The Asher-McDade Aesthetic Index in Comparison With Two Scoring Systems in Nonsyndromic Complete Unilateral Cleft Lip and Palate Patients.

OBJECTIVE: To compare the Asher-McDade aesthetic index with 2 systems used to score the appearance of the nasolabial area in patients with a complete cleft lip and palate. DESIGN: Retrospective analysis of the results of complete unilateral cleft lip and palate patients. SETTING: Academic Center for Dentistry of Amsterdam and the VU University Medical Center. PATIENTS: Six-year-olds with complete unilateral cleft lip and palate. MAIN OUTCOME MEASURES: Cleft lip and palate patients assessed using the scoring system proposed by Prahl et al, a 5-point ordinal scale, and the scoring system proposed by Asher-McDade et al by 6 judges, 3 orthodontists, and 3 plastic surgeons. A calculation of intra- and interobserver reliability was made. A comparison was made of all the assessment methods using Kendalls' tau. RESULTS: Photographs of 55 children (38 boys and 17 girls) with complete unilateral cleft lip and palate were assessed. For the scoring system of Prahl et al, interobserver reliability varied from 0.43 to 0.53, for the 5-point scale between 0.45 and 0.57, and for the scoring system by Asher-McDade et al these varied between 0.52 and 0.66. Multiple significant correlations were found between the used scoring systems. CONCLUSION: It can be concluded that the Asher-McDade aesthetic index is still superior to the other scoring systems used in this study. However, all 3 scoring systems can reliably be used when 3 or more observers are used.

Transverse dental arch relationship at 9 and 12 years in children with unilateral cleft lip and palate treated with infant orthopedics: a randomized clinical trial (DUTCHCLEFT).

OBJECTIVE: A long-term evaluation to assess the transverse dental arch relationships at 9 and 12 years of age in unilateral cleft lip and palate treated with or without infant orthopedics (IO). The hypothesis is that IO has no effect on the transverse dental arch relationship. MATERIAL AND METHODS: A prospective two-arm randomized controlled trial (DUTCHCLEFT) in three academic cleft palate centers (Amsterdam, Nijmegen and Rotterdam, the Netherlands). Fifty-four children with complete unilateral cleft lip and palate and no other malformations were enrolled in this evaluation. One group wore passive maxillary plates (IO+) during the first year of life, and the other group did not (IO-). Until the age of 1.5, all other interventions were the same. Hard palate was closed simultaneously with bone grafting according to protocol of all teams. Orthodontic treatment was performed when indicated. The transverse dental arch relationship was assessed on dental casts using the modified Huddart/Bodenham score to measure the maxillary arch constriction at 9 and 12 years of age. RESULTS: No significant differences were found between the IO+ and IO- groups. Differences between the centers increased from 9 to 12 years of age. CONCLUSIONS: Transverse dental arch relationships at 9 and 12 years of age do not differ between children with UCLP treated with or without IO. CLINICAL RELEVANCE: There is no orthodontic need to perform IO as applied in this study in children with UCLP.

Comparison of two scoring systems in the assessment of nasolabial appearance in cleft lip and palate patients.

OBJECTIVE: The aim of this study was to determine the reliability of 2 scoring systems. DESIGN: This study used a retrospective analysis of the results of complete unilateral cleft lip and palate patients. SETTING: The study was conducted at the VU Medical Center and the Academic Center for Dentistry of Amsterdam. PATIENTS: Patients were complete unilateral cleft lip and palate patients at the age of 6 years. MAIN OUTCOME MEASURES: Assessment of the nose and lip together and separately with a numerical photographic reference scoring system and with a 5-point ordinal scale without the use of a reference photograph by 6 judges. Intraobserver and interobserver reliability was calculated; both ways of assessment were compared by using Kendall tau. RESULTS: Photographs were available of 55 children (6 years old, 38 boys and 17 girls) with a complete unilateral cleft lip and palate. The interobserver reliabilities of the lip and nose together were 0.53 and, for the nose and lip separately, 0.51 and 0.43, respectively with the use of the numerical scale. In the 5-point scale, these were 0.55 for the nose and lip together and 0.57 and 0.45 for the nose and lip separately, respectively. Furthermore, it was found that the lip dominates in the scorings of the lip and nose together (linear regression analysis). CONCLUSIONS: The 2 tested systems are equivalent in their reliability and outcome. The lip is dominating in the overall scorings. It is advocated to use the 5-point scale without the use of a reference photograph and to assess the lip and nose separately.

[Preprosthetic orthodontic treatments]. / Preprothetische orthodonti- sche behandelingen.

The objective of a preprosthetic orthodontic treatment is to position the teeth in such a way that a treatment with (fixed) dental prostheses is made possible or simplified or to affect the result of this treatment positively. Conceivable preprosthetic orthodontic treatments are: correcting primary orthodontic anomalies, closing or reducing interdental spaces and correcting the migration of teeth. In the case of unfavourable maxillomandibular relations, a preprosthetic surgical treatment is usually needed together with a preprosthetic orthodontic treatment. For children with agenesis and/or early loss of teeth and/or aberrant morphology of teeth, a treatment with fixed dental prostheses, either implant-supported or not, may be indicated after the tooth development or in some cases earlier. Until that time, preprosthetic orthodontic treatments may be indicated to offer an aesthetically sound provisional solution and to achieve optimal teeth positions for the final fixed dental prostheses.

[Systemic reactions to orally applied metal alloys]. / Systemische reacties op in de mond toegepaste metaallegeringen.

Orally applied metal alloys can cause undesirable physical effects. A distinction needs to be made in this respect between local and systemic reactions and toxic and immunological reactions. A case is presented which illustrates this problem. In this case, the application of orthodontic appliances was probably the trigger for an exacerbation of nickel allergy. The oral exposure to nickel resulted in hand eczema. The patient was also exposed to nickel by single-unit fixed dental prostheses, a removable dental prosthesis, and food, as a result of which removal of the orthodontic appliances did not result in complete healing. Therefore, the single-unit fixed dental prostheses also had to be removed and food had to be prepared henceforward in nickel free pans.

[Orthodontics and quality of life]. / Orthodontie en levenskwaliteit.

The impact of oral health on quality of life among orthodontic patients was assessed using the Child Oral Health Impact Profile. Responses of parents and children to questions about the quality of life of the child were very similar, suggesting that the parents were quite well able to assess the oral health-related quality of life of their children. Girls experienced more adverse effects on their quality of life due to oral health problems as compared to boys. Subscales of the Child Oral Health Impact Profile appeared to have little predictive value with respect to the general feeling of healthiness among orthodontic patients.

[Quality of life in patients with craniofacial disorders]. / Levenskwaliteit bij craniofaciale afwijkingen.

Children with a serious congenital craniofacial disorder experience a variety of problems. Research on quality of life in these children has commenced relatively late. A specially developed questionnaire, the Child Oral Health Impact Profile, was used for a group of cleft lip and palate children and their parents. The study set out to determine the extent to which the answers given by the children corresponded to those of their parents. The children's perception of oral health-related quality of life appeared to differ from that of their parents.

Infant orthopedics and facial growth in complete unilateral cleft lip and palate until six years of age (Dutchcleft).

OBJECTIVE: To evaluate longitudinally the effect of infant orthopedics (IO) on dentofacial cephalometric variables in unilateral cleft lip and palate (UCLP) patients from 4 to 6 years of age. DESIGN: Prospective two-arm randomized controlled clinical trial in three cleft palate centers in The Netherlands (Dutchcleft trial). PATIENTS: Fifty-four children with complete UCLP. INTERVENTIONS: Patients were divided randomly into two groups. Half of the patients (IO+) had IO until surgical closure of the soft palate at the age of +/-52 weeks; the other half (IO-) received no intervention. MEAN OUTCOME MEASURES: Cephalometric values representing soft tissue, hard tissue, and dental structures, measured on lateral headfilms made at 4 and 6 years of age. RESULTS: In the IO+ group, 21 patients were analyzed; in the IO- group, 20 patients were analyzed at age 4 and 22 at age 6. No differences were found between IO+ and IO-, except for two measurements: The interincisal angle was larger and the mentolabial angle was smaller in the IO+ group. CONCLUSIONS: For infants with UCLP whose surgical management included soft palate repair at 12 months and delayed hard palate closure, cephalometric outcomes at ages 4 and 6 provide no indication for the type of IO used in this study.

A randomised prospective clinical trial into the effect of infant orthopaedics on maxillary arch dimensions in unilateral cleft lip and palate (Dutchcleft).

Aim of the study was to evaluate the effect of infant orthopaedics (IO) on maxillary dimensions in infants with unilateral cleft lip and palate (UCLP). The study design was a prospective two-arm randomised controlled trial in parallel with three participating academic Cleft Palate Centres. Treatment was assigned by means of a computerised balanced allocation method. One group (IO+) wore passive maxillary plates during the first year of life, the other group (IO-) did not. Maxillary casts, made at birth, and at 15, 24, 48, 78 wk were digitised three-dimensionally. Before lip closure alveolar, midpalatal and posterior cleft width reduced significantly more in IO(+) than in IO(-). After lip closure, the alveolar cleft width reduced significantly more in IO(-). Until soft palate closure the slope of the palatal vault flattened significantly by IO. It is concluded that IO only has a temporary effect on maxillary arch dimensions that does not last beyond surgical soft palate closure. Therefore, infant orthopaedics as a tool to improve maxillary arch form could be abandoned. However, other outcome variables like facial and dental appearance, speech outcome, and cost-effectiveness need to be investigated further in order to assess the comprehensive effect of infant orthopaedics.

Short-term cost-effectiveness analysis of presurgical orthopedic treatment in children with complete unilateral cleft lip and palate.

OBJECTIVE: The aim of this article was to investigate cost-effectiveness in cleft palate treatment using cost-effectiveness of presurgical orthopedic treatment (PSOT) as an example. DESIGN: A three-center randomized clinical trial compared PSOT with non-PSOT for children with unilateral cleft lip and palate (UCLP, n=52). PATIENTS: The inclusion criteria for the trial were: complete UCLP, no other malformations, born at term, both parents Caucasian, trial entrance preferably within 2 weeks after birth, and informed consent by the parents. INTERVENTIONS: PSOT was performed by means of a passive plate according to Hotz and Gnoinski. MAIN OUTCOME MEASURE: The short-term cost-effectiveness of PSOT was based on the time taken for the surgical lip closure procedure. Medical and nonmedical costs until surgical lip closure at 18 weeks of age were analyzed. RESULTS: The durations of the surgical lip closure procedures did not differ significantly (57.2 minutes for PSOT and 56.4 minutes for non-PSOT). The mean medical cost for PSOT treatment was US$852. The non-PSOT treatment group had a significantly different mean medical cost (US$304). Mean travel costs and indirect nonmedical costs were US$128 and US$231 for PSOT and US$79 and US$130 for non-PSOT, respectively. CONCLUSIONS: The combination of a clinical trial and an economic evaluation makes it possible to relate effects to costs involved in treatment alternatives. Longer-term costs and effects will be incorporated into an extended cost-effectiveness analysis to determine the cost-effectiveness of PSOT.