Structural color changes in permanent enamel of patients with cleft lip and palate: a case-control study.

OBJECTIVES: White spots are more common in patients with cleft lip and palate (CLP) than in the normal population. Whether these are due to the cleft itself or concomitant circumstances (e.g., surgical procedures, orthodontic treatments, systemic fluoridation, increased caries risk) remains unclear. This case-control study evaluated both their prevalence in CLP patients versus control subjects and associated risk factors. PATIENTS AND METHODS: A total of 73 CLP patients (average age 8.7 years, range 6-18 years, 42 % male) and a control group of 73 age- and gender-matched non-CLP patients were included. Enamel color changes, subsuming mineralization defects (DDE index), mild dental fluorosis (Dean's index), and initial caries (ICDAS score 2), were recorded. Caries index (dmf-t/DMF-T) scores were also recorded to distinguish between high or low caries risk as defined by the Deutsche Arbeitsgemeinschaft für Jugendzahnpflege criteria. Histories of systemic fluoridation, trauma to primary teeth, surgery, and orthodontic treatment were obtained using a questionnaire. Statistical analysis included t test, χ (2) test, and multivariable logistic regression. RESULTS: Enamel color changes were observed three times more often in the CLP group than in the control group (39.7 vs. 12.3 %; p < 0.001). Significantly more patients in the CLP group had a history of orthodontic treatment (38.4 vs. 15.1 %; p < 0.05). An increased risk for enamel color changes was associated with CLP itself [OR (odds ratio) 3.6; 95 % confidence interval (CI) 1.3-9.9] and table salt plus tablets combined for systemic fluoridation (OR 2.7, 95 % CI 1.1-6.9). No increased risks were identified for increased caries risk, history of primary-tooth trauma, or history of orthodontic treatment. CONCLUSION: The higher prevalence of enamel color changes in the CLP group (more than threefold compared to the control group) was not related to previous orthodontic treatments; however, systemic fluoridation (table salt and tablets) constituted a risk factor for the enamel color changes seen in the CLP patients.

Assessment of quality of life in patients undergoing orthognathic surgery.

CLINICAL QUESTION: Analysis to date on the impact of a pronounced skeletal dentofacial deformity on quality of life remains inadequate. OBJECTIVE: The objective of this study was to introduce a validated and internationally comparable questionnaire for the assessment of quality of life, and to use this questionnaire in a consecutively-selected patient cohort. MATERIAL AND METHODS: The Orthognathic Quality of Life Questionnaire (OQLQ) used internationally was translated into German and adapted in accordance with EU guidelines (OQLQ-G). A total of 50 patients (f = 25, m = 25) indicated for combined orthodontic and surgical treatment were included in the study. In addition to the assessment of individual questions, the patients were classified according to the following categories: (1) perception of the malocclusion, (2) masticatory function, (3) esthetics, and (4) social aspects. The statistics were assessed with software SPSS((R)) 15.0 (chi-squared test; p = 0.05). RESULTS: Patients with a pronounced dentofacial malocclusion demonstrated a considerably high awareness of the degree of the deformity. Responses frequently included severe and very severe functional restrictions (50.4%) and/or esthetic impairment (43.0%). With regard to social aspects, the responders also reported a reduction in quality of life. CONCLUSION: An internationally-comparable assessment of quality of life in patients with a pronounced jaw discrepancy was carried out for German-speaking countries. This pilot study demonstrates that their quality of life is significantly impaired.

Evaluation of vertical parameters in cephalometry.

AIM: The aim of this study was to determine the validity of different vertical parameters in cephalometry. MATERIALS AND METHODS: The cephalograms of 94 patients were used in this study. The inclusion criteria were as follows: skeletal Class I, completion of maximum skeletal growth, and no history of orthodontic therapy. The control group consisted of 34 subjects with very good occlusion (overbite 2-4 mm). The patients were classified with the help of dental casts: Group 1 (n = 31) patients with cover-bite (overbite > 5.5 mm) and Group 2 (n = 29) patients with anterior open bite (overbite < -0.5 mm). In addition to the 24 standard cephalometric measurements (Bergen-Analysis), we included individualized norm values (Segner & Hasund), the Overbite Depth Indicator (ODI) described by Kim, the Denture Frame Analysis (DFA) described by Sato, and facial-type evaluations according to Schopf. RESULTS: We observed significant differences among the three study groups in all the vertical parameters tested. We demonstrated statistically-significant classification results for the Segner & Hasund harmony box's individualized norm values (83.8%), and those of the ODI (77.7%) and ML-AB angle (76.6%). CONCLUSIONS: Based on the vertical cephalometric parameters, we succeeded in statistically differentiating among the groups with open bite, cover-bite and the control group. Various measurements must be taken to ensure that the cephalometric vertical relationships are reliably evaluated.

Complications of orthodontic-orthognathic surgery treatment in mentally handicapped patients.

AIM: The aim of this study was to analyse possible intra- and postoperative complications and long-term results in combined orthodontic-orthognathic treatment of mentally handicapped patients compared with a control group of patients without handicap. PATIENTS AND METHODS: A group of 20 mentally handicapped patients (male = 7, female = 13) and of 102 non-handicapped patients (male = 36, female = 66) were evaluated retrospectively. The results of the two point-discrimination sensory test and the cephalometric findings of both groups were assessed. Complications during and after the operation, the results of nerve function tests and relapse rates were reported. The statistical analysis was carried out using binary logistical regression analysis with adjustment according to the diagnosis and the type of operation (p < 0.05) RESULTS: No significant differences could be found between the mentally handicapped and the non-handicapped patients. Only the nerve function test immediately postoperatively revealed differences between the two patient groups. The relapse rate in mentally handicapped patients was similar to non-handicapped patients. Forty-seven months after the operation, relapse (change in the ANB angle of more than 0.5 degrees ) was observed in four patients only (handicapped patients). CONCLUSION: Orthognathic surgical procedures in mentally handicapped patients can be carried out with a similarly high success rate as in mentally healthy patients.