Growth Outcomes Audit for Unilateral Cleft Lip and Palate (UCLP) After 2-stage Palate Repair.

PURPOSE: To assess the impact of 1 and 2-stage palatoplasty protocol on the dental arch relationships in unilateral cleft lip and palate (UCLP) in a single center. METHODS: Our study consisted of 349 individuals divided into 2 groups according to the palatoplasty protocol. Two-stage group comprised 169 subjects with UCLP (mean age: 6.9 y, 110 male and 59 female) who underwent lip, nasal ala, and anterior palate repair with vomer flap from 3 to 6 months (first surgery stage). Soft palate repair occurred from 12 to 18 months (second surgery stage). The one-stage group comprised 180 subjects with UCLP (mean age: 7.2 y, 108 male and 72 female) who underwent 1-stage palatoplasty. Dental models were evaluated by 3 experienced orthodontists applying Goslon Yardstick and the 5-year-old index (FYOI). The influence of the palatoplasty technique and surgeon factor on the interarch relationship was evaluated. The weighted Kappa was used to assess intraexaminer and interexaminer agreements for comparisons of dental arch relationships. Intergroup comparisons were conducted using the χ 2 test ( P <0.05). RESULTS: The intraexaminer reliability was very good (0.81 to 0.98) and interexaminer reliability varied from satisfactory to very good (0.56 to 0.83). The mean occlusal index of the 2-stage and 1-stage groups was 2.77 and 3.03, respectively. The variability of the mean index between surgeons varied from 2.38 to 3.2 in the 2-stage group and 2.91 to 3.2 in the 1-stage group. There were significant differences in the frequency of Goslon 5 index ( P =0.002) between groups, with the 2-stage group presenting less cases (1.18%) than the group 1-stage (11.11%). CONCLUSION: The interarch relationship was similar for both palate repair protocols. Two-stage palatoplasty showed a decreased prevalence of Goslon index 5.

A Cleft-Customized Occlusal Rating System to Assess Orthodontic Occlusal Improvement in Patients With Unilateral Cleft Lip and Palate.

OBJECTIVE: This study aimed to develop a new method to quantify occlusal improvement in patients with unilateral cleft lip and palate (UCLP) who had undergone orthodontic treatment and to evaluate its reproducibility. DESIGN: A panel of orthodontists decided on the relevance of different occlusal features to score initial and final 3-dimensional study models and panoramic radiographs. A subsequent subjective analysis was later performed by a local orthodontic panel. SETTING: The sample was obtained from the orthodontic clinical archives of a hospital known for the treatment of patients with craniofacial differences. PATIENTS: Thirty-one nonsyndromic patients, 17 males and 14 females, were randomly selected according to preestablished inclusion/exclusion criteria. INTERVENTIONS: The records corresponded to the period during which the patients were treated with conventional multibracket mechanics and adjunctive restorative procedures. MAIN OUTCOME/MEASURES: The intraclass correlation coefficient measured intraexaminer and interexaminer agreements. The Spearman correlation test assessed the relationship between the local orthodontic panel perception and the improvement scores. RESULTS: Inter- and intra-rater ICCs varied between fair/good to excellent. There was a strong correlation between the Cleft-Customized Occlusal Rating system classification of occlusal improvement and the local orthodontic panel's perception, thereby enabling the utilization of the interpretation scale by the panel. CONCLUSIONS: The method showed to be a useful tool in quantifying and classifying occlusal improvement in this specific population. As any other method, some limitations apply and need to be accounted for.

Is the early mixed dentition dental arch relationship related to the anteroposterior alignment of the maxillary segments in infants with CUCLP?

OBJECTIVE: Midface retrusion is a concern in patients with complete unilateral cleft lip and palate (CUCLP). Maxillary segment alignment may influence the prognosis after corrective surgery. This study assessed the association between maxillary segment alignment and interarch relationship observed in the early mixed dentition. The null hypothesis was that there is no relation between the initial alignment of cleft segments and the width of the cleft in the infant, and the early mixed dentition interarch relationship. SETTING AND SAMPLE POPULATION: The sample consists of 352 children with CUCLP treated at the Hospital for Rehabilitation of Craniofacial Anomalies/USP. MATERIAL AND METHODS: Dental models were obtained before lip repair at three months and at the age of six. Based on the first, the sample was then divided into two groups: anteroposterior aligned and anteroposterior misaligned maxillary segments. They were also divided into 4 groups according to the cleft width (Narrow, Medium, Wide and Very Wide). Interarch relationship was graded using the 5-year-old index. The statistical association was evaluated using the chi-squared test (P < .05). RESULTS: Cleft width was inversely related to interarch relationship in the early mixed dentition phase. Interarch relationship at the age of six was more favourable in children with misaligned maxillary segments than in children with aligned segments (P = .048). CONCLUSION: Five-year interarch relationship in patients with CUCLP is related to the anteroposterior relationship of infant maxillary segments and initial cleft width before primary surgeries. Wide alveolar clefts and sagittally aligned maxillary segments showed a worse interarch relationship in the early mixed dentition.

Facial profile esthetics in operated children with bilateral cleft lip and palate.

OBJECTIVE:: The aim of this study was to evaluate the facial profile esthetics of rehabilitated children with complete bilateral cleft lip and palate (BCLP), comparing the judgment of professionals related and not related to cleft rehabilitation and laypersons. METHODS:: Thirty children in the mixed dentition (24 male; 6 female) with a mean age of 7.8 years were evaluated using facial profile photographs by 25 examiners: 5 orthodontists and 5 plastic surgeons with experience in cleft care, 5 orthodontists and 5 plastic surgeons without experience in oral cleft rehabilitation and 5 graduated laymen. Their facial profiles were classified into esthetically unpleasant (grade 1 to 3), esthetically acceptable (grade 4 to 6), and esthetically pleasant (grade 7 to 9). Intraexaminer and interexaminer errors were evaluated using Spearman correlation coefficient and Kendall's test, respectively. Inter-rater differences were analyzed using Friedman test and Student-Newman-Keuls test for multiple comparisons. RESULTS:: Orthodontists dealing with oral clefts rehabilitation considered the majority of the sample as esthetically pleasant. Plastic surgeons of the cleft team and laypersons classified most of the sample as esthetically acceptable. Most of the orthodontists and plastic surgeons not related to cleft care evaluated the facial profile as esthetically unpleasant. The structures associated to unpleasant profiles were the nose, the midface and the upper lip. CONCLUSIONS:: The facial profile of children with BCLP was classified as esthetically acceptable by laypersons. Professionals related to cleft rehabilitation were more lenient and those not related to cleft care were stricter to facial esthetics than laypersons.

Facial profile esthetics in operated children with bilateral cleft lip and palate

ABSTRACT Objective: The aim of this study was to evaluate the facial profile esthetics of rehabilitated children with complete bilateral cleft lip and palate (BCLP), comparing the judgment of professionals related and not related to cleft rehabilitation and laypersons. Methods: Thirty children in the mixed dentition (24 male; 6 female) with a mean age of 7.8 years were evaluated using facial profile photographs by 25 examiners: 5 orthodontists and 5 plastic surgeons with experience in cleft care, 5 orthodontists and 5 plastic surgeons without experience in oral cleft rehabilitation and 5 graduated laymen. Their facial profiles were classified into esthetically unpleasant (grade 1 to 3), esthetically acceptable (grade 4 to 6), and esthetically pleasant (grade 7 to 9). Intraexaminer and interexaminer errors were evaluated using Spearman correlation coefficient and Kendall's test, respectively. Inter-rater differences were analyzed using Friedman test and Student-Newman-Keuls test for multiple comparisons. Results: Orthodontists dealing with oral clefts rehabilitation considered the majority of the sample as esthetically pleasant. Plastic surgeons of the cleft team and laypersons classified most of the sample as esthetically acceptable. Most of the orthodontists and plastic surgeons not related to cleft care evaluated the facial profile as esthetically unpleasant. The structures associated to unpleasant profiles were the nose, the midface and the upper lip. Conclusions: The facial profile of children with BCLP was classified as esthetically acceptable by laypersons. Professionals related to cleft rehabilitation were more lenient and those not related to cleft care were stricter to facial esthetics than laypersons.

RESUMO Objetivo: o objetivo desse estudo foi avaliar a estética do perfil facial de crianças com fissura labiopalatina completa bilateral (FLCB) operadas, comparando o julgamento de leigos e de profissionais relacionados e não relacionados à reabilitação de fissuras. Métodos: fotografias do perfil facial de trinta crianças na dentadura mista (24 do sexo masculino e 6 do sexo feminino), com idade média de 7,8 anos, foram avaliadas por 25 examinadores: 5 ortodontistas e 5 cirurgiões plásticos com experiência em fissuras, 5 ortodontistas e 5 cirurgiões plásticos sem experiência na reabilitação de fissuras, e 5 leigos com formação superior. Os perfis faciais foram classificados como esteticamente desagradável (grau 1 a 3), esteticamente aceitável (grau 4 a 6) e esteticamente agradável (grau 7 a 9). Para verificar a concordância intraexaminadores e interexaminadores, foram utilizados o Coeficiente de Correlação de Spearman e o Coeficiente de Concordância de Kendall, respectivamente. Para comparação entre as categorias de acordo com os escores atribuídos, foram aplicados o teste de Friedman e o teste de Student-Newman-Keuls, para comparações múltiplas. Resultados: os ortodontistas que lidam com reabilitação de fissuras labiopalatinas consideraram a maioria da amostra como esteticamente agradável. Cirurgiões plásticos com experiência em fissuras e leigos classificaram a maioria da amostra como esteticamente aceitável. Grande parte dos ortodontistas e cirurgiões plásticos sem experiência na reabilitação de fissuras classificou o perfil facial como esteticamente desagradável. As estruturas associadas aos perfis desagradáveis foram o nariz, o terço médio da face e o lábio superior. Conclusões: o perfil facial de crianças com FLCB foi classificado como esteticamente aceitável pelos leigos; já os profissionais relacionados à reabilitação de fissuras foram mais complacentes, em comparação aos profissionais sem experiência na reabilitação de fissuras, que, por sua vez, foram mais rigorosos quanto à estética facial do que os leigos.

Dentoskeletal outcomes of a rapid maxillary expander with differential opening in patients with bilateral cleft lip and palate: A prospective clinical trial.

INTRODUCTION: The purpose of this 2-arm parallel study was to evaluate the dentoskeletal effects of rapid maxillary expansion with differential opening (EDO) compared with the hyrax expander in patients with complete bilateral cleft lip and palate. METHODS: A sample of patients with complete bilateral cleft lip and palate was prospectively and consecutively recruited. Eligibility criteria included participants in the mixed dentition with lip and palate repair performed during early childhood and maxillary arch constriction with a need for maxillary expansion before the alveolar bone graft procedure. The participants were consecutively divided into 2 study groups. The experimental and control groups comprised patients treated with rapid maxillary expansion using EDO and the hyrax expander, respectively. Cone-beam computed tomography examinations and digital dental models of the maxillary dental arches were obtained before expansion and 6 months postexpansion. Standardized cone-beam computed tomography coronal sections were used for measuring maxillary transverse dimensions and posterior tooth inclinations. Digital dental models were used for assessing maxillary dental arch widths, arch perimeters, arch lengths, palatal depths, and posterior tooth inclinations. Blinding was used only during outcome assessment. The chi-square test was used to compare the sex ratios between groups (P <0.05). Intergroup comparisons were performed using independent t tests with the Bonferroni correction for multiple tests. RESULTS: Fifty patients were recruited and analyzed in their respective groups. The experimental group comprised 25 patients (mean age, 8.8 years), and the control group comprised 25 patients (mean age, 8.6 years). No intergroup significant differences were found for age, sex ratio, and dentoskeletal variables before expansion. No significant differences were found between the EDO and the hyrax expander groups regarding skeletal changes. The EDO promoted significantly greater increases of intercanine width (difference, 3.63 mm) and smaller increases in canine buccal tipping than the conventional hyrax expander. No serious harm was observed other than transitory variable pressure sensations on the maxillary alveolar process in both groups. CONCLUSIONS: The EDO produced skeletal changes similar to the conventional hyrax expander. The differential expander is an adequate alternative to conventional rapid maxillary expanders when there is need for greater expansion in the maxillary dental arch anterior region. REGISTRATION: This trial was not registered. PROTOCOL: The protocol was not published before trial commencement. FUNDING: This study received financial support from FAPESP (process number 2009/17622-9). As a possible conflict of interest, a patent with an EDO was submitted in March 2011 to the National Institute of Industry Property and is still in process. However, we believe that this is a natural step of translational research (bench-to-bedside), and we guarantee that the scientific results are true.

Ocorrência de ceceio em fricativas vozeadas e não vozeadas em crianças com fissura labiopalatina operada / Occurrence of lisping in voiced and unvoiced fricatives in children with operated cleft lip and palate

Objetivo investigar se o ceceio, quando identificado, difere entre as fricativas alveolares não vozeadas e vozeadas produzidas por crianças com fissura labiopalatina operada. Métodos estudo prospectivo, em que frases constituídas pelas consoantes [s] e [z] produzidas por 32 crianças com fissura labiopalatina operada (idade média, 8 anos, 8 meses) foram selecionadas de um banco de dados e posteriormente julgadas auditivamente. Todas as crianças apresentavam relação inter-arcos alteradas, conforme avaliação ortodôntica realizada por três ortodontistas (concordância inter-juiz quase perfeita, kappa= 0.81), a partir da análise de modelos de gesso. Três fonoaudiólogas julgaram auditivamente as produções áudio gravadas. A concordância inter-juízes variou entre 56% e 78% e entre 59% e 93% para as frases constituídas de [s] e [z], respectivamente. Resultados o ceceio foi identificado em 69% das crianças e, particularmente, em 72% e 50% das produções envolvendo [s] e [z], respectivamente. Houve diferença significante entre os julgamentos para as fricativas [s] e [z], com maior ocorrência de ceceio em [s]. Conclusões deformidades dentofaciais podem favorecer a ocorrência do ceceio na população com fissura labiopalatina. A maior ocorrência do ceceio em [s] em comparação à [z], a partir da identificação auditiva, pode ser justificado por razões acústicas e/ou articulatórias. Sugere-se que o ceceio é dependente do contexto fonético-fonológico da frase devendo o mesmo ser considerado para fins clínicos e de pesquisa. .

Purpose to investigate whether lisp, when identified, differs between voiced and unvoiced alveolar fricatives produced by children with cleft palate. Methods a prospective study in which sentences comprising the consonants [s] and [z] produced by 32 children with cleft palate (mean age, 8 years, 8 months) were selected and after auditory judged. All children presented altered inter-relationship arches as evaluated by three orthodontists (inter-judge agreement almost perfect kappa = 0.81), performing analysis of dental casts. Three Speech-Language-Pathologists judged perceptually audio recorded productions. The inter-judges agreement ranged between 56% and 78% and between 59% and 93% for the phrases consisting of [s] and [z], respectively. Results the lisp was identified in 69% of children, particularly, in 72% and 50% [s] and [z] sounds, respectively. There were significant differences between judgments for the fricatives [s] and [z], with higher prevalence of lisping in [s]. Conclusions dentofacial deformities may favor the occurrence of lisp in population with cleft palate. The increased occurrence of lisp in [s] compared to [z], based on auditory perceptual identification, can be justified by acoustic and / or articulatory reasons. It is suggested that lisp is dependent of the phonetic-phonological context of the sentence and therefore must be considered for clinical and research purposes. .

Prevalence of dental anomalies of number in different subphenotypes of isolated cleft palate

OBJECTIVE: This study aimed at carrying out a radiographic analysis on the prevalence of dental anomalies of number (agenesis and supernumerary teeth) in permanent dentition, in different subphenotypes of isolated cleft palate pre-adolescent patients. METHODS: Panoramic radiographs of 300 patients aged between 9 and 12 years, with cleft palate and enrolled in a single treatment center, were retrospectively analyzed. The sample was divided into two groups according to the extension/severity of the cleft palate: complete and incomplete . The chi-square test was used for intergroup comparison regarding the prevalence of the investigated dental anomalies (P < 0.05). RESULTS: Agenesis was found in 34.14% of patients with complete cleft palate and in 30.27% of patients with incomplete cleft palate. Supernumerary teeth were found in 2.43% of patients with complete cleft palate and in 0.91% of patients with incomplete cleft palate. No statistically significant difference was found between groups with regard to the prevalence of agenesis and supernumerary teeth. There was no difference in cleft prevalence between genders within each study group. CONCLUSION: The prevalence of dental anomalies of number in pre-adolescents with cleft palate was higher than that reported for the general population. The severity of cleft palate did not seem to be associated with the prevalence of dental anomalies of number. .

OBJETIVO: o propósito deste estudo foi avaliar radiograficamente a prevalência das anomalias dentárias de número (agenesias e supranumerários), na dentição permanente, em diferentes subfenótipos da fissura isolada de palato, em pacientes pré-adolescentes. MÉTODOS: foram investigadas, de forma retrospectiva, 300 radiografias panorâmicas de pacientes com fissura palatina (pós-forame), de 9 a 12 anos de idade, matriculados em um mesmo centro. A amostra foi dividida em dois grupos de acordo com a extensão/gravidade da fissura palatina: completa e incompleta. O teste qui-quadrado foi utilizado para comparação intergrupos das prevalências de anomalias avaliadas (p < 0,05). RESULTADOS: a agenesia dentária foi encontrada em 34,14% dos pacientes com fissura pós-forame completa e em 30,27% com fissura pós-forame incompleta. A prevalência de dentes supranumerários correspondeu a 2,43% nos pacientes com fissura palatina completa e a 0,91% no grupo com fissura palatina incompleta. Não houve diferença estatística significativa entre os grupos quanto à prevalência de agenesias dentárias e supranumerários. Não se observou diferença sexual quanto à prevalência de fissura dentro de cada grupo de estudo. CONCLUSÃO: os pacientes pré-adolescentes com fissura palatina apresentam maior prevalência de anomalias dentárias em relação à população em geral. A gravidade da fissura palatina parece não se associar com a prevalência de anomalias dentárias de número. .

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) - Part 5: institutional outcomes assessment and the role of the Laboratory of Physiology.

The Laboratory of Physiology provides support for the diagnosis of functional disorders associated with cleft lip and palate and also conducts studies to assess, objectively, the institutional outcomes, as recommended by the World Health Organization. The Laboratory is conceptually divided into three units, namely the Unit for Upper Airway Studies, Unit for Stomatognathic System Studies and the Unit for Sleep Studies, which aims at analyzing the impact of different surgical and dental procedures on the upper airways, stomatognathic system and the quality of sleep of individuals with cleft lip and palate. This paper describes the main goals of the Laboratory in the assessment of procedures which constitute the basis of the rehabilitation of cleft lip and palate, i.e., Plastic Surgery, Orthodontics and Maxillofacial Surgery and Speech Pathology.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) - Part 4: oral rehabilitation.

Treatment of patients with cleft lip and palate is completed with fixed prostheses, removable, total, implants and aims to restore aesthetics, phonetics and function and should be guided by the basic principles of oral rehabilitation, such as physiology, stability, aesthetics, hygiene and the expectations of the patient. In order to obtain longevity of a prosthetic rehabilitation, the periodontal and dental tissue as well as the biomechanics of the prosthesis are to be respected. The purpose of this article is to describe the types of prosthetics treatment, which are performed at HRAC/USP for the rehabilitation of cleft area in adult patients.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) - Part 5: Institutional outcomes assessment and the role of the Laboratory of Physiology

The Laboratory of Physiology provides support for the diagnosis of functional disorders associated with cleft lip and palate and also conducts studies to assess, objectively, the institutional outcomes, as recommended by the World Health Organization. The Laboratory is conceptually divided into three units, namely the Unit for Upper Airway Studies, Unit for Stomatognathic System Studies and the Unit for Sleep Studies, which aims at analyzing the impact of different surgical and dental procedures on the upper airways, stomatognathic system and the quality of sleep of individuals with cleft lip and palate. This paper describes the main goals of the Laboratory in the assessment of procedures which constitute the basis of the rehabilitation of cleft lip and palate, i.e., Plastic Surgery, Orthodontics and Maxillofacial Surgery and Speech Pathology.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) Part 4: Oral Rehabilitation

Treatment of patients with cleft lip and palate is completed with fixed prostheses, removable, total, implants and aims to restore aesthetics, phonetics and function and should be guided by the basic principles of oral rehabilitation, such as physiology, stability, aesthetics, hygiene and the expectations of the patient. In order to obtain longevity of a prosthetic rehabilitation, the periodontal and dental tissue as well as the biomechanics of the prosthesis are to be respected. The purpose of this article is to describe the types of prosthetics treatment, which are performed at HRAC/USP for the rehabilitation of cleft area in adult patients.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies - USP (HRAC-USP) - part 3: Oral and Maxillofacial Surgery

This paper presents the treatment protocol of maxillofacial surgery in the rehabilitation process of cleft lip and palate patients adopted at HRAC-USP. Maxillofacial surgeons are responsible for the accomplishment of two main procedures, alveolar bone graft surgery and orthognathic surgery. The primary objective of alveolar bone graft is to provide bone tissue for the cleft site and then allow orthodontic movements for the establishment of an an adequate occlusion. When performed before the eruption of the maxillary permanent canine, it presents high rates of success. Orthognathic surgery aims at correcting maxillomandibular discrepancies, especially anteroposterior maxillary deficiencies, commonly observed in cleft lip and palate patients, for the achievement of a functional occlusion combined with a balanced face.

Facial pattern of patients with post-foramen incisor cleft

OBJECTIVE: The assessment and establishment of the facial growth pattern for patients with a cleft palate. MATERIAL: This cross-sectional retrospective study was based on front and profile photos of a sample of 71 patients at the HRAC-USP, 22 males and 49 females, Brazilians, young adults, with a mean age of 17 years 8 months, without previous orthodontic treatment and no associated syndromes. The method was the subjective facial diagnosis based on technical concepts, that is, the qualitative morphologic analysis of the face through clinical examination. Individuals were classified as Pattern I, II, III, Long Face or Short Face. RESULTS: The distribution found with the frontal morphologic analysis was: Pattern I (69%), II (6%), III (7%), Long (18%) and Short (0%). As for the profile morphologic analysis, the distribution was: Pattern I (35%), II (38%), III (10%), Long (17%) and Short (0%).The distribution observed in the frontal analysis was very positive, since individuals Pattern I prevailed. For the profile evaluation, the anterior-posterior dysplasias were essentially shown, significantly increasing their participation. Long Face Pattern maintained a balance in both ratings and Short Face Pattern was not found in the sample used, probably related to the low prevalence in the general population. CONCLUSION: The prevalence of different Facial Patterns for patients with cleft palate was similar to that found in individuals without cleft.

OBJETIVO: avaliar e determinar o padrão de crescimento facial de indivíduos com fissura pós-forame incisivo. MÉTODOS: esse estudo transversal retrospectivo usou fotografias frontais e de perfil de uma amostra de 71 pacientes matriculados no HRAC-USP (Bauru/SP), sendo 22 indivíduos do sexo masculino e 49 do feminino, jovens adultos brasileiros, com idade média de 17 anos e 8 meses, sem tratamento ortodôntico prévio ou síndromes associadas. O método utilizado foi o diagnóstico facial subjetivo, baseado em conceitos técnicos, constando da análise morfológica qualitativa da face. Os indivíduos foram classificados, por dois ortodontistas do HRAC/USP, com base no conceito de padrão sugerido por Capelozza Filho: Padrão I, II, III, Face Longa e Face Curta. RESULTADOS: a distribuição na análise morfológica frontal encontrada foi: Padrão I (69%), Padrão II (6%), Padrão III (7%), Padrão Face Longa (18%) e Padrão Face Curta (0%). Na análise morfológica de perfil, a distribuição encontrada foi: Padrão I (35%), Padrão II (38%), Padrão III (10%), Padrão Face Longa (17%) e Padrão Face Curta (0%). A distribuição no aspecto frontal foi muito positiva, já que os indivíduos Padrão I predominaram. Na análise do perfil, as displasias anteroposteriores foram expressas em essência, aumentando significativamente sua participação. Já o Padrão Face Longa manteve um equilíbrio em ambas as avaliações e o Padrão Face Curta não foi encontrado na amostra utilizada, provavelmente devido à baixa prevalência na população geral. CONCLUSÃO: a prevalência dos diversos padrões faciais para os pacientes com fissura pós-forame incisivo foi semelhante à encontrada para indivíduos sem fissura.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies-USP (HRAC-USP)--part 2: pediatric dentistry and orthodontics.

The aim of this article is to present the pediatric dentistry and orthodontic treatment protocol of rehabilitation of cleft lip and palate patients performed at the Hospital for Rehabilitation of Craniofacial Anomalies-University of São Paulo (HRAC-USP). Pediatric dentistry provides oral health information and should be able to follow the child with cleft lip and palate since the first months of life until establishment of the mixed dentition, craniofacial growth and dentition development. Orthodontic intervention starts in the mixed dentition, at 8-9 years of age, for preparing the maxillary arch for secondary bone graft procedure (SBGP). At this stage, rapid maxillary expansion is performed and a fixed palatal retainer is delivered before SBGP. When the permanent dentition is completed, comprehensive orthodontic treatment is initiated aiming tooth alignment and space closure. Maxillary permanent canines are commonly moved mesially in order to substitute absent maxillary lateral incisors. Patients with complete cleft lip and palate and poor midface growth will require orthognatic surgery for reaching adequate anteroposterior interarch relationship and good facial esthetics.

Influence of palatoplasty on occlusion of patients with isolated cleft palate

OBJECTIVE: This study compared the dental arch morphology of adult patients with isolated cleft palate in order to verify the influence of palatoplasty on occlusion. METHODS: Cast models of 77 patients, 30 males and 47 females, with an average age of 21 years and no syndromes were taken. They were in the permanent dentition and had not undergone orthodontic treatment. The sample was divided into non-operated and operated patients, the latter having been submitted to palatoplasty at a mean age of 2.2 years. RESULTS: Almost 80% of the sample exhibited sagittal discrepancies in the inter-arch relationship, with a Class II malocclusion prevailing (59.74%) followed by Class III (20,78%), regardless of palatoplasty. Transverse analysis showed a 23% incidence of posterior crossbite also not influenced by palatoplasty. Intra-arch relationship indicated that constriction and crowding on the upper arch were more frequent in the operated group (p=0.0238 and p=0.0002, respectively), showing an influence of palatoplasty on its morphology. The predominant morphological characteristics in patients with isolated cleft palate were a Class II malocclusion, upper dental arch constriction and upper and lower anterior crowding. CONCLUSION: The influence of palatoplasty was restricted to constriction and crowding of the upper dental arch, with no interference from the extension of the cleft, except for the upper crowding, which occurred more in patients with complete cleft palates.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies - USP (HRAC-USP) - Part 2: Pediatric Dentistry and Orthodontics

The aim of this article is to present the pediatric dentistry and orthodontic treatment protocol of rehabilitation of cleft lip and palate patients performed at the Hospital for Rehabilitation of Craniofacial Anomalies - University of São Paulo (HRAC-USP). Pediatric dentistry provides oral health information and should be able to follow the child with cleft lip and palate since the first months of life until establishment of the mixed dentition, craniofacial growth and dentition development. Orthodontic intervention starts in the mixed dentition, at 8-9 years of age, for preparing the maxillary arch for secondary bone graft procedure (SBGP). At this stage, rapid maxillary expansion is performed and a fixed palatal retainer is delivered before SBGP. When the permanent dentition is completed, comprehensive orthodontic treatment is initiated aiming tooth alignment and space closure. Maxillary permanent canines are commonly moved mesially in order to substitute absent maxillary lateral incisors. Patients with complete cleft lip and palate and poor midface growth will require orthognatic surgery for reaching adequate anteroposterior interarch relationship and good facial esthetics.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP)--Part 1: overall aspects.

Cleft lip and palate is the most common among craniofacial malformations and causes several esthetic and functional implications that require rehabilitation. This paper aims to generally describe the several aspects related to this complex pathology and the treatment protocol used by the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC-USP) along 40 years of experience in the treatment of individuals with cleft lip and palate.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) - Part 1: overall aspects

Cleft lip and palate is the most common among craniofacial malformations and causes several esthetic and functional implications that require rehabilitation. This paper aims to generally describe the several aspects related to this complex pathology and the treatment protocol used by the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC-USP) along 40 years of experience in the treatment of individuals with cleft lip and palate.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies-USP (HRAC-USP)--part 3: oral and maxillofacial surgery.

This paper presents the treatment protocol of maxillofacial surgery in the rehabilitation process of cleft lip and palate patients adopted at HRAC-USP. Maxillofacial surgeons are responsible for the accomplishment of two main procedures, alveolar bone graft surgery and orthognathic surgery. The primary objective of alveolar bone graft is to provide bone tissue for the cleft site and then allow orthodontic movements for the establishment of an an adequate occlusion. When performed before the eruption of the maxillary permanent canine, it presents high rates of success. Orthognathic surgery aims at correcting maxillomandibular discrepancies, especially anteroposterior maxillary deficiencies, commonly observed in cleft lip and palate patients, for the achievement of a functional occlusion combined with a balanced face.