Treatment of a severe Class II Division 1 malocclusion combined with surgical miniscrew anchorage.

This article reports the camouflage treatment of a female patient, aged 15 years 2 months, who had a Class II Division 1 malocclusion with severe anterior protrusion and deep incisor overbite. The camouflage treatment plan included bilateral extraction of the maxillary first premolars combined with the use of temporary anchorage devices (TADs) and tension coil springs to retract canines into the extraction spaces and then the 4 incisors. The treatment included use of a mandibular fixed labial arch with minimal use of Class II elastics to correct mild mandibular spacing and level the curve of Spee. Ideal overjet and overbite relationships were established, and the final result was well balanced and esthetically pleasing. The molars were finished in a Class II relationship. Total treatment time was 2 years 6 months. Cephalometric superimpositions revealed that mandibular molars were not disturbed by the limited use of Class II elastics. Surgical miniscrews in canine and incisor retraction in Class II Division 1 malocclusion are an alternate type of temporary anchorage that reduce or remove reliance on conventional intermaxillary anchorage.

Evaluation of alveolar bone grafting in unilateral cleft lip and palate patients using a computer-aided diagnosis system.

PURPOSE: This study aimed to evaluate the trabecular bone changes after alveolar bone grafting in unilateral cleft lip and palate (UCLP) patients using a computer-aided diagnosis (CAD) system. MATERIALS AND METHODS: The occlusal radiographs taken from 50 UCLP patients were surveyed retrospectively. The images were categorized as: 50 images in group 0 (before bone grafting), 33 images in group 1 (one month after bone grafting), 24 images in group 2 (2-4 months after bone grafting), 15 images in group 3 (5-7 months after bone grafting), and 21 images in group 4 (8 or more months after bone grafting). Each image was grouped as either "non-cleft side" or "cleft side". The CAD system was used five times for each side to calculate the pixel area based on the mathematical morphology. Significant differences were found using a Wilcoxon signed ranks test or paired samples t test. RESULTS: The pixel area showed a significant difference between the "non-cleft side" and "cleft side" in group 0 (404.27±103.72/117.73±92.25; p=0.00), group 1 (434.29±86.70/388.31±109.51; p=0.01), and group 4 (430.98±98.11/366.71±154.59; p=0.02). No significant differences were found in group 2 (423.57±98.12/383.47±135.88; p=0.06) or group 3 (433.02±116.07/384.16±146.55; p=0.19). CONCLUSION: Based on the design of this study, alveolar bone grafting was similar to normal bone within 2-7 months postoperatively.

Primary unilateral cleft lip-nose repair: the Tawanchai cleft center's integrated and functional reconstruction.

BACKGROUND: The challenges of previously described techniques in unilateral cleft lip repairs inadequately address all deformities of the primary palate, the problems of scar and secondary deformities and achievement of optimum outcome. OBJECTIVE: To propose the integrated and functional reconstruction of primary unilateral cleft lip-nose repair and to present the preliminary outcome and advantages of this technique. MATERIAL AND METHOD: The integrated concepts and functional reconstruction includes analysis of the deformities, interdisciplinary management and The Tawanchai Center's interdisciplinary protocol for cleft lip and palate care, pre-surgical orthopedic treatments, the integrated primary cleft lip-nose repair and post-operative management. This technique of repair includes modified rotation advancement technique for skin surgery, functional muscle reconstruction, the correction of nasal deformities, the reconstruction of vermillion and final skin closure. RESULTS: Between 2002 and 2010, this technique was performed and evaluated on 122 patients who received primary unilateral cleft lip-nose repair, including 72 complete and 50 incomplete, 81 males and 41 females. Six parameters (scar, Cupid's bow symmetry, vermillion border symmetry, philtrum anatomic fidelity, muscle function and nasal symmetry) were used for evaluating the results, based on 4 scales (0-3) by 2 plastic surgeons. Among the mean scores better rating scales were achieved in philtrum anatomic fidelity (0.25) and muscle function (0.36), while the mean of the those with less satisfactory rating scales were achieved found in scar (0.82) and nasal asymmetry (0.72). These preliminary outcomes showed satisfactory results. Secondary reconstruction is less difficult and may be performed at the age of 4-6 years if indicated. DISCUSSION AND CONCLUSION: The authors introduce The Tawanchai Center's integrated concepts and functional reconstruction technique for unilateral cleft lip-nose repair. The technique provides the advantages of integrated assessment of all deformities of the cleft of primary palate, the design of integrated techniques together with the proper perioperative care, presurgical orthodontic treatment and a holistic and well-coordinated interdisciplinary management. The good preliminary outcome has been demonstrated. More improvement in outcome can be achieved by continuing assessment of these groups of patients until they reach maturity, continuing refinement of technique, improvement of interdisciplinary care and benchmarking of the outcome.

Early maxillary arch changes in complete bilateral cleft lip and palate: a report of four cases.

OBJECTIVE: To evaluate early maxillary arch changes in infants with complete bilateral cleft lip and palate (BCLP), using a simple measurement technique. MATERIAL AND METHOD: A measurement model technique simplified from previously reported methods was used to analyze early maxillary changes of four non-syndromic complete BCLP. Study models of these cases were evaluated before presurgical orthopedic treatment and lip reconstruction (T1) and prior to palatal closure (T2). Comparisons of maxillary arch changes were performed. RESULTS: At T1, protrusion with or without deviation of the primary palate and different amounts of cleft width were found. Anterior alveolar arch width was larger than the posterior At T2, the primary palate was retracted and initial lateral displacement was corrected. Cleft widths were narrowed at all levels with the narrowest part located anteriorly, corresponding with the increasing of primary palate arch width. Posterior alveolar arch width was wider than the anterior region. Although the posterior alveolar arch was lengthened, total alveolar arch length was decreased which could be attributable to a large retraction of the primary palate. CONCLUSION: Early morphological and positional changes to the three segments of maxillary arch could be visualized and clarified with this technique, using study models and arch form superimposition methods.

Distraction osteogenesis treatment of maxillary deficiency for cleft patient using internal distraction device: a case report.

A case of severe maxillary hypoplasia in a 21 years old male Thai patient with a complete unilateral cleft of primary and secondary palates treated by internal distraction osteogenesis for maxillary advancement is presented. Initial evaluation showed Class III malocclusion with total crossbite and Class III skeletal malrelationship. Two intraoral distractors were placed following a Le Fort I osteotomy. A maxillary advancement of 8 mms was obtained with 1 mm overjet. Following distraction, Class III elastics were used to increase the overjet until an overjet of 3 mms was obtained. Both acceptable skeletal and soft tissue relationships and satisfactory occlusion have been produced. After 20 months of postoperative follow-up, the occlusal result is stable and skeletal relapse can not be detected.