Alveolar bone graft evaluation agreement using cone beam computed tomography in cleft lip and palate patients: a pilot study.

OBJECTIVE: To develop and test assessor agreement using a new cone beam computed tomography (CBCT) examination method for evaluating the outcome of alveolar bone grafts in cleft lip and palate patients. MATERIAL AND METHOD: Twenty patients with complete cleft lip and cleft palate who had undergone alveolar bone grafting with CBCT follow-up 3-6 months postoperative at the Faculty of Dentistry, Khon Kaen University were recruited into the study. Four trained clinical assessors (two orthodontists, an oral surgeon and an oral radiologist) had made a judgment of three outcome measurements: 1) cemento-enamel junction (CEJ) to marginal bone level of the teeth adjacent to the cleft site, 2) marginal bone level to root apex of the teeth adjacent to the cleft site, 3) labio-lingual alveolar bone grafted thickness. Repeat measurements were made by the same assessors. RESULTS: The Kappa values of intra-assessor agreements of each assessor were 0.82, 0.91, 0.91 and 1, respectively, while the inter-assessor agreements for the first and second time of determinations were 0.81 and 0.74. CONCLUSION: This CBCT method for scoring alveolar bone graft outcomes produced good agreement among four assessors, which suggests its potential use to evaluate the success of alveolar bone grafting. In the future, this new method of alveolar bone graft evaluation should be compared with the standard method for testing validity.

Orthodontic treatment of unilateral cleft lip and alveolus patient with maxillary lateral incisor missing: case report.

The esthetics of a patient with a cleft lip and alveolus and missing maxillary lateral incisor is important. A girl, aged 9 years 3 months with repaired left unilateral cleft of primary palate only was referred for orthodontic evaluation of her anterior tooth-crowding. She was unhappy with the unattractive appearance of her maxillary anterior teeth, which were behind her mandibular anterior teeth. Alveolar bone grafting along with canine substitution to replace her missing lateral incisor were recommended for this patient. The post-treatment results were excellent with good occlusion, acceptable profile, and remained stable one year after conclusion of active treatment.

Growth modification in unilateral cleft lip and palate patients with face mask.

The intended aim of treatment in cleft lip and palate patients with growth modification is to improve the relation of jaws by advance the maxilla, restrict the mandible or combination of these. The appliances usually used are face mask or protraction headgear (Delaire and Petit types). Modification of growth is advocated to be applied before the end of adolescent growth spurt and long-term and permanent improvement cannot be guaranteed. Achieving the aim of growth modification is still controversial since most reported results of this treatment are dento-alveolar changes and backward rotation of the mandible that would not be considered to be growth modification.