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This study aimed at monitoring the maxillary growth of children with cleft lip/palate in the first two years of life, and to evaluate the effects of primary surgeries on dental arch dimensions. The sample consisted of the three-dimensional digital models of 25 subjects with unilateral complete cleft lip and palate (UCLP) and 29 subjects with isolated cleft palate (CP). Maxillary arch dimensions were measured at 3 months (before lip repair), 1 year (before palate repair), and at 2 years of age. Student's ttest was used for comparison between the groups. Repeated measures ANOVA followed by Tukey's test was used to compare different treatment phases in the UCLP group. Paired ttest was used to compare different treatment phases in the CP group. P<0.05 was considered statistically significant. Decreased intercanine distance and anterior arch length were observed after lip repair in UCLP. After palate repair, maxillary dimensions increased significantly, except for the intercanine distance in UCLP and the intertuberosity distance in both groups. At the time of palate repair and at two years of age, the maxillary dimensions were very similar in both groups. It can be concluded that the maxillary arches of children with UCLP and CP changed as a result of primary surgery.

Passively retained precision attachment removable partial dentures have been used successfully since the 1920s. Adult cleft palate patients and accident victims often have endured a lifetime of wearing awkward appliances to replace the missing structures that never formed intraorally or were lost in a traumatic accident. These patients tend to be poor candidates for dental implants, even with repeated grafting surgeries. The anterior double-tilt precision attachment case is a great treatment option for adults to restore the missing dental structures. Anterior precision partial dentures are stable appliances in the mouth that are worn 24 hours a day and only removed for hygiene. They can be custom designed for maximum esthetics. They do not require denture paste, and they extend minimally onto the palate. As a result, they do not interfere with musculature, tongue movements, speech and taste. Cleft palate patients and accident victims with poor or non-existent edentulous ridges will have difficulty retaining a denture, so preservation of the existing dentition is essential for comfort and function. Because these prostheses do not apply destructive forces to the abutment teeth, they can last decades with minimal maintenance.

Rehabilitation of cleft patients is a process that occurs from birth to adult life and involves a team of many professionals. Reconstructive plastic surgery, despite its functional and aesthetic benefits to the patient, can restrict the normal anterior displacement that occurs in the growth of the maxilla, which, in turn, can lead to a concave profile that requires correction. This study aimed to demonstrate an alternative rehabilitation treatment for cleft patients who have severe maxillomandibular discrepancy and choose not to undergo orthognathic surgery. A retrospective review and case reports of rehabilitation treatment of cleft patients were performed, with an emphasis on prosthetic rehabilitation without orthognathic surgical procedures. Prosthetic rehabilitation is a fast and reversible option for cleft patients that provides facial harmony and facilitates the reintegration of these patients into society.

Objectives: This retrospective study assessed the dentoskeletal effect of late maxillary protraction (LMP; reverse-pull headgear, Class III elastics, and maxillary sutural loosening) in unilateral cleft lip and palate (UCLP) patients versus a control group of untreated UCLP patients., Materials and Methods: Cephalograms taken at age 13 to 14 years (T1) and 17 to 18 years (T2) were used for this study. The study group comprised 18 patients (10 male and 8 female, mean age at start of LMP therapy = 13.4 [0.45] years). A control groups of 17 patients (8 male and 9 female, mean age = 13.5 [0.44] years) was used for comparison., Results: The repeated-measures analysis of variance showed statistically significant changes across time between groups for the following variables (mean difference [T2-T1] in the study group, 95% confidence interval): SNA (°) (1.95, 0.75 to 3.15), A ⊥ Na Perp (mm) (1.82, 0.86 to 2.77), CoA (mm) (2.92, 1.53 to 4.31), ANB (°) (3.13, 2.02 to 4.24), Wits (mm) (7.82, 5.01 to 10.54), Mx-Md Diff (mm) (0.62, -1.58 to 2.83), Occl P-SN (°) (-3.98, -5.99 to -1.98), overjet (mm) (8.82, 5.90 to 11.74), FMIA (°) (4.05, -0.05 to 8.15), and IMPA (°) (-5.77, -9.74 to -1.80). Late maxillary protraction created a slight open bite (0.66 mm). Trends for overeruption of mandibular incisors and an increase in lower face height (P = .07 for both) were noted in the study group., Conclusions: Late maxillary protraction produced a combination of skeletal changes (protraction of maxilla, improvement in the maxillo-mandibular skeletal relationship) and dental compensations (counterclockwise rotation of occlusal plane, retroclination of mandibular incisors) in patients with UCLP. Late maxillary protraction was also associated with some unwanted tooth movements (open bite tendency, mandibular incisors overeruption).

The hybrid obturator prosthesis aims to provide a sense of well-being to the patient, offering improvements in speech, chewing, and swallowing. Thus, the retention and stabilization of the prosthesis become decisive factors for the success of the rehabilitation treatment. The objective of this study was to describe the treatment of a 70-year-old man with a congenital maxillary cleft performed through aesthetic and functional prosthetic rehabilitation with hybrid obturator prosthesis. In this study, the fabricated prosthesis achieved its purpose by providing adequate functional and aesthetic conditions to the patient, promoting the reduction of airspace through the sealing of the oronasal communication, with consequent improvement in the quality of life.

Objective: To determine the difference in the effects of facemask with miniplate (FM-MP) anchorage on maxillary protraction in growing cleft patients between unilateral (UCLP) and bilateral cleft lip and palate (BCLP) groups., Materials and Methods: The samples consisted of a UCLP group (N  =  15, 13 boys and 2 girls; mean age 10.98 years; mean protraction duration 2.37 years) and a BCLP group (N  =  15, all boys; mean age 11.42 years; mean protraction duration 2.36 years), who were treated with the same surgical technique (rotation and advancement flap and double opposing Z-plasty) by one surgeon and with FM-MP by one orthodontist. Lateral cephalograms were taken before (T1) and after FM-MP (T2). Fourteen skeletal and dental variables were measured. Independent and paired t-tests were performed for statistical analysis., Results: There were no differences in mean age and values of variables at the T1 stage and in the duration of protraction between the two groups. The BCLP group showed less advancement of point A than the UCLP group (ΔA-vertical reference plane, 2.51 mm vs 4.06 mm, P < .05; ΔA-N perpendicular, 0.79 mm vs 2.26 mm, P < .05; ΔSNA, 0.45° vs 2.85°, P < .01). Since counterclockwise rotation of the palatal plane in two groups was minimal (-0.36° vs -0.87°), no difference was observed with regard to clockwise rotation of the mandible (0.46° vs -0.07°). There were no differences in the degree of labioversion of the maxillary incisor (8.16° vs 7.10°), linguoversion of the mandibular incisor (-2.66° vs -2.14°), and increase in overjet (5.39 mm vs 5.70 mm) between the two groups., Conclusion: In FM-MP therapy of growing cleft patients under the conditions of this study, the UCLP group shows a more favorable change in maxillary advancement than the BCLP group.

Purpose: The purpose of this study was to investigate the changes in and stability of the maxilla and soft tissue profile achieved after the application of distraction osteogenesis (DO) by use of rigid external distraction (RED) with a retention plate system in unilateral cleft lip and palate (UCLP) adult patients. We compared 2 treatment methods in the management of maxillary hypoplasia: Le Fort I osteotomy and DO., Materials and Methods: Six UCLP adult patients who underwent treatment with the RED retention plate system were examined (DO group). Changes in the positions of soft and hard tissue landmarks were calculated from lateral cephalograms taken before distraction, at the removal of the halo, and 1 year after surgery and were compared with those in 7 other UCLP patients who underwent Le Fort I osteotomy (LF1 group)., Results: The mean maxillary advancement was significantly larger in the DO group than in the LF1 group after distraction. During the follow-up period, the relapse rate of the maxilla was significantly smaller in the DO group. An undesirable labial inclination of the upper incisors was found in the LF1 group, which may have been due to relapse. The DO group tended to have a higher soft tissue-to-hard tissue anterior movement ratio from the time of distraction to follow-up., Conclusions: The RED retention plate system improved the midfacial profile by advancement of soft and hard tissue and minimized the risk of injury to the upper lip. Using the RED system with retention plates prevented the undesirable labial inclination of upper incisors that was found in the LF1 group., (Copyright 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

The aim of this retrospective, mixed longitudinal study was to assess the long-term outcome of early secondary closure and premaxilla osteotomy in 40 bilateral cleft lip and palate patients who underwent early secondary osteotomy of the premaxilla and bone grafting at the age of 8-12 years. Clinical and cephalometric evaluations of profile, lip relation, nasolabial angle and position of the maxilla preoperatively, postoperatively and at adolescence were compared to normal values of non-cleft individuals and the reported data of 90 bilateral cleft lip and palate patients treated in Oslo. In 68% of patients the profile was considered acceptable, but in 26 maxillary growth appeared to be impaired by cephalometric standards. In four patients a Le Fort I osteotomy was carried out and nine patients would have benefited from such a procedure. This study reveals a trend towards maxillary growth retardation partially compensated by orthodontic and dental treatment. Since the results are comparable to those reported for the Oslo group with regard to maxillary growth, the surgical protocol followed does not require revision. Considering the benefits, i.e. closure of alveolo-palatal cleft, continuity of dental arch, eruption of canine in the graft and closure of oro-nasal communications, this mode of treatment should be continued.

In patients with bilateral cleft lip and palate (BCLP), orthodontic and facial orthopedic treatments alone occasionally fail to resolve problems because of the absence of alveolar and palatal hard and soft tissue or contraction resulting from previous surgical repair. Prosthetic reconstruction of the anterior maxilla is important for these patients. Patients with BCLP have premaxillary displacement in up to 3 dimensions. It may be difficult to make impressions without deformation. This clinical report describes a method for positioning the mobile premaxilla during impression making for a patient with BCLP.

Purpose: The external traction hooks of the intraoral splint used in the rigid external distraction (RED) system for maxillary distraction osteogenesis interfere with the surgical procedures. The purpose of this study is to introduce an innovative splint fixation method for maxillary distraction osteogenesis with Locking Attachments and evaluate their advantages, such as reduction of operating time compared with the traditional intraoral splint method., Patients and Methods: Retrospective comparison of operative times of maxillary Le Fort I osteotomy procedures was carried out with the traditional protocol using the intraoral splint cemented to the maxillary dentition (n = 14), and a removable intraoral splint that is inserted postsurgically (n = 14). Operative procedure times were compared and analyzed statistically using the data extracted from the surgical records., Results: There were no complications inserting the removable splint postsurgically, including pain, discomfort, or time-consuming procedure. Stable and secure splint fixation was obtained before the distraction procedure and the desired treatment goals were obtained in all patients. The total operative procedure times were significantly reduced in the Locking Attachments group by 24% to 41% (approximately 65 minutes) compared with earlier operations involving the conventional splints (P < .05)., Conclusions: Maxillary distraction osteogenesis with the Locking Attachments is a highly effective fixation approach to manage severe hypoplastic maxilla, eliminating lip constraints resulting from scarring and allowing for easier, more deliberate and careful dissection. The use of the Locking Attachments is reliable in craniofacial surgery and has proved to be advantageous in the reduction of the operating time and surgical risks.

Purpose: This study hypothesizes comparable implant success in bone-grafted cleft-alveolus versus traumatic anterior maxillary defects. Though of different pathogenesis, both defects comprise bone deficit, scarred periosteum, and soft tissues. Additional complicating factors are isolated., Patients and Methods: Twenty cleft and 20 traumatic defect cases were followed-up 48 months in average. After 9 secondary and 11 tertiary cleft-osteoplasties, 25 implants were inserted; in traumatic defects following 8 two-stage and 12 one-stage osteoplasties, 37 incisor or canine implants were inserted. After secondary and tertiary cleft-osteoplasties, 57 and 13 months elapsed until implantation, 4 months in the two-stage posttraumatic osteoplasties. Implants were loaded at 6 months by single crowns., Results: Four (20%) cleft patients faced 2 failures and 2 first-year losses; 2 (10%) trauma cases faced 2 failures and 2 first-year losses; and cumulative 5-year implant success was 80% and 88%, respectively. Other parameters' 12-month results were: values for mean cleft, trauma patients (+/- standard deviation), significance of comparison in t testing at a cut-off level of alpha = 0.05; bone loss 0.3+/-0.5 mm, 0.5+/-0.7 mm, P < .2; Periotest score 1.1+/-3.1, 1.2+/-2.5, P < .7; gingival recession 2.1+/-0.3 mm, 2.2+/-0.5 mm, P < .6; periimplant probing depth 2.5+/-0.5 mm, 2.8+/-2.6 mm, P < .3., Conclusion: Similar success rates without statistically significant differences were found; a multiple factor analysis discerned as positive predictive factors the following; generous transplant volume, 3 to 6 months latency, sufficient implant dimension, early adulthood. Early loading cannot be encouraged from the success rates. Negative predictive factors were spongiosa or milled-bone transplants, dehiscence, smoking, and anorexia. Intraorally harvested membranous bone transplants may prospectively amend secondary osteoplasty-associated bone resorption. Donor site morbidity, local growth, and tooth breakthrough require additional observation in a prospective study when implant insertion should directly follow the growth spurt.

Primary surgery for cleft lip, alveolus, and palate is only the beginning of management for this condition, because the congenital malformation and the scars of corrective surgery during infancy affect the physiological development of the skeleton and the soft tissue. Once the patient has stopped growing, therefore, secondary maxillomandibular malformation is frequent in these patients. The most frequent skeletal malformations in secondary cleft lip and palate are hypoplasia and malposition in the three planes of the superior maxilla space. In these cases, combined orthodontic and surgical treatment is necessary; of the various techniques available, Le Fort I osteotomy is the one most indicated for repositioning of the maxilla. Although this technique is now standardized to correct the simple maxillo-mandibular malformation, in the case of secondary malformation in the cleft lip and palate, modifications are necessary in the surgical technique to ensure the best esthetic and functional result and to reduce the possibility of relapse. After 20 years' experience in the treatment of secondary skeletal malformation in cleft lip, alveolus, and palate, a critical review is made of the different steps of planning and performing Le Fort I osteotomy in these patients.

Objective: Collapse of the maxillary minor segment with lateral crossbite is a common feature in patients with repaired unilateral cleft lip/palate because of maxillary alveolar bony defect and palatal scar tissue. Distraction osteogenesis (DOG) is an effective technique of lengthening and augmentation for bone and gingiva. This case report describes the effects of unilateral advancement of the maxillary minor segment by DOG in two patients with the repaired unilateral cleft lip/palate.

The aim of this study was to analyze the vibratory characteristics in the maxillary dentition of 4 cleft lip and palate (CLP) patients before and after bone grafting. First, the central incisor on the noncleft side was impacted with an impact hammer, and the responses were received using an acceleration sensor from the teeth between the upper first molars on both sides. The transfer functions were then obtained from each measurement point using a fast Fourier transform analyzer. Finally, a computer analysis and simulation were performed based on the measured transfer functions to obtain the natural frequency, modal shape, decay rate (DR) and maximum displacement (MDP). Before bone grafting, distinct phase differences between the major and minor dental arches (MDA and mDA) were observed in the modal shapes. After surgery, however, both the MDA and mDA vibrated in phase. These results were identical in all subjects. The MDPs of the central incisors conspicuously decreased after bone grafting in 3 subjects. From the standpoint of vibratory characteristics, this study indicated that bone grafting had a favorable effect on prosthodontic treatment using a fixed prosthesis across the cleft in CLP patients.

The aim of this study was to investigate the long term post-treatment transverse stability of the maxillary dental arch in subjects with unilateral complete cleft lip and palate (UCLP) treated by the Harvold/Bøhn method of orthodontic expansion and prosthodontic retention. The treatment of 22 consecutive patients, primarily operated on during the period 1957-60, was completed at a mean age of 18.1 years by the provision of a fixed partial retention prosthesis across the cleft using the cleft side central incisor and canine only as abutment teeth. The cleft side lateral incisor was missing in each case. Dental casts were made at the time of abutment preparation and at six subsequent times with the final observation 13.5 years after treatment completion. Measurements of any shift in the transverse position of cleft side and non-cleft side canines, premolars and first molars were made on standardized photographs of the casts. A constructed anteroposterior palatal line served as 'midline' reference. A mean reduction of width at the final observation, as recorded from the palatal surface to the reference line, was for the cleft side canine: -0.4 mm, the premolar immediately distal to the prosthesis and the first molar: both -1.2 mm. The corresponding mean width reductions on the noncleft side were: canine -0.9 mm, premolar -1.2 mm, first molar -1.6 mm. The rate of movement towards the midline decreased linearly with In(time) for all variables (P < 0.02) but for the cleft side canine.

By means of videofluoroscopic recordings, chewing, swallowing and speech were monitored in nine patients with congenital and acquired maxillary defects. All of them were rehabilitated with a maxillary obturator prosthesis. The defective region was seldom used for chewing. No leakage between the obturator and surrounding tissue was observed, either for solids or for liquids. All of the prosthetic reconstructions were surprisingly stable during function. In the phonetic analysis, speech production was judged to be restored almost to normal. Videofluoroscopy may be valuable as a complement to other functional diagnostic procedures, and for the evaluation and improvement of rehabilitation with an obturator prosthesis.

We have already reported that the maxillary was markedly contracted 1 month after a cleft palate operation. Since we thought that this was mainly attributable to cicatrized contraction of the operation region, we prepared a palatal plate and inserted it from an early stage after palate plasty. In this paper we present our summarized findings on the use of the palatal plate. We report on its use both immediately after the operation, and for a period of 3 months after the operation. Its use in both cases is intended to prevent maxillary contraction following surgical treatment of the cleft palate.

The long-term treatment of cleft palate patients starts immediately after birth and is pursued in orderly fashion [correction of persecuted orderly] to adolescence. The results of anonymous survey of the opinion of parents of cleft palate children who undergo or underwent early treatment procedures, up to seven years of age, are presented. Questions concerned mother's or parent's experience of birth, first medical information, early orthopedic care and treatment, and psychosocial adjustment of the children as well. This study suggests that objective findings in children and subjective conditions of parents do not correlate in the beginning, as is to be seen in cleft palate versus cleft lip palate group. One other conclusion indicates the existence of a small quantity of parents able to accept their affected child without additional problems arising from the cleft.

Computer aerography, which is based on the use of the double-aerometer by Sven Smith, is described as an objective method for clinic-scientific problems. Medical examination of labio-maxilla-palate-cleft patients shows how this procedure, which has a low degree of inconvenience and is also applicable to children, contributes essentially to the settling of clinic-scientific problems. Further scopes are still being tested.

Missing or peg-shaped upper lateral incisors in cleft patients require different treatment. The Maryland bridge, recontouring the tooth with composite or reconstruction of the alveolar bone with subsequent prosthetic treatment influences the result of orthodontic treatment in a positive procedures way: the procedures help to shorten the retention period and to improve the aesthetic result.

Sixty-three individuals with complete bilateral cleft lip and palate (BCLP) were studied. In 51 of these subjects no surgical set-back or early bone grafting procedures were done. In the other 12 subjects early surgical procedures to reduce the prominence of the premaxilla had been done. In the larger group the premaxilla was, on the average, protrusive until age 12, after which it gradually became more retrusive. By the end of the growth period the premaxilla was not excessively protrusive in any of these subjects. It was concluded that it is advantageous for the premaxilla in individuals with BCLP to be protrusive during most of the growth period, since the premaxilla grows forward at a slower rate than the mandible. In the 12 subjects with premaxillary surgery, midface retrusion was demonstrated at an early age. The forward growth of the premaxilla in these individuals was slower than in the BCLP without premaxillary surgery and all 12 subjects developed rather severe midface retrusion. Orthodontic treatment principles for four different stages of craniofacial and dental development have been outlined.