IADR Abstract Archives
Presurgical Orthopedics in Patients with Cleft Palate: A Systematic Review
Objectives: Cleft lip and palate (CLP) are the most frequent congenital pathology of the maxillofacial territory. There is a great variety of treatment protocols with different surgical procedures and approximately half of them consider the use of pre-surgical orthopedics (PSO). The current evidence regarding this intervention is controversial with reports that suggest that PSO does not present benefits on maxillary growth and craniofacial development and that it could even have adverse effects. Nevertheless, this intervention is included in the “GES de Fisuras Labiopalatinas” program. The objective of this systematic review of controlled and randomized clinical trials is to evaluate the effectiveness of PSO in patients with CLP.
Methods: Manual and electronic searches were performed in THE COCHRANE LIBRARY, MEDLINE and EMBASE databases. Selection of studies using predetermined inclusion criteria, data extraction and assessment of risk of bias were performed by two independent reviewers. We calculated the mean difference with 95% confidence intervals and performed a meta-analysis using a random effects model. We determined the certainty of evidence for each outcome using the GRADE approach.
Results: A total of eight studies were included in this review. All studies evaluated maxillary morphology. The intercanine width (anterior arch with) presented statistically significant results favoring control with a mean difference of 2.06 (CI95%: 0.47, 3.66). The intertuberocity width (posterior arch with) had a mean difference of 0.05 (CI95%: -1.85, 1.96) and the sagittal maxillary length had a mean difference of 1.73 (CI95%: -0.71, 4.17). All the presented outcomes had a very low certainty of evidence due to risk of bias, imprecision and inconsistency.
Conclusions: Definitive conclusions about the effectiveness of PSO and its impact on the growth of the maxilla cannot be drawn because of the very low certainty in the evidence. There is a need for well-designed studies to clarify the effect of PSO, therefore we suggest that the inclusion of PSO in the national program should be reevaluated.
Methods: Manual and electronic searches were performed in THE COCHRANE LIBRARY, MEDLINE and EMBASE databases. Selection of studies using predetermined inclusion criteria, data extraction and assessment of risk of bias were performed by two independent reviewers. We calculated the mean difference with 95% confidence intervals and performed a meta-analysis using a random effects model. We determined the certainty of evidence for each outcome using the GRADE approach.
Results: A total of eight studies were included in this review. All studies evaluated maxillary morphology. The intercanine width (anterior arch with) presented statistically significant results favoring control with a mean difference of 2.06 (CI95%: 0.47, 3.66). The intertuberocity width (posterior arch with) had a mean difference of 0.05 (CI95%: -1.85, 1.96) and the sagittal maxillary length had a mean difference of 1.73 (CI95%: -0.71, 4.17). All the presented outcomes had a very low certainty of evidence due to risk of bias, imprecision and inconsistency.
Conclusions: Definitive conclusions about the effectiveness of PSO and its impact on the growth of the maxilla cannot be drawn because of the very low certainty in the evidence. There is a need for well-designed studies to clarify the effect of PSO, therefore we suggest that the inclusion of PSO in the national program should be reevaluated.