IADR Abstract Archives
Dental arch form changes following use of pre-surgical orthopaedic appliances in bilateral cleft lip and palate infants
Objectives: Infants born with a bilateral cleft lip and palate (BCLP) commonly exhibit protrusion of the pre-maxilla and distortion of the maxillary alveolar segments. Surgical repair is challenging and use of pre-surgical orthopaedic appliances (PSOs) has been advocated to facilitate lip repair. This study aimed to evaluate dental arch form changes following the use of passive PSOs in infants with BCLP
Methods: A consecutive series of records of 37 BCLP infants born between 1985 and 2010, and treated using PSOs at Princess Margaret Hospital for Children, were obtained. Models were laser scanned, dento-alveolar landmarks indicated, 3-dimensional coordinates extracted and a set of Euclidean distances and angles calculated from the coordinate geometry. Time periods representing; T1 neonatal (0-3 weeks of age); T2 following PSO and prior to lip repair (~3 months of age); T3 prior to palate repair (~9 months of age) were assessed.
Results: Systematic and significant changes in the position of the premaxillary segment were observed between T1-T2 and T2-T3. The PSO phase (T1-T2) exhibited changes consistent with the PSO objectives: to retract and centralise the premaxilla; centralise the vomer; and reduce the cleft width. Significant differences were also recorded between T2-T3 with further retraction of the premaxilla and reduction in the cleft width. However, these changes were not evident in all of the treated cases. A collapse in the arch form was frequently observed along with maxillary segment deflection and midline deviation of the premaxilla.
Conclusions: PSOs may facilitate improvements in the dento-alveolar form prior to lip repair. However, symmetrical alignment and maintenance of the arch form still remains a challenge.
Methods: A consecutive series of records of 37 BCLP infants born between 1985 and 2010, and treated using PSOs at Princess Margaret Hospital for Children, were obtained. Models were laser scanned, dento-alveolar landmarks indicated, 3-dimensional coordinates extracted and a set of Euclidean distances and angles calculated from the coordinate geometry. Time periods representing; T1 neonatal (0-3 weeks of age); T2 following PSO and prior to lip repair (~3 months of age); T3 prior to palate repair (~9 months of age) were assessed.
Results: Systematic and significant changes in the position of the premaxillary segment were observed between T1-T2 and T2-T3. The PSO phase (T1-T2) exhibited changes consistent with the PSO objectives: to retract and centralise the premaxilla; centralise the vomer; and reduce the cleft width. Significant differences were also recorded between T2-T3 with further retraction of the premaxilla and reduction in the cleft width. However, these changes were not evident in all of the treated cases. A collapse in the arch form was frequently observed along with maxillary segment deflection and midline deviation of the premaxilla.
Conclusions: PSOs may facilitate improvements in the dento-alveolar form prior to lip repair. However, symmetrical alignment and maintenance of the arch form still remains a challenge.