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Background Studies addressing the periodontal health of the teeth surrounding the bone-grafted cleft in patients born with unilateral cleft lip and palate disagree on whether periodontal health is compromised. Objectives To determine periodontal health differences between the cleft and the non-cleft sides nearly a decade after secondary alveolar bone grafting. Methods This prospective, controlled (split-mouth design) study comprised an intraoral apical radiographic and a periodontal examination of 40 consecutive patients from one centre (n = 26 males) who had undergone bone grafting at mean age of 10.2 years (±1.6). Probing pocket depth, gingival index, gingival recession, and radiographic bone support were assessed. Results No significant difference occurred in probing pocket depth between teeth at cleft and non-cleft sites (OR 1.8, P = .488). Gingival recession was present at 6.6% of all examined sites on the cleft side and at 1.7% on the non-cleft side (OR 17.3, P < .001). Gingival recession occurred most often on the buccal and disto-buccal surfaces of the central incisor on the cleft side. The gingival index was significantly higher on the cleft side (OR 8.0, P < .001). The Bergland index was I or II in most patients (87%). Limitations Recruitment of eligible patients was lengthy. Conclusion The teeth on the cleft side had high levels of gingival inflammation. Few pathological gingival pockets, however, were found. Shallow gingival recessions frequently occurred around the central incisor on the cleft side. Teeth in the bone-grafted cleft region generally had good bone support.

Purpose: The aim of this retrospective study was to evaluate facial growth in children with juvenile idiopathic arthritis (JIA) by means of lateral head cephalometric radiographs and relate the findings to temporomandibular joint (TMJ) condylar changes on panoramic radiographs. Methods: Radiographic and medical records were evaluated in 65 children with JIA. Cephalometric and panoramic analyses were performed for the impact of condylar changes on facial growth. We compared children with condylar alterations, minor or major, with those without condylar alterations. Results: Based on panoramic radiographs, no condylar alterations were seen in 27 of the 65 children and condylar alterations were seen in 38 children (i.e., 23 had minor and 15 major condylar alterations). The cephalometric analyses of the children with condylar changes showed significant growth disturbances with a more retrognathic mandible (SNB; p = 0.03), retruded chin position (SNPog; p = 0.02), larger mandibular angulation (ML/NSL; p = 0.009) and maxillary angulation (NL/NSL; p = 0.03) compared with children without condylar alterations. Children with minor condylar alterations had a significantly more retruded chin position (SNPog) than those with no condylar changes (p = 0.04). Conclusions: Condylar changes in the TMJ, judged on panoramic radiography, in children with JIA, have impact on craniofacial growth. Even minor alterations seem to have an impact.

Background: Juvenile idiopathic arthritis (JIA) is an autoimmune, heterogeneous disease and the temporomandibular joint (TMJ) can be affected, with consequences for mandibular growth and function. The aim of this study was to evaluate the importance of longitudinal medical treatment and the burden of disease activity on the development of temporomandibular condylar alterations as judged on panoramic radiographs. Methods: The study was a retrospective evaluation of dental and medical records in consecutive JIA patients referred to three specialist dental clinics in Sweden during an eight-year period. Data on the total pharmacological treatment and disease activity were evaluated longitudinally from disease onset to the time of the panoramic examination, during a median observation period of 2.5 years. The radiographs were analysed in terms of structural and shape alterations in the condyles and judged dichotomously. Results: Panoramic examinations were analysed in 158 patients from 266 referrals diagnosed with JIA. Condylar alterations (shape or structural) were seen in 68 patients (43%). Patients with condylar alterations were more extensively treated over time compared with those without condylar alterations. Powerful disease activity and/or potent medication at any time during the course of the disease implied an increased risk of alterations. Conclusions: Patients with JIA who require more intensive medication over time run the greatest risk of condylar alterations. As yet, current medical programmes have not been specified for the TMJ and more knowledge in this area is needed.

Objective: To identify factors related to Quality of Life (QoL) and satisfaction with nasal appearance among patients treated for unilateral cleft lip and palate (UCLP). Design: Cross sectional population study with long-term follow-up. Patients/Settings: All patients with UCLP born between 1960-1987, treated at Uppsala University Hospital, were invited (n=109), 86 (79%) participated. Mean follow-up time was 35 years. Main outcome measures: QoL was measured with Short Form-36 (SF-36) and analyzed using mental and physical cluster scores (MCS and PCS). Nasal appearance was self-assessed with "Satisfaction with Appearance" questionnaire and by panel judgment. Multivariate regression analyses explored endogenous factors (age, gender, infancy cleft width, nasal function, nasolabial appearance) and exogenous factors (marital status, number of children, education level, operation method, number of rhinoplasties performed). Results: A larger cleft width in infancy was associated with less satisfaction with nasal appearance as adults. A lower mental health QoL was associated with less satisfaction with nasal appearance. Despite female gender being linked to less satisfaction with nasal appearance, it was associated with higher mental health QoL. Higher resistance during nasal breathing was associated to lower physical health QoL. Conclusions: Gender and infant cleft width may affect QoL and satisfaction with nasal appearance among adults. They are potential predictive factors for satisfaction with nasal appearance and QoL during adulthood. The correlation of nasal function impairment and decreased physical health QoL underlines the importance of treatment of nasal symptoms in these patients.

Objective: To study changes in cleft size and maxillary arch dimensions from infancy to 5 years and evaluate these changes in relation to performed surgical procedures. Design: Retrospective longitudinal study. Setting: The Cleft Lip and Palate Centre, Uppsala University Hospital, Sweden. Patients: Dental study models of 79 consecutive children, 28 with unilateral cleft lip and palate (UCLP), 39 with cleft palate (CP) and 12 with Pierre Robin Sequence (PRS) were analyzed. Interventions: Lip repair at 3-4 months, soft palate repair at 6-10 months and hard palate repair at 25-26 months of age. Main Outcome Measures: Cleft size was measured before each surgical intervention up to 2 years and arch dimensions were measured before each surgical intervention and at 5 years. Results: Cleft widths decreased from infancy up to 2 years, but the antero-posterior cleft length in CP was unchanged. Arch widths at C-C1and T-T1 and also the change over time in C-C1 and T-T1 differed significantly between the groups from infancy up to 5 years. Conclusions: Cleft widths decreased after lip closure and/or soft palate closure. The UCLP children had wider maxillary arch dimensions than the CP and PRS children during the first years of life, but after hard palate closure the transverse growth was reduced in the UCLP children. At 5 years the UCLP children had smaller maxillary widths than the CP and PRS children especially at the level of the cuspids.

BACKGROUND: Juvenile idiopathic arthritis (JIA) is a heterogeneous disease that frequently affects also the temporomandibular joint (TMJ) and associated structures. The main aim of this observational study was to describe systematically orofacial clinical signs and subjective symptoms in JIA patients, classified according to the International League of Associations for Rheumatology (ILAR) criteria, and to relate the findings to disease activity and radiological TMJ condyle lesions. METHODS: The study was a retrospective evaluation of dental and medical records in consecutive JIA patients referred to one of three dental specialist clinics in Sweden during an eight-year period. Data concerning temporomandibular signs, symptoms and general disease activity were collected and condylar alterations were judged on panoramic radiographs. RESULTS: All ILAR categories of JIA were represented among the 266 referrals included in the study. The distribution of patients among categories resembled the pattern seen in epidemiological studies. Persistent oligoarthritis was the largest category with 36.5 % of the patients. Temporomandibular clinical signs (mild, moderate or severe) occurred in 57.7 % to 92.0 %, and subjective symptoms (mild or severe) in 32.0 % to 76.0 % of the patients in all categories. Patients in the juvenile psoriatic arthritis category had the largest number of orofacial signs and symptoms, and patients in the persistent oligoarthritis category had the fewest signs and symptoms. There were significant associations between clinical signs as well as subjective symptoms and overall disease activity. Half of all the patients had undergone panoramic examinations and 37.9 % of those were judged to have condylar alterations after a mean of 2.9 years after onset. No associations between radiological findings and variables, such as signs, symptoms or disease activity, were found. CONCLUSIONS: Temporomandibular signs and symptoms can be expected to a varying degree, incl

The aim of this project was to study possible influences of Turner syndrome (TS) karyotype and the number of X chromosomes with intact short arm (p-arm) on dental crown width. Primary and permanent mesio-distal crown width was measured on plaster casts from 112 TS females. The influence on crown width of four karyotypes: 1. monosomy (45,X), 2. mosaic (45,X/46,XX), 3. isochromosome, and 4. other, and the number of intact X chromosomal p-arms were investigated. In comparisons between karyotypes, statistically significant differences were found for isochromosome karyotype maxillary second premolars, canines, laterals, mandibular first premolars, and canines, indicating that this karyotype was the most divergent as shown by the most reduced crown width. When each karyotype group were compared versus controls, all teeth in the isochromosome group were significantly smaller than controls (P < 0.01-0.001). The 45,X/46,XX karyotype expressed fewer and smaller differences from controls, while 45,X individuals seemed to display an intermediate tooth width compared with 45,X/46,XX and isochromosomes. No significant difference in crown width was found comparing the groups with one or two intact X chromosomal p-arms. Both primary and permanent teeth proved to have a significantly smaller crown width in the entire group of TS females compared to healthy females. We conclude that the isochromosome group deviates most from other karyotypes and controls, exhibiting the smallest dental crown width, while individuals with 45,X/46,XX mosaicism seemed to have a less affected crown width. An influence of the number of intact p-arms on crown width could not be demonstrated in this study.

This retrospective, long-term study evaluated the influence of two different treatment protocols, one including infant periosteoplasty, on facial growth and occlusion in patients with complete bilateral cleft lip and palate (BCLP). Thirty-five patients with records of 5-, 8- and I 6-19-year-olds were included. Sixteen of these received infant periosteoplasty (BCLP-pp) to the cleft alveolus in conjunction with lip repair and a one-stage closure of the palate. The remaining 19 patients with a two-stage closure of the palate did not have an infant periosteoplasty (BCLP-np). The bone formation induced by periosteoplasty in the BCLP-np group was insufficient and both groups had secondary bone grafting to the alveolar clefts before the eruption of the lateral incisor or the canine. Facial growth was evaluated with cephalometry at the recorded ages and dental arch relationships with the Huddart and Bodenham crossbite scores at the age of 16-19 years. Until 19 years a significant retrusion of the maxillary position (SNA) was observed in both groups. At 16-19 years of age there was no significant difference of maxillary protrusion (SNA), intermaxillary position (ANB), maxillary length (ss-pm) or vertical skeletal relationships (ML/NSL, MI/NL) between the two groups. However, a significant difference of the crossbite scores was found. The BCLP-pp group did not show more facial growth problems but more malocclusion and the insufficient bone formation of the alveolar clefts after infant periosteoplasty required a secondary bone grafting.

The noses of patients with clefts are often functionally inadequate. The aim of the present study was to evaluate the correlation between size of the maxillary cleft in infancy and size and function of the nasal airway in adults with unilateral cleft lip and palate (UCLP). This is a long-term follow up study including 53 patients with UCLP born between 1960 and 1987 and treated at the Cleft Lip and Palate Centre, Uppsala University Hospital, Sweden. Lip repair was performed at 3--4 months of age followed by either a one-stage or a two-stage palatal closure. The size of the cleft was measured on infant maxillary dental casts. Nasal minimum cross-sectional area (cm

Objective: To study facial growth from 5 to 19 years of age and the correlation with maxillary arch dimensions and cleft size in infancy in children with unilateral cleft lip and palate (UCLP) and cleft palate (CP). Design: Retrospective longitudinal study. Setting: The Cleft Palate Centre, Uppsala University Hospital, Sweden. Patients: Thirty-three consecutive patients with UCLP, 64 with CP (51 with cleft palate only (CPo) and 13 with Pierre Robin Sequence (PRS)) were included in the study. Interventions: Lip repair at 3-4 months in UCLP children. Soft palate repair at 6-7 months and hard palate repair at 2 years in UCLP and CP. Secondary bone grafting at 9 years of age in UCLP. Main Outcome Measures: Maxillary arch dimensions and cleft size were measured on dental casts taken in infancy. Cephalometrics was used to study facial growth from 5 to 19 years of age. Results: Maxillary arch depths showed positive correlations to SNA and ANB. Cleft width in infancy was negatively correlated to SNA, ANB and NSBa. The growth rates for SNA and ANB were significantly more negative for the UCLP group compared to the CPo group. Conclusions: Maxillary arch depths and cleft widths in infancy were associated with maxillary protrusion and sagittal jaw relationships during growth in both UCLP and CP children. Maxillary protrusion and sagittal jaw relation developed less favourably in UCLP compared to CPo.

Objective: To investigate the association between cleft size in infancy and crossbite at 5 years of age in children with cleft palate (CP) and unilateral cleft lip and palate (UCLP). Design: Retrospective study. Setting: University Hospital, Uppsala, Sweden. Patients: Dental study models of 80 consecutive children, 51 children with CP and 29 children with UCLP, born between 1990 and 1999 were analyzed. Interventions: Lip repair at 3 to 4 months in UCLP children. Primary soft palate repair at 6 to 10 months and secondary hard palate closure at 25 to 26 months of age. Main Outcome Measures: Maxillary arch dimensions and cleft size were measured on infancy dental casts. At follow-up at 5 years, crossbite scores were registered on dental study models. Results: The cleft dimensions in infancy showed large interindividual variation. Mean posterior cleft width was larger in UCLP children than in children with CP. The UCLP group also had significantly more crossbite at 5 years than the CP group. No significant association was noted between initial cleft size and crossbite scores at 5 years in the CP group. For the UCLP group, larger cleft widths at the level of the cuspid points were significantly associated with less anterior and posterior crossbite. Conclusions: The findings support the hypothesis that cleft size in infancy affects early outcome with respect to crossbite in children with UCLP, but not in children with CP.

The aim of the current study was to evaluate the relation between professional and lay rating and patients' satisfaction with nasolabial appearance in adults with repaired unilateral cleft lip and palate (UCLP). A cross-sectional population study, long-term follow-up with controls matched for age and sex was performed. All patients with complete UCLP born between 1960 and 1987 (n = 109), treated at Uppsala University Hospital, Sweden were invited and 83 (76%) agreed to participate. Follow-up was 20-47 years after primary lip surgery. An age-and sex-matched control group of 65 people were evaluated in the same way. Ratings from professional and lay panels of cropped photographs using a 5 point categorical scale for 4 features of the nasolabial appearance and the satisfaction with appearance questionnaire (SWA) for self-assessment were used. Professional and lay ratings correlated positively but the professionals consistently rated nasolabial appearance as better than did the lay panel (p < 0.001). Self-assessment of nasolabial appearance with the SWA (by patients and controls) did not correlate with the judgement of lay or professional panels. Judgement of nasolabial appearance in adults with repaired UCLP differs among professionals, lay people, and patients. This should be considered when deciding about secondary surgical treatment of signs of clefts.