Cleft Laterality Dental Arch Relationship Outcomes for Children with Unilateral Cleft Lip and Palate in New Zealand.

OBJECTIVES: To investigate cleft laterality dental arch relationship outcomes of children with non-syndromic complete unilateral cleft lip and palate (UCLP) in New Zealand. DESIGN: A retrospective nationwide study. SETTINGS: Virtual 3D orthodontic study models collected prior to undertaking secondary alveolar bone grafting. PARTICIPANTS: A total of 104 patients with UCLP (L = 80: R = 24). OUTCOME MEASURES: Four calibrated assessors used the GOSLON Yardstick and 100 mm Visual Analogue Scale (VAS) to score the randomised models on 2 separate assessment sessions. Weighted Kappa were used to determine the intra/inter-rater reliability for the GOSLON and correlations for the VAS. RESULTS: Intra-rater reliability ranged from 0.57-0.88 (GOSLON) and 0.45-0.93 (VAS). Inter-rater reliability ranged from 0.62-0.86 (GOSLON) and 0.64-0.93 (VAS).GOSLON scores for the left UCLP were 31.2% for good/very good; 26.3% for fair; 42.5% for poor/very poor while the right UCLP scored 8.3% for good/very good; 37.5% for fair; 54.2% for poor/very poor. The mean VAS for left and right UCLP were 53.4 (sd 22.5) and 44.6 (sd 17.1) respectively. Neither the GOSLON nor VAS differences reached statistical significance (both P = .08). CONCLUSIONS: From a clinical perspective right UCLP had worse dental arch relationship outcomes, however, these differences failed to reach statistical significance. Further studies using larger sample sizes are required to determine if cleft laterality is an important consideration when investigating UCLP dental arch outcomes.

Patient reported experiences and treatment outcomes of orthodontic patients treated within secondary care settings in the South West of England during the COVID-19 pandemic.

OBJECTIVE: To assess the impact of the temporary cessation of orthodontic services on patients undergoing treatment during the COVID-19 pandemic. DESIGN: Two-phase multicentre service evaluation. SETTING: Secondary care orthodontic departments in the South West of England. MATERIALS AND METHODS: Phase 1 - Patient-Reported Experience Measure questionnaire (PREM). The questionnaire was distributed to patients who had undergone orthodontic treatment during the COVID-19 pandemic once services had resumed. Phase 2 - assessment of treatment outcomes, specifically with the Peer Assessment Rating (PAR) Index. A total of 280 PAR scores were obtained from a cohort of patients treated before and during the pandemic. RESULTS: A total of 711 PREM questionnaires were completed. Participants generally felt relaxed when visiting secondary care settings, orthodontic departments and whilst wearing orthodontic appliances during the pandemic. Nearly 40% of participants were concerned that the pandemic would impact on their treatment, particularly treatment length. Treatment outcomes revealed that patients treated before and during the pandemic experienced percentage PAR score reductions of 83.9% and 80.6%, respectively. Patients receiving treatment during the pandemic experienced longer treatment durations of 126 days. CONCLUSION: During the pandemic, low levels of anxiety were reported with respect to receiving orthodontic treatment in secondary care settings. Irrespective of the pandemic, a high standard of orthodontic treatment was provided. However, patient concerns regarding treatment length were justified.

Speech Outcomes of a National Cohort of Children with Orofacial Cleft at 5 and 10 Years of age.

OBJECTIVE: To assess speech outcomes at five and ten years of age in a nationwide study of children with orofacial cleft. DESIGN: Prospective study. PARTICIPANTS: Children born with orofacial cleft and having primary surgery in New Zealand. Speech samples were available for 151 five-year-old, and 163 ten-year-old children. MAIN OUTCOME MEASURES: Intelligibility, Acceptability, Velopharyngeal function, Hypernasality, Hyponasality, severity of airflow evaluated by perceptual speech assessment (using the standardised Rhinocleft assessment), and overall assessment of requirement for clinical intervention. RESULTS: A large proportion of five-year-old children had speech that was considered to be not completely intelligible, was not acceptable, and had inadequate velopharyngeal function. The noted deficiencies led to a clinical judgement that further speech and/or surgical intervention was required in 85% with cleft lip and palate, 65% with cleft palate and 26% with cleft lip. The proportion of children with poor speech outcomes in the ten-year-old children was lower, though of clinical importance, further intervention required for 25% with CLP, 15% with CP and 3% with CL. The number of sound production errors in both age groups followed the same pattern with fewest in those with CL and most in those with CLP. CONCLUSIONS: A significant proportion of children with orofacial cleft were found to have poor speech outcomes requiring further treatment. The outcomes are poor compared to centres reported in the UK and Scandinavia. New Zealand requires a review of the current services for individuals born with cleft to improve speech outcomes and interdisciplinary care.

Are dentists considering a career in orthodontic clinical academia? A qualitative study into the factors influencing a career in orthodontics.

Introduction Dental clinical academics are essential members of the dental workforce with roles in teaching, research and scholarship. There is currently a national shortage of UK dental clinical academics, with difficulties recruiting to all grades. In addition, there is evidence of gender inequality within academia, with segregation at a horizontal and vertical level.Aim To investigate the factors that influence a career in orthodontic clinical academia and highlight ways to improve recruitment and retention.Method A qualitative research study utilising focus groups. Purposive sampling was carried out to recruit participants at different stages of an orthodontic career. A total of eight face-to-face focus groups were conducted with 26 participants. Focus groups were split by gender and career stage. An inductive thematic analysis was used to generate themes.Results Three major themes were generated: academic career options, motivations and barriers to pursuing a clinical academic career.Conclusion This paper sheds light on the current factors affecting a career in orthodontic clinical academia. Worryingly, most dentists do not strive for an academic career and the barriers to pursuing this career option are discussed. Ways of addressing the issues facing recruitment and retention of individuals to orthodontic clinical academia are suggested.

A Nationwide Survey of Oral Health Related Quality of Life of Children With Orofacial Cleft in New Zealand.

OBJECTIVES: To describe (1) oral health related quality of life (OHRQoL) for children with orofacial cleft (OFC) in New Zealand and (2) assess any differences in OHRQoL by sex, ethnicity, and cleft phenotype using the 16 item (and 8 item subset) of the Child Perception Questionnaire (CPQ) and Parent version (P-CPQ). DESIGN AND SETTING: Prospective cross-sectional nationwide study. METHODS AND MATERIALS: Children with OFC and their parents completed the 16-item CPQ or the Parent CPQ, respectively, when attending cleft clinic appointments between January 2015 and December 2017. RESULTS: Overall, 174 children (mean age 10.4 ± 1.2 years) and their parents (n = 181) completed the CPQ or P-CPQ. In multivariable analysis, neither the CPQ nor P-CPQ 16-item or 8-item subset showed significant differences in OHRQoL total score with cleft phenotype. Children with cleft lip and palate (CLP) had higher (worse) well-being scores than those with cleft palate alone (CP) on the P-CPQ. Pacific Island children had consistently higher scores across both CPQ and P-CPQ, total and subscales. CONCLUSIONS: Significant differences in OHRQoL among children with OFC were found for the well-being domain for children with CLP as reported by P-CPQ, but the symptom domain and total score showed no differences. Poorer scores were reported for children of Pacific Island descent using both questionnaires. The study findings indicate that children with OFC in New Zealand are a group who experience worse OHRQoL when referenced to normative non-OFC data. Further investigations are required to establish greater insight into specific factors influencing OHRQoL.

Behavioral Outcomes in Children With an Orofacial Cleft in a National Study in New Zealand.

OBJECTIVE: To determine whether children with an orofacial cleft have higher levels of behavioral problems than the general population and whether this differs by cleft phenotype. DESIGN: A cohort of children with cleft lip and/or palate (CL/P) born in New Zealand from January 1, 2000. SETTING: Cleft clinics in New Zealand participating in a larger outcomes study between 2014 and 2017. PARTICIPANTS: Children (N = 378) aged 5 to 12 years of age and their parents. MAIN OUTCOMES: The Strengths and Difficulties Questionnaire (SDQ) and Pediatric Quality of Life Inventory (PedsQL) Generic Core Scales 4.0 and Family Impact Module 2.0. RESULTS: Compared to standardized norms, children with a cleft had higher than expected (defined as 20%) levels of abnormal/borderline SDQ scores for conduct problems (27.4%, P = .0003) and peer relationship problems (31.6%, P < .0001) but lower than expected levels of problems with pro-social skills (6.3%, P < .0001). There were no significant differences by age-group and or cleft phenotype other than an increased risk of hyperactivity in children with CP compared to children with CL. Total difficulties SDQ scores had moderate correlations with the PedsQL. CONCLUSIONS: While over 90% of children with CL/P had normal prosocial skills, they may not be easily accepted by their peers which may result in behavioral problems. These concerns were moderately related to lower quality of life. Support for establishment and maintenance of peer relationships is important to address externalizing and peer difficulties in children with CL/P. Community knowledge and understanding of CL/P needs to continue to be promoted.

Quality of Life Using General Population Validated Questionnaires in Children With Cleft Lip and/or Palate in New Zealand.

OBJECTIVE: To determine the level of quality of life (QoL) in children with cleft lip and/or palate (CL/P) and whether this differs by cleft phenotype. DESIGN: A cohort of children with CL/P born in New Zealand. SETTING: A nationwide study of children born with CL/P and having primary surgery in New Zealand. PARTICIPANTS: Children with CL/P and their families (n = 397) who attended a cleft clinic between October 1, 2014, and September 30, 2017, and agreed to complete questionnaires on QoL. MAIN OUTCOMES: Primary outcomes were QoL from the PedsQL 4.0 core generic questionnaires and the PedsQL 2.0 Family impact scale. RESULTS: Children with CL/P in New Zealand generally have a high QoL as assessed by the PedsQL. The impact of cleft phenotype had limited effects on the child, however there were significant impacts on parents and families. We found that the family impact scale differed by cleft phenotype with those with CL having the highest QoL and those with cleft palate the lowest, and this was consistent across QoL subscales. Quality of life improved as a whole by age, particularly in physical and cognitive functioning, as well as in the ability to undertake family activities. CONCLUSIONS: Children with CL/P have generally good levels of QoL in New Zealand, however cleft phenotype impacts on the level, with the lowest levels in those with cleft palate. Psychological support of children with cleft and their families should be an integral part of cleft care.

A retrospective nationwide study of the dental caries experience of New Zealand children with orofacial cleft.

OBJECTIVES: To investigate the dental caries experience of New Zealand children born with orofacial cleft (OFC), to compare this to age-specific national population-based data and to investigate any differences by demographic characteristics, cleft type and exposure to community water fluoridation. METHODS: Nationwide retrospective study of 554 dental records from 478 children born after 1 January 2000 with OFC were assessed at aged 5 (n = 333) and 12 years (n = 221), with 76 children (15.9%) having records at both ages. Community Oral Health Service records were analysed to determine dental caries experience (dmft/DMFT). Logistic regression was used to assess the likelihood of having experienced dental caries (d3 mft/D3 MFT ≥ 1) and multivariable models for variables including demographic characteristics, cleft type and exposure to community water fluoridation. RESULTS: A higher (49.6%) caries prevalence (dmft ≥ 1) and mean dmft at 5 years old (2.3; SD 3.6) were found in children with OFC than 5-year-olds in the general population (prevalence 40.4% and mean dmft 1.8). The 12-year-old (37.6%) caries prevalence (DMFT ≥ 1) and mean DMFT 0.8 (SD 1.4) were similar to population-based data (caries prevalence 37.3% and mean DMFT 0.9). Children with caries (dmf/DMF ≥ 1) had means of 4.8 (SD 3.8) at age 5 and 2.1 (SD 1.4) at age 12 years. Greater caries experience was associated Pacific and Maori ethnicity, and not receiving community water fluoridation. No differences were detected by sex or cleft type. CONCLUSION: The dental caries experience for 5-year-old children with OFC was poor in relation to population-based data and similar for 12-year-olds. Preventive guidelines for children with OFC from an early age should be a priority, along with the extension of community water fluoridation coverage.

Nasolabial outcomes in a nationwide study of orofacial cleft in New Zealand.

OBJECTIVES: To (a) assess nasolabial outcomes across four main cleft subgroups, (b) assess agreement using a categorical and a continuous scoring measure and (c) compare outcomes to international studies. SETTINGS AND SAMPLE POPULATION: Analysis of 470 images of which 218 was unilateral cleft lip and palate (UCLP), 128 unilateral cleft lip (UCL), 90 bilateral cleft lip and palate (BCLP) and 34 bilateral cleft lip (BCL). Images were taken around five (n = 279) and eight-ten (n = 191) years of age. MATERIALS & METHODS: Cropped images were assessed using the Asher-McDade (AM) and a 100 mm visual analogue scale (VAS) by a panel of six raters. Scoring was undertaken for vermillion border and nasal form, symmetry and profile. Analysis was undertaken for each subscore, a total score with sensitivity analysis using a total score based on the subscores for each patient. AM intra- and inter-rater reliability was assessed using weighted kappa and for the VAS components reliability was assessed using Pearson correlation. RESULTS: The AM intra-rater reliability was moderate/substantial, whilst inter-rater reliability was fair. The VAS intra-rater correlations were high, and inter-rater correlations were moderate. Better outcomes were found with cleft lip (CL) vs cleft lip and palate (CLP). No differences were found for sex, ethnicity, age and cleft laterality (unilateral). The AM found no difference between unilateral or bilateral. The VAS found bilateral scored worse than unilateral for both CL and CLP. CONCLUSIONS: The nasolabial outcomes differ by cleft type. The correlation was relatively high for the VAS whilst the AM had relatively poor reliability.

Craniofacial morphology and soft tissue profile outcomes for complete unilateral and complete bilateral cleft lip and palate in New Zealand.

OBJECTIVE: (a) To establish baseline lateral craniofacial morphology and soft tissue profile outcomes for New Zealand children with complete unilateral and complete bilateral cleft lip and palate (CUCLP/CBCLP) and determine differences in relation to demographic characteristics including cleft type, sex and ethnicity and (b) To compare these outcomes to similar international studies. SETTINGS AND SAMPLE POPULATION: Nation-wide prospective and retrospective cephalometric analysis of 76 patients with CUCLP and 23 patients with CBCLP pre-secondary alveolar bone graft. MATERIALS AND METHODS: Assessment was undertaken by three experienced orthodontists blinded to patient identity. A total of 13 hard tissue and 8 soft tissue landmarks were identified allowing for an assessment of 16 angular, three linear and one ratio variables. Inter-assessor reliability was determined by pre-defined measurement error thresholds. RESULTS: Inter-assessor reliability of cephalometric landmarks restricted reporting to 10 hard tissue, four soft tissue and one ratio variables. CUCLP had greater midface and mandibular retrusion than CBCLP. Females had greater midface and mandibular prominence and smaller nasal projections. The Pacific and Maori groups had more retrusive midfacial profiles, and the Pacific group had more prominent mandibles. A sub-analysis of New Zealand European CUCLP results found they were closely aligned to Eurocleft and Americleft study centres with less favourable outcomes. CONCLUSIONS: The reliability of a number of cephalometric measurements was poor. Lateral craniofacial morphology and soft tissue profile outcomes varied between CUCLP/CBCLP, sex and ethnicity. The New Zealand European outcomes are similar to or less favourable to other studies.

Dental arch relationship outcomes for children with complete unilateral and complete bilateral cleft lip and palate in New Zealand.

OBJECTIVES: To evaluate dental arch relationships of patients with complete unilateral and complete bilateral cleft lip and palate (CUCLP/CBCLP) in New Zealand. SETTING AND SAMPLE POPULATION: Retrospective nationwide observational outcomes study involving 100 CUCLP and 32 CBCLP non-syndromic patients. MATERIAL AND METHODS: Four calibrated assessors, blinded to the origin of the randomized digital models, used the GOSLON (UCLP) and the Bauru-BCLP (BCLP) Yardsticks and a 100 mm visual analogue scale (VAS) (UCLP&BCLP) to assess dental arch relationships. Weighted Kappa statistics were used to determine the intra- and inter-rater reliability for the GOSLON/Bauru-BCLP Yardsticks and correlations for the VAS. RESULTS: Intra-rater reliability ranged from 0.57 to 0.88 (GOSLON), 0.62-0.84 (Bauru-BCLP) and 0.45-0.93 (VAS). Inter-rater reliability ranged from 0.62 to 0.86, (GOSLON), 0.48-0.75 (Bauru-BCLP) and 0.64-0.93 (VAS). Of the 100 CUCLP models, 46% had poor/very poor, 28% fair and 26% had good/very good dental arch relationships. Of the 32 CBCLP models, 37.5% were poor/very poor, 40.6% fair and 21.9% had good/very good dental arch relationships. The mean CUCLP VAS score was 50.5 mm (SD 19.9 mm) whilst the mean CBCLP VAS score was 40.0 mm (SD 22.0 mm) and both showed a strong relationship with their respective Yardstick scorings. CONCLUSION: The dental arch relationships of children in New Zealand with CUCLP are similar to those centres in the Eurocleft and Americleft studies which had less favourable outcomes. Those with CBCLP are inferior to those reported elsewhere. Continued monitoring will allow for tracking of improvement in outcomes.

Bone fill following secondary alveolar bone grafting for children with cleft of the alveolus in New Zealand.

OBJECTIVE: To investigate the amount of bone fill post-secondary alveolar bone grafting for children with cleft in New Zealand. SETTINGS AND SAMPLE POPULATION: Retrospective analysis of post-operative intra-oral periapical and upper anterior occlusal radiographs of 45 grafted sites where all grafting was undertaken within the New Zealand public hospital service. MATERIALS AND METHODS: A modified Kindelan Index and a 100 mm visual analogue scale (VAS) were used to assess the amount of bone fill using intra-oral radiographs by 4 orthodontists experienced in cleft care and who were blind to the patient's identity. Fourteen duplicated radiographs were randomly selected and added to the sample for reliability assessment. RESULTS: The Kindelan Index rated 37.8% Grade 1 (Good), 31.1% rated Grade 2 (Satisfactory), 22.2% rated Grade 3 (Unsatisfactory) and 8.9% Grade 4 (Failure), a combined unsatisfactory/failure rate of 31.1%. The average VAS score was 50 mm ± 24 mm, and there was a strong relationship between Kindelan and VAS assessments. Those patients aged 10-11 years had significantly better outcomes using both assessments compared to those aged <10 and >11. The VAS assessment found that higher caseload surgeons had better outcomes, although the difference was of borderline statistical significance (mean VAS 56 mm vs 44 mm P = 0.07). CONCLUSIONS: Contemporary secondary alveolar bone grafting bone fill outcomes in New Zealand are poor when compared to contemporary international studies. These findings indicate a review of secondary bone grafting is required to improve outcomes for New Zealand children with cleft.

Long-term changes in oral health-related quality of life of standard, cleft, and surgery patients after orthodontic treatment: A longitudinal study.

INTRODUCTION: The aim of this study was to assess long-term changes and describe the trajectories of oral health-related quality of life (OHRQoL) in a cohort of cleft, surgery, and standard patients who received orthodontic treatment. METHODS: Standard (n = 16), cleft (n = 19), and orthognathic surgery (n = 22) patients completed the short-form of the Oral Health Impact Profile (OHIP-14) before treatment, immediately posttreatment, and approximately 5 years posttreatment. RESULTS: An overall reduction in OHIP-14 scores (improvement in OHRQoL) occurred after orthodontic treatment; however, this was only significant for the surgery and standard groups (P <0.05). The total OHIP-14 score increased significantly from posttreatment to 5 years follow-up for all 3 study groups (P <0.05). Relative to pretreatment, however, there were significant reductions in total OHIP-14 scores at 5 years posttreatment in the surgery group (-57.4%; P <0.05), but not in the standard sample (-24.2%; P >0.05). By contrast, the OHIP-14 score in the cleft group increased but not significantly (40.2%; P >0.05). Using a mixed model analysis, a significant interaction was detected between patient group and time (ie, study time point) (F = 6.0; P <0.0001), after adjusting for age and sex. CONCLUSIONS: Distinct patient groups showed different OHRQoL trajectories after orthodontic treatment. Treatment-related improvements in OHRQoL are maintained over time for surgery patients, but not for those with standard malocclusions and orofacial clefts.

Comparison of Reliability of Categorical and Continuous Scales for Radiographic Assessments of Bone Infill Following Secondary Alveolar Bone Grafting.

OBJECTIVES: To investigate examiner reliability of scoring intraoral radiographs of bone infill following secondary bone grafting using a categorical scale (modified Kindelan Index) and a 10-cm visual analog scale (VAS). To investigate the level of clinical experience on the reliability of these assessments. DESIGN: Retrospective study involving 10 clinicians of varying clinical experience who were blind to the patient's identity. SETTING: All grafting was carried out within the New Zealand public hospital service. PATIENTS: Fifty-eight grafts (48 UCLP and 5 BCLP) were assessed with 14 duplicated radiographs randomly added to the sample, making a total of 72 radiographs for assessment. MAIN OUTCOME MEASURES: Weighted kappa was used for intra- and interrater examiner reliability for the categorical scale and correlations for the VAS. RESULTS: Relatively poor intrarater examiner agreement for categorical scoring (median 0.46) was found. Clinicians with greater experience generally recording higher intrarater weighted kappa. The intrarater correlations for the continuous scale (median 0.89) suggest better consistency regardless of the level of experience. The interrater relationships were generally low, with an average of weighted kappa of 0.25 while the overall average VAS correlation was 0.49. For the majority of scorers, there was a relationship between the VAS and the Kindelan Index, with lower VAS scores related to worse Kindelan scores. CONCLUSIONS: The use of a VAS produced better intra- and interexaminer reliability than the categorical Kindelan Index and was more consistent despite the level of clinical experience. Further evaluation of the validity of the VAS for the assessment of bone infill is warranted.

The incidence of Orofacial Cleft in live births in New Zealand.

AIM: To determine the incidence of orofacial cleft at birth in New Zealand over 10 years from January 2000. METHODS: Comparison of data collected from cleft units and data held on the national minimum dataset. RESULTS: The overall incidence of OFC in New Zealand over a 10 year period was found to be 1.79 per 1,000 live births, higher than the norm for Western society. The major reason for this increased rate was an increased rate for the Maori 2.37 per 1,000 live births, specifically related to a Cleft Palate alone rate over twice that of the European (1.54 vs 0.73 per 1,000 live births). The rate for Pacific was half way between (1.04 per 1,000 live births). The rate of Cleft Lip alone was significantly lower in both Maori and Pacific populations. Different sex ratios were also seen in relation to Cleft Lip and Cleft Lip and Palate for Maori and Pacific compared to those normally reported. CONCLUSIONS: Maori have an increased incidence of Orofacial Cleft due to one of the highest rates of Cleft Palate alone in the world. Further aetiological studies involving genetic and environmental factors are required to elicit the reasons for this increased incidence.

Oral health-related quality of life changes in standard, cleft, and surgery patients after orthodontic treatment.

INTRODUCTION: The purpose of this study was to investigate the effect of orthodontic treatment on oral health-related quality of life (OHRQoL) in groups of standard patients with severe malocclusions; cleft lip, cleft palate, or cleft lip and palate patients; and orthognathic surgery patients. METHODS: The study sample consisted of 83 consecutive patients undergoing treatment at the orthodontic unit of Christchurch Hospital, Christchurch, New Zealand, divided into 3 groups: 30 adolescents with severe malocclusions; 24 adolescents with cleft lip, cleft palate, or cleft lip and palate; and 29 adults with severe skeletal discrepancies requiring both orthognathic surgery and orthodontic treatment. Each patient completed the Short Form of the Oral Health Impact Profile (OHIP-14) questionnaire before and after orthodontic treatment. RESULTS: The baseline OHIP-14 subscale scores among the 3 study groups were significantly different, with the surgery patients having nearly twice the OHIP-14 scores of the other 2 groups for nearly half of the items (P <0.05). The surgery patients experienced the greatest reduction in OHIP-14 scores (ie, improvement in OHRQoL), with the largest effect sizes reported for the psychological discomfort (+2.73) and disability (+2.65) domains. The group with clefts experienced the smallest changes in OHIP-14 scores across all 7 domains (-0.03 to +0.63). After adjusting for age and sex, the surgical patients had a significantly greater reduction in pretreatment OHIP-14 scores than did the standard and the cleft patients (P <0.01). CONCLUSIONS: The effect of orthodontic treatment on OHRQoL varies for different patient groups even after adjusting for age and sex. The greatest improvement in OHRQoL occurred in adults with a need for orthognathic surgery, whereas the least improvement seemed to occur in adolescents with cleft lip, cleft palate, or cleft lip and palate.

Severity and outcome assessments of patients undertaking surgical orthodontic treatment.

BACKGROUND: Combined orthognathic-orthodontic treatment can be lengthy and expensive. It is therefore important to evaluate the effectiveness of proposed treatment and the likely outcomes. OBJECTIVES: To determine the demographic and surgical details of patients who received orthognathic-orthodontic treatment at Christchurch Hospital, New Zealand, and to assess treatment using the Severity and Outcome Index (SOI). METHODS: An observational and retrospective study was conducted of patients who received surgical orthodontic treatment between 2005 and 2012 at Christchurch Hospital. Pre- and post-treatment lateral cephalometric radiographs of 93 patients were evaluated. Seven cephalometric parameters were assessed using the Severity and Outcome Index. A severity score ranged from 0 for the most severe to 7 for the least severe, while the outcome score ranged from 0 for the worst to 7 for the best outcome. RESULTS: Class II patients had a severity score of 3.4 and the best outcome score of 6.2. Class III patients had a severity score of 3.3 and an outcome score of 6.1. Patients with an anterior open bite (AOB) had the worst severity score of 3.0, and the worst outcome score of 5.9. The overall treatment outcome scores for all groups were statistically significantly greater than the severity scores, which increased from 3.4 to 6.1 (p < 0.05). CONCLUSIONS: Favourable outcomes were achieved for a group of patients with a high need for treatment. Christchurch Hospital appeared to be treating cases of increased severity and gained better treatment outcomes when compared with a United Kingdom (UK) national audit.

Non-syndromal orofacial clefts in the Canterbury/West Coast region during the 2000-2009 period.

OBJECTIVES: To describe the incidence and ethnic characteristics of orofacial clefting in the Canterbury/West Coast region over the ten-year period 2000-2009 and compare it with previously-reported data. DESIGN: A retrospective analysis of case-series data. SETTING: Cleft clinic, Oral Health Centre, Christchurch Hospital. PARTICIPANTS: All babies born in the Canterbury/West Coast region from 1 January 2000 to 31 December 2009 with a non-syndromal orofacial cleft were included. RESULTS: The calculated incidence of non-syndromal orofacial clefts was 1.69 per thousand live births, comprising 0.85 for cleft lip with or without cleft palate (CL[P]) and and 0.84 for isolated cleft palate (CP). The earlier 40-year data estimated an incidence of 1.94 per thousand live births made up of 1.13 CL[P] and 0.81 CP. Maori and non-Maori had a similar incidence of CL[P]; however, it appears that Maori had a much higher incidence of CP than non-Maori (incidence of 1.35 and 0.88 per thousand live births respectively). CONCLUSIONS: The incidence of CL[P] has decreased while that of CP has remained constant. The incidence of CP in Maori is higher than in non-Maori.