Rapid Maxillary Expansion Treatment in Patients with Cleft Lip and Palate: A Survey on Clinical Experience in the European Cleft Centers.

Cleft lip and palate patients require complex interdisciplinary treatment, including maxillary expansion and secondary alveolar bone grafting. However, the evidence on these treatment procedures and outcomes is lacking. Therefore, this study aimed to survey the subjective observations of European maxillofacial surgeons and orthodontists on the maxillary expansion and bone grafting treatment protocols and the associated complications. An online questionnaire was sent to 131 centers. The questions assessed the participants' demographic data, maxillary expansion and alveolar bone grafting protocols, and the associated complications. Descriptive statistics and a t-test were used to analyze the data. The response rate was 40.5%. The average age for maxillary expansion was 9-10 years. The secondary alveolar bone grafting was planned 5-10 months after the expansion. The most common complications were asymmetric expansion, relapse, and fistula formation. The protocols and materials used vary widely among centers. Anatomical alterations and developmental processes, like tooth eruption adjacent to the cleft, should be seriously considered for treatment planning. This survey showed that there is still a lack of consensus on these treatment procedures. Further clinical trials should focus on long-term outcome evaluation to identify treatment components for optimal alveolar bone substitution and transversal maxillary expansion treatment in patients with clefts.

The adaptation of Demirjian's dental age estimation method on North German children.

The aim of this study was to test the accuracy of Demirjian's method for dental age (DA) estimation on north German children, to adapt the method used in case of inaccuracy in this sample and to construct dental maturity percentile curves for this population. Orthopantomograms (OPGs) of 1260 north German children (566 males and 694 females) aged 5-17 years were used from patients' records of the Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité - Universitätsmedizin Berlin, Germany. Demirjian's dental maturity scale for the seven left mandibular teeth was applied to the first sample (951 OPGs) to estimate the DA and compare it to the chronological age (CA) of each child. For the adaptation of Demirjian's method on this sample of radiographs, new weighted maturity scores were created by the use of linear regression. Polynomial percentile curves of the total dental maturity in comparison to the CA are presented. The second sample (309 OPGs) was used to evaluate the adapted method and compare it to Demirjian's method. Demirjian's method overestimated the mean CA of boys by 0.46±0.86 years (mean difference±standard deviation) and of girls by 0.55±0.95 years. The new adapted weighted scores estimated the CA of boys (0.07±0.82 years) and girls (-0.04±0.82 years) more accurately. The adapted method showed no significant difference between DA and CA. The method by Demirjian et al., when applied to north German children, significantly overestimated most age cohorts for both sexes. The adapted north German weighted scores and percentile curves showed a notable improvement in age estimation and were more reliable for CA estimation and DA assessment.

Age estimation in 5-16-year-old children by measurement of open apices: North German formula.

The aims of this study were to test the accuracy of Cameriere et al.'s European formula on a sample of North German children based on dental age (DA) for chronological age (CA) assessment and to adapt the formula used, in case of regional peculiarities of this group of children. Orthopantomograms of 1000 children (444 males and 556 females) aged 5-16years were used. The roots of seven left mandibular teeth were evaluated. The number of teeth with complete root development (N zero (0)) was counted. Teeth with incomplete root development were examined and the distance between the inner sides of the open apex was measured and normalized by dividing it by the tooth length to avoid error due to magnification. Cameriere et al.'s European formula underestimated the mean CA of boys by 0.56±1.04years and of girls by -0.32±0.96. The results of the regression analysis showed that sex (g), the sum of normalized open apices (s), number of teeth with closed apices (N0) and the first-order interaction between the normalized apex width of the canine (x3) and N0 contributed significantly to the fit. All previously mentioned factors were included in the regression model, yielding to the following formula: DA=9.829+0.632 N0-1.037s+0.686g-1.582N0×x3, where g is a variable: 1 for males and 0 for females. The adapted formula explained 84.1% of the total deviance, with a median age of 0.070 years and 1.185 years interquartile range, (IQR).