys and girls in the levels of F- in both types of saliva, determined at the end of the six-month period. The most important finding was that for all children, a significantly positive relationship was found between the disappearance of white spots turning into sound enamel (regression) and the F-concentration in unstimulated saliva. In addition, girls who developed new white spots had higher levels of F-, but those who developed new cavities had lower F- levels in both types of saliva. Apparently F- can prevent dental caries by acting very early on remineralization and demineralization processes in enamel surfaces.

Influence of oral hygiene on early enamel caries.

For 548 children aged 4-16 years, mean (+/- SD) age 10.3 +/- 2.7 at visit 1, the dental status was recorded at four consecutive 6-monthly visits. Simultaneously oral hygiene was scored according to a modified patient hygiene performance (PHP) index after application of disclosing solution and before the dental examination. The following cariogenic changes could be observed: initiation (white spot formation), progression (cavitation), stabilisation and regression (disappearance of a white spot). The PHP score was examined in relation to these changes in smooth surfaces, as well as in fissures. For fissures when oral hygiene worsened, stabilisation of a white spot increased significantly. Also, regression of a white spot into sound enamel increased with poor oral hygiene, but the significance was only marginal. White spots turning into cavities, however, did not change with poor oral hygiene. It was speculated that under low oral hygiene conditions the remaining plaque of children receiving intensive fluoride treatment can bind fluoride to the fissure surfaces, thereby promoting enamel maturation concomitant with stabilisation and regression of white spots, which in an earlier study were also found to be dependent on posteruptive age.

Posteruptive age dependency of cariogenic changes in enamel of permanent teeth of children.

During a cariogenic attack at the enamel surface a white spot can be formed (initiation) or disappear (regression) or remain the same (stabilisation). In the present clinical study it was shown that at least regression and stabilisation depend significantly on the posteruptive age and may be associated therefore with changes in porosity or mineral composition in the young enamel surface after eruption. In contrast, the progression of a white spot towards a cavity, which took place in this study almost exclusively in the fissures, does not change with posteruptive age. An explanation for this may be that in such white spots remineralization is less effective due to retention of acids in the fissures. On the other hand, rapid development of a cavity from sound enamel within half a year decreased with posteruptive age.

Use of fluoride by young children and prevalence of mottled enamel.

The prevalence of mottled enamel in the permanent dentition of children participating in a fluoride (F-) program at the dental school of the Vrije Universiteit (Amsterdam) was investigated in a study utilizing the Thylstrup-Fejerskov (TF) index. The randomly chosen children received a F- regime considered optimal by the Dutch Advisory Committee for Prevention of Oral and Dental Diseases. From the children examined (n = 83; 49 boys and 34 girls; mean age, 13 years and 5 months), 74% exhibited mottled enamel in a slight to moderate degree. More teeth were affected and the degree of mottling was higher when children started to use F- at an earlier age. Unintentional ingestion of toothpaste containing 0.15% F- during frequent toothbrushing in combination with the daily intake of F- tablets before the age of four may explain the high prevalence of mottled enamel. After these treatments, F- concentrations in plasma of young children can reach values which can directly affect the developing tooth germ.

Prevalence of mottled enamel in permanent dentition of children participating in a fluoride programme at the Amsterdam dental school.

The prevalence of mottled enamel in the permanent dentition of children participating a fluoride (F-) programme at the Amsterdam Dental School has been investigated in a pilot study, utilizing the Thylstrup-Fejerskov (TF) index. From all children examined (n = 83) 74% exhibited mottled enamel, in a slight to moderate degree. More teeth were affected and the degree of mottling was higher when children started to use F- at an earlier age. Unintentional ingestion of toothpaste containing 0.15% F- during frequent tooth brushing in combination with the daily intake of F- tablets before the age of four may explain the high prevalence of mottled enamel.

[Fluoride and mottled enamel]. / Fluoridegebruik. Gvelekt glazuur bij kinderen.

The prevalence of mottled enamel in permanent teeth of children, visiting the pediatric clinic of the Dental School ACTA in Amsterdam and using fluoride, has been examined utilizing the Thylstrup-Fejerskov index for enamel fluorosis. Of all children examined (n = 83) 74% exhibited mottled enamel, varying from a very mild to a moderate degree. The amount and degree of mottling increased when children started using fluoride at an earlier age. A high frequency of toothbrushing along with a high concentration of 0.15% fluoride in toothpaste, in combination with ingesting fluoride tablets, may be responsible for the high prevalence of enamel fluorosis.