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Objective: The aim of this systematic review was to elucidate the role of orthodontic retainers on the stability of compensatory orthodontic treatment in patients with unilateral cleft lip and palate., Methods: Five electronic databases (PubMed, Scopus, Web of Science, LILACS, and LIVIVO) and the grey literature (OpenGrey and Google Scholar) were investigated, according to the population, exposure, comparator, outcomes and Study design eligibility criterion. The risk of bias assessment was determined based on the Risk of Bias In Nonrandomized Studies of Exposure (ROBINS-E) and the level of evidence with the GRADE tool., Results: Three studies were included: two presented moderate risk of bias and one high. A moderate level of evidence revealed a mean value of 0.6 mm of intercanine relapse distance, and great variability between the data, regardless of the use or type of retention or rehabilitation. Relapse in the posterior region showed clinical significance, from -1 to -1.7 mm, especially in individuals who did not use retention, except in patients with symmetrical arches with Hawley retainer, where this value varies from -0.2 ± 0.63 mm., Conclusions: Orthodontic retainers do not seem essential to prevent relapse at anterior maxillary dimensions after compensatory orthodontic treatment in patients with unilateral cleft lip and palate. Relapse in the posterior region can achieve greater clinical significance, which highlights the need for prolonged use of Hawley retainers and periodic evaluation of the stability of treatment results. Prospective studies with a longer follow-up can improve the certainty of the evidence., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Restoring the integrity of the dentition with orthopedic structures should be carried out strictly according to indications, taking into account the condition of the supporting teeth and/or teeth limiting the defect., Objective: To conduct a retrospective analysis of the results of orthopedic treatment of patients with shortened dentition according to clinical and radiological methods., Materials and Methods: The material for the study was data from cone beam computed tomography (CBCT) of 126 patients with shortened dentition (most patients with the absence of a second molar, as well as the absence of the first and second molars), who sought a consultation about missing teeth in the orthopedic and surgical department of the Federal State Budgetary Institution National Medical Research Center TsNIISiCHLKh Ministry of Health of Russia., Results: At the stages of treatment for patients in the study group, insufficient attention is paid to the restoration of terminal defects of the dentition in the upper and lower jaws, especially the restoration of second molars. This may be due to improper planning of dental treatment and insufficient motivation of the patient to carry out comprehensive dental rehabilitation. According to CT studies, the number of complications of orthopedic treatment in the area of supporting teeth and/or teeth limiting the included defect or terminal defect of the dentition in the masticatory region increases depending on the period of use of the orthopedic structure., Conclusions: The use of cantilever structures leads to functional overload of the supporting teeth. Neglecting the restoration of a full dentition and prosthetics of end defects of the dentition leads to dentoalveolar advancement of antagonists of missing teeth and the appearance of complications such as functional overload of supporting teeth and resorption of alveolar bone.

Hypophosphatemic rickets (HR) is a genetic disorder with various types of inheritance. It results mainly from defects in factors that control mineral ion homeostasis such as 1,25(OH) 2 D (Calcitriol) and FGF23 (Fibroblast Growth Factor 23). The existing bibliography regarding orthodontic treatment in patients with hypophosphatemic rickets is extremely limited. The aim of this case report is to describe the orthodontic treatment of a 9-year old Caucasian female patient suffering from HR. The patient presented a healthy late mixed dentition and periodontium. She suffered from a mild Class III maxillary skeletal pattern. There was a bilateral posterior crossbite, short lingual frenulum, a right maxillary mesioposition with a Class II subdivision on this side and a moderate space deficiency in the dental arches. The disorder was controlled by medication. In specific, patient was taking 1.5mL of phosphate four times per day, 0.3mL of calcitriol twice per day and 50,000 IU of Vitamin D3 on a weekly basis. Given the Class III skeletal pattern, the medical condition and the absence of relevant bibliography, it was decided to perform maxillary expansion, facemask traction and orthodontic treatment with fixed appliances. By the end of treatment, Class I canine and molar relationships were achieved, overjet and overbite were corrected and space deficiency was addressed in both arches. PAR index was 27 at the beginning of treatment and became 2 by the end of treatment (92.5% correction). The aesthetic component of IOTN was 4 and changed to 1, while the dental component used to be 5i and became 2g. With regards to retention, upper and lower fixed retainers from canine to canine and upper and lower vacuum formed appliances were used. In conclusion, a patient with controlled HR was orthodontically treated in a successful way. Orthodontic therapy was performed in a minimally invasive manner. Thus, HR does not constitute a contraindication for orthodontic treatment, when the disorder is kept under control., (Copyright © 2020 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Objective: The aim of this study was to determine the association between transverse maxillary discrepancy and occurrence of potentially impacted maxillary canines in mixed dentition patients., Material and Methods: This cross-sectional analytical study was conducted on 85 Pakistani subjects (32 males and 53 females) aged between 8 to 13 years, having good quality orthopantomographs and dental casts. Maxillary transverse discrepancy was assessed by subtracting the mandibular intermolar width from the maxillary intermolar width on dental cast. Maxillary lateral incisors and canines were traced from orthopantomographs, and canines were placed into sector classification. Chi-square test was used to determine the difference in the occurrence of potentially impacted maxillary canines between patients with maxillary transverse discrepancy and patients without maxillary transverse discrepancy., Results: There was no significant difference seen in the occurrence of impacted maxillary canines in patients with and without maxillary transverse discrepancy in mixed dentition patients., Conclusion: Patients with maxillary transverse discrepancy may not be at a higher risk of palatal canine impaction. Radiological presence of canine in sector II, III and IV, pose a higher risk of canine impaction., (Copyright © 2019 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Objectives: To determine whether the intramaxillary relationship of patients with Muenke syndrome and Saethre-Chotzen syndrome or TCF12-related craniosynostosis are systematically different than those of a control group., Material and Methods: Forty-eight patients (34 patients with Muenke syndrome, 8 patients with Saethre-Chotzen syndrome, and 6 patients with TCF12-related craniosynostosis) born between 1982 and 2010 (age range 4.84 to 16.83 years) that were treated at the Department of Oral Maxillofacial Surgery, Special Dental Care and Orthodontics, Children's Hospital Erasmus University Medical Center, Sophia, Rotterdam, the Netherlands, were included. Forty-seven syndromic patients had undergone one craniofacial surgery according to the craniofacial team protocol. The dental arch measurements intercanine width (ICW), intermolar width (IMW), arch depth (AD), and arch length (AL) were calculated. The control group existed of 329 nonsyndromic children., Results: All dental arch dimensions in Muenke (ICW, IMW, AL, p < 0.001, ADmax, p = 0.008; ADman, p = 0.002), Saethre-Chotzen syndrome, or TCF12-related craniosynostosis patients (ICWmax, p = 0.005; ICWman, IMWmax, AL, p < 0.001) were statistically significantly smaller than those of the control group., Conclusions: In this study, we showed that the dental arches of the maxilla and the mandible of patients with Muenke syndrome and Saethre-Chotzen syndrome or TCF12-related craniosynostosis are smaller compared to those of a control group., Clinical Relevance: To gain better understanding of the sutural involvement in the midface and support treatment capabilities of medical and dental specialists in these patients, we suggest the concentration of patients with Muenke and Saethre-Chotzen syndromes or TCF12-related craniosynostosis in specialized teams for a multi-disciplinary approach and treatment.

Objective: To assess reliability of scoring plaster models and their 3D digital copy of children with complete unilateral cleft lip and palate (CUCLP) using a continuous scale (10-cm visual analog scale [VAS]) and a categorical scale (GOSLON Yardstick)., Design: Reliability observational study involving 3 trained GOSLON Yardstick assessors blinded to the origin of the models., Patients: Models from 35 New Zealand (NZ) and 35 Oslo CUCLP patients were standardized and randomly ordered before rating., Outcome Measures: Assessments were undertaken using the GOSLON and the VAS for both model formats. Twenty percent of sample were randomly selected and rescored at the first assessment, and whole sample was rescored 1 week later. Weighted κ was used to assess GOSLON reliability, while correlation was used for the VAS., Results: The VAS and GOSLON intra- and inter-rater agreement was similar for both model formats. Repeat measurements on the day have similar intra-rater reliability as repeat measurements at least a week part. There was no significant difference between the 2 model formats, and both the GOSLON and VAS found the NZ models were significantly worse than Oslo., Conclusions: A 10-cm VAS is a reliable method to assess dental arch relationships and appears to have good face validity when compared to GOSLON. The VAS allows for statistically robust rankings of the dental arch relationships, although more studies will be required to enable the VAS scores to have greater clinical meaning. The 3D digital models can be used for GOSLON and VAS rankings with a high degree of reliability.

The question addressed by this doctoral research was whether the concept of the shortened dental arch has become an obsolete treatment therapy. To answer this question, a systematic review of literature concerning the oral health related quality of life of people with a shortened dental arch was carried out, a questionnaire among people with and without a shortened dental arch was employed to determine the longevity and clinical outcomes of shortened dental arches and finally, semi-structured interviews were conducted to assess perceptions and attitudes regarding absent molars and prostheses. The conclusion is that in certain situations the shortened dental arch concept is still valid. Patients with a shortened dental arch experience an oral health related quality of life comparable to people with a full dental arch and a shortened dental arch can function well for up to 30 years or more. During the joint decision-making process about whether to apply the shortened dental arch concept, it is important to address the underlying issues involved in having or treating a shortened dental arch.

Objective: To evaluate the dental arch relationship (DAR) of nonsyndromic unilateral cleft lip and palate (UCLP) and to explore the various phenotype and postnatal treatment factors that are responsible for poor DAR., Design: Retrospective study., Setting: School of Dental Science, Universiti Sains Malaysia., Subjects: Eighty-four Bangladeshi children with nonsyndromic UCLP who received cheiloplasty and palatoplasty., Main Outcome Measures: Dental models were taken at 5 to 12 years of age (man: 7.69), and dental arch relationships were assessed using modified Huddart/Bodenham index (mHB) by two raters. Kappa statistics was used to evaluate the intra- and interexaminer agreements, chi-square was used to assess the associations, and logistic regression analysis was used to explore the responsible factors that affect DAR., Results: The total mHB score (mean [SD]) was -8.261 (7.115). Intra- and interagreement was very good. Using crude and stepwise backward regression analysis, significant association was found between positive history of class III (P = .025, P = .030, respectively) and unfavorable DAR. Complete UCLP (P = .003) was also significantly correlated with unfavorable DAR., Conclusion: This multivariate study suggested complete type of UCLP and positive history of class III had a significantly unfavorable effect on the DAR.

Objective: To test the reliability of the modified Huddart-Bodenham (MHB) numerical scoring system and its agreement with the GOSLON Yardstick categorization for assessing the dental arch relationships in unilateral cleft lip and palate (UCLP) cases., Design: A retrospective study., Setting: Faculty of Dentistry, The University of Hong Kong., Patients: Forty-one nonsyndromic UCLP consecutive patients attending the Joint Cleft Lip/Palate Clinic at Faculty of Dentistry in the University of Hong Kong were selected., Interventions: Study models at 8 to 10 years old (T1) and 10 to 12 years old (T2) were obtained from each patient., Main Outcome Measures: Models were rated with the MHB scoring system and GOSLON Yardstick index. The intra- and interexaminer reliabilities as well as correlation of both scoring systems were evaluated. Furthermore, to investigate the outcome measurements consistency, the MHB scoring system and GOSLON Yardstick were independently used to compare the dental arch relationships from T1 to T2, with the samples split into intervention and nonintervention groups., Results: The MHB scoring system presented good intra- and interexaminer agreement, which were comparable to those of the GOSLON Yardstick. The correlation between the MHB scoring system and GOSLON Yardstick scores was good. Both scoring systems showed similar results when assessing the change in the dental arch relationships from T1 to T2., Conclusions: The MHB scoring system can be used as an alternative method to the commonly used GOSLON Yardstick for assessing dental deformities in UCLP patients. Both scoring systems showed similar results in assessing the improvement in dental arch relationships.

Objective: To evaluate the severity of the dental arch relationships and the treatment outcomes of reverse headgear (RHG) in southern Chinese patients with unilateral cleft lip and palate (UCLP)., Design: A retrospective study., Setting: Faculty of Dentistry, The University of Hong Kong., Patients: Thirty-eight UCLP patients with complete records. Among them, 14 were later treated with RHG (RHG group) and 24 were under review (non-RHG group) before definitive orthodontic or in conjunction with orthognathic surgery., Interventions: Study models at T1 (aged 9.4 ± 0.4 years old), prebone grafting and before any orthodontic treatment started; T2 (aged 11.3 ± 0.6 years old), after bone grafting, and RHG treatment (RHG group) or under review (non-RHG group); and T3 (aged 15.3 ± 3.2 years old), pretreatment of definitive orthodontic or in conjunction with orthognathic surgery., Main Outcome Measures: With satisfactory intra- and interexaminer agreement proven by the kappa value, the dental arch relationships of the study models at T1, T2, and T3 were assessed by a solo calibrated examiner using the GOSLON Yardstick., Results: The median GOSLON score for southern Chinese patients with UCLP at T1 was 4.0. Sixty percent of the patients were categorized as "poor" at T1. RHG significantly improved dental arch relationships from T1 to T2, and the improvement was maintained until T3 assessed by the GOSLON Yardstick., Conclusions: The dental arch relationships in southern Chinese UCLP patients at 8 to 10 years old are unfavorable. RHG treatment shows positive effects in improving the dental arch relationships in UCLP patients, as assessed by the GOSLON Yardstick.

Aims: To investigate whether a shortened dental arch (SDA), as identified by reduced posterior occlusal contacts, is a risk factor for the progression of temporomandibular joint (TMJ) intra-articular disorders (ID), as identified using imaging techniques., Methods: This multisite, prospective observational study with a mean follow-up period of 7.9 years had a sample of 345 participants with at least 1 temporomandibular disorder (TMD) diagnosis at baseline. SDA was defined as reduced occlusal posterior support due to lack of occlusal intercuspal contacts in the molar region on the left and/or right side. SDA was assessed at baseline and at follow-up with metalized Mylar Tape. The presence or absence of a TMJ ID and the specific TMJ ID diagnoses for baseline and follow-up images were established by a calibrated, blinded radiologist at each of three sites by using bilateral magnetic resonance imaging for soft tissue imaging for disc displacement and by bilateral multidetector computed tomography or cone beam computed tomography for hard tissue imaging for degenerative joint diseases. Wilcoxon rank sum test and linear regression analyses were used to test for an impact of SDA on TMJ ID status., Results: At baseline, TMJ ID status of either side was not significantly affected by the presence of SDA on the ipsilateral or contralateral side of the jaw (all P > .05). Furthermore, the presence or absence of SDA at baseline was also not a significant predictor for progression of the TMJ ID status between baseline and follow-up (all P > .05)., Conclusion: The findings of this study suggest that there is no significant effect of SDA on progression of TMJ ID.

Objectives: The aim of this study is to assess the treatment outcome of complete unilateral cleft lip and palate (CUCLP) patients using modified Huddart/Bodenham scoring system (MHB). To determine whether there is an association of congenital and postnatal factors with the treatment outcome., Design: Retrospective observational study., Setting: Two regional cleft-referral centers., Main Outcome Measures: In the current study, 101 pairs of dental models of non-syndromic CUCLP patients were retrieved from hospital archives. Each occlusal relationship from central incisor till the first permanent molars were scored except the lateral incisor. Sum of 10 occlusal relationships in each study sample gave a total occlusion score. The primary outcome was the mean total occlusion score., Results: According to MHB, a mean (standard deviation) total occlusion score of -8.92 (6.89) was determined. Based on treatment outcome, 66 cases were favorable (grades 1, 2, and 3) and 35 cases were unfavorable (grades 4 and 5). Chi-square tests indicated, difference of cheiloplasty ( P = .001) and palatoplasty ( P < .001) statistically significant. Five variables-gender, family history of cleft, cleft side, cheiloplasty, and palatoplasty-were analyzed with a logistic regression model., Conclusions: Final model indicated that cases treated with modified Millard technique (cheiloplasty) and Veau-Wardill-Kilner method (palatoplasty) had higher odds of unfavorable treatment outcome.

The purpose of this study was to compare the alignment pattern of the constricted maxillary dental arch by fixed orthodontic treatment (FOT) in the well-aligned and constricted arches of unilateral cleft lip and palate (UCLP) patients. 19 UCLP patients were divided into Group 1 (well-aligned arch, n = 9) and Group 2 (constricted arch, n = 10). After the cephalometric and maxillary dental arch variables before (T1) and after FOT (T2) were measured, statistical analysis was performed. There were no significant differences in the surgical timing of cheiloplasty, palatoplasty, and secondary alveolar bone grafting and in the surgical method of cheiloplasty between the 2 groups. However, Group 2 had a higher percentage of palatoplasty method, which could leave the denuded bone for secondary healing than Group 1 (P < 0.05). Although Group 2 showed more constriction and asymmetry in the maxillary dental arch compared to Group 1 at the T1 stage (inter-second premolar width, greater segment angle [GSA], and lesser segment angle [LSA], all P < 0.05), these problems could be effectively resolved by FOT. As a result, at the stage T2, there was no significant difference in all the variables between the 2 groups. During T1-T2, there was a different pattern in change of variables between Groups 1 and 2 (anterior segment angle in the greater segment [P < 0.05] in Group 1 and U1-SN [P < 0.01], inter-molar width [P < 0.05], GSA [P < 0.05[, and LSA [P < 0.01] in Group 2). Therefore, according to the maxillary dental arch shape, different strategy is necessary to obtain proper alignment by FOT.

Purpose: Juvenile idiopathic arthritis (JIA) is an autoimmune disease with multiple potential causal factors. In case of temporomandibular joint (TMJ) affection, the inflammatory reaction can result in restricted mandibular growth with implied skeletal and facial deformities. Aim of the present study was to examine dentoalveolar and occlusion characteristics in children with JIA., Patients and Methods: The sample consisted of 66 children (27 boys, 39 girls) with JIA. Thirty-three of them showed unilateral or bilateral condylar destruction, while the other half did not manifest any TMJ involvement. Corresponding dental casts of these patients were evaluated and Angle classification, overjet, overbite, crossbite, crowding, and ectopic teeth were registered. All dental casts were subsequently scanned and digitized to analyze 26 additional variables. Subgroups according to sex and condylar affection were formed. Statistical analysis was performed using Fisher's least significant difference (LSD) post hoc test of analysis of variance (ANOVA)., Results: The prevalence of Class II, division 1 malocclusion in this JIA sample was high (28.8%). Compared to girls, boys had significantly greater dental arch widths and lengths. The group with bilateral condylar affection had significantly decreased lower arch length and increased irregularity index (p < 0.035) compared to the non-affected group., Conclusions: Bilateral condylar involvement in children with JIA seems to reduce the lower arch length, while increasing the irregularity index of the lower front teeth.

Objective: The modified Huddart and Bodenham scoring system assesses maxillary arch constriction and surgical outcomes in cleft lip and palate. This project automates modified Huddart and Bodenham scoring using three-dimensional digital models., Design: Development of a novel software tool., Setting: The design, construction, development, and testing of the system was carried out at Dundee Dental Hospital., Patients, Participants: Subjects with cleft lip and palate., Interventions: A plug-in has been developed using an open three-dimensional development platform: Rhinoceros, version 5 ( http://www.rhino3d.co.uk ). Users select cusps on mandibular and maxillary teeth on three-dimensional digital models. A three-dimensional cubic spline generates a mandibular curve, and a best-fit horizontal mandibular reference plane is produced using a least-squares method. Horizontal distances projected from the shortest three-dimensional distances were subsequently calculated between the maxillary cusps and the mandibular curve to calculate the modified Huddart and Bodenham score., Main Outcome Measures: Automatic scoring of digital models using the modified Huddart and Bodenham system produces similar results to manual scoring., Results: By standardizing outcome assessment in cleft care, multicenter comparisons for audit and research can be simplified, allowing centers throughout the world to upload three-dimensional digital models or intraoral scans of the dental arches for remote scoring. Thereafter, these data can feed back into the global database on orofacial clefting as part of the World Health Organization's international collaborative "Global Burden of Disease" research project for craniofacial anomalies., Conclusions: The automated system facilitates quicker and more reliable outcome assessments by minimizing human errors.

Objective: To compare the mixed dentition incisor and molar overjet, severity of contraction of the dental arch, and the sagittal molar relationship on the cleft side vs the noncleft side in children with repaired complete unilateral cleft of the lip and palate (UCLP)., Materials and Methods: Orthodontic records taken prior to orthodontic preparation for alveolar bone grafting were screened to select study casts from patients with nonsyndromic repaired complete UCLP who did not have mandibular skeletal or dental asymmetry. The study sample comprised dental casts from 74 children aged 8.9 ± 1 years. Standardized digital photographs were acquired at 1:1 magnification. A coordinate system was developed using digital image-processing software (Photoshop CS4 and Adobe Illustrator). Incisor and molar overjet, Angle's classification, and arch contraction were recorded. Descriptive statistics, paired t-tests, and kappa statistics were used to compare the cleft and noncleft sides., Results: A negative overjet of -1 to -5 mm was often present at the incisors, with greater frequency and magnitude on the cleft side. Class II molar relation was more frequent on the cleft side (61.1%) than on the noncleft side (47.2%). Significantly greater contraction of the cleft side deciduous canine and deciduous first molar was noted, while the difference was very minor at the first permanent molar., Conclusions: Cleft side maxillary arch contraction was most severe in the deciduous canine and first deciduous molar region and progressively less severe in the posterior region of the arch. A greater frequency and severity of negative overjet and Class II molar relationship was seen on the cleft side.

Background and Aim: Good dentofacial growth is a major goal in the treatment of unilateral cleft lip and palate (UCLP). The aim was to evaluate dental arch relationships at age 5 years after four different protocols of primary surgery for UCLP., Design: Three parallel randomised clinical trials were undertaken as an international multi-centre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK., Methods: Three different surgical procedures for primary palatal repair (Arms B, C, D) were tested against a common procedure (Arm A) in the total cohort of 448 children born with non-syndromic UCLP. Study models of 418 patients (273 boys) at the mean age of 5.1 years (range = 4.8-7.0) were available. Dental arch relationships were assessed using the 5-year index by a blinded panel of 16 orthodontists. Kappa statistics were calculated to assess reliability. The trials were tested statistically with t- and Chi-square tests., Results: Good-to-very good levels of intra- and interrater reliability were obtained (0.71-0.94 and 0.70-0.87). Comparisons within each trial showed no statistically significant differences in the mean 5-year index scores or their distributions between the common method and the local team protocol. The mean index scores varied from 2.52 (Trial 2, Arm C) to 2.94 (Trial 3, Arm D)., Conclusion: The results of the three trials do not provide statistical evidence that one technique is better than the others. Further analysis of the possible influence of individual surgical skill and learning curve are being pursued in this dataset., Trial Registration: ISRCTN29932826.

Apert syndrome is a rare craniosynostosis syndrome characterized by irregular craniosynostosis, midface hypoplasia, and syndactyly of the hands and feet. Previous studies analyzed individuals with Apert syndrome and reported some facial and intraoral features caused by severe maxillary hypoplasia. However, these studies were performed by analyzing both individuals who had and those had not received a palate repair surgery, which had a high impact on the maxillary growth and occlusion. To highlight the intrinsic facial and intraoral features of Apert syndrome, five Japanese individuals with Apert syndrome from 5 years and 2 months to 9 years and 10 months without cleft palate were analyzed in this study. A concave profile and a skeletal Class III jaw-base relationship caused by severe maxillary hypoplasia were seen in all patients. The patients exhibited anterior and posterior crossbites possibly due to a small dental arch of Maxilla., (© 2016 Japanese Teratology Society.)

The aim of this study was to propose a classification for unilateral cleft lip and palate (UCLP) malformations based on cone beam computed tomography (CBCT) images, as well as to estimate the amount of bone necessary for grafting, and to evaluate the relationship of this volume with scores obtained using the classification. CBCT images of 33 subjects with UCLP were evaluated according to gap, arch, nasal, and dental parameters (GAND classification). Additionally, these defects were segmented and the amount of graft needed for alveolar bone grafting was estimated. The reproducibility of GAND classification was analyzed by weighted kappa test. The association of volume assessment with the classification (gap and nasal parameters) was verified using analysis of variance, while the intra-observer agreement was analyzed using the intra-class correlation coefficient. The intra-observer reproducibility of the classification ranged from 0.29 to 0.92 and the inter-observer agreement ranged from 0.29 to 0.91. There were no statistically significant values when evaluating the association of the volume with the classification (P>0.05). The GAND classification is a novel system that allows the quick estimation of the extent and complexity of the cleft. It is not possible to estimate the amount of bone needed for alveolar bone grafting based on the classification; individualized surgical planning should be done for each patient specifically., (Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

The palate is considered typical of the structures in which schizophrenia-related minor physical anomalies may occur. In this study, we aimed to compare the dimensions and form of palate in patients with schizophrenia with nonpsychiatric controls in a blinded manner. Dental stone casts of 127 patients with schizophrenia and 127 controls were prepared from impressions of the maxillary dental arch. Palate dimensions were measured on the stone casts using a digital caliper and palatometer. Palate length did not differ significantly between the groups, but there was a significant difference in palate width and depth, which were significantly higher in the schizophrenia group. As a result of using multivariate analysis for assessing independent risk factors affecting patients with schizophrenia, furrowed palate shape, palate width, and ellipsoid maxillary dental arch shape were found to be significant. This study also revealed that patients with schizophrenia demonstrate certain gender-related predilections in the differences of palate parameters compared to same-sex controls. As the palate develops in conjunction with both the face and brain, our study findings can significantly contribute to the assumption that there might be structural abnormalities of the palate that could represent specific markers of embryological dysmorphogenesis underlying schizophrenia., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Objectives: The purpose of this study was to compare the dentoalveolar effects of slow (SME) and rapid (RME) maxillary expansions in patients with complete bilateral cleft lip and palate (BCLP)., Material and Methods: A sample of 50 patients with BCLP and maxillary arch constriction was randomly and equally allocated into two groups. Group SME comprised patients (mean age of 8.8 years) treated with quad-helix appliance. Group RME comprised individuals (mean age of 8.9 years) treated with Hyrax expander. Digital dental models obtained immediately pre-expansion (T1) and 6 months after the active expansion period (T2) were used for measuring maxillary dental arch widths, arch perimeter, arch length, palatal depth, buccolingual inclination of posterior teeth and differential amount of expansion accomplished at the canine and molar regions. Inter-phase and intergroup comparisons were performed using paired t tests and t tests, respectively (p < 0.05)., Results: SME and RME caused significant increase of arch widths and arch perimeter. Arch length and palatal depth decreased nonsignificantly with SME but significantly with RME. Buccal tooth inclination was significant only for maxillary deciduous canines in both groups. The quad-helix appliance showed a significant differential expansion between anterior and posterior regions. No differences were observed between SME and RME for all variables., Conclusions: Differences were not found between the dentoalveolar effects of SME and RME in patients with BCLP. SME demanded a greater therapy time compared to RME., Clinical Relevance: Both expansion procedures can be similarly indicated to correct maxillary arch constriction in patients with BCLP in the mixed dentition.

Objective: To assess a three-dimensional (3D) stereophotogrammetric method for area delimitation and evaluation of the dental arches of children with unilateral cleft lip and palate (UCLP). Obtained data were also used to assess the 3D changes occurring in the maxillary arch with the use of orthopedic therapy prior to rhinocheiloplasty and before the first year of life., Design: Within the collaboration between the Università degli Studi di Milano (Italy) and the University CES of Medellin (Colombia), 96 palatal cast models obtained from neonatal patients with UCLP were analyzed using a 3D stereophotogrammetric imaging system., Main Outcome Measures: The area of the minor and greater cleft segments on the digital dental cast surface were delineated by the visualization tool of the stereophotogrammetric software and then examined. "Trueness" of the measurements, as well as systematic and random errors between operators' tracings ("precision") were calculated., Results: The method gave area measurements close to true values (errors lower than 2%), without systematic measurement errors for tracings by both interoperators and intraoperators (P > .05). Statistically significant differences (P < .05) were noted for alveolar segment and time., Conclusions: Maxillary segments have the potential for growth during presurgical orthopedic treatment in the early neonatal period. The cleft segment delimitation on digital dental casts and area measurements by the 3D stereophotogrammetric system revealed an accurate (true and precise) method for evaluating the stone casts of newborn patients with UCLP.

The present study targeted patients with unilateral cleft lip and palate (UCLP) undergoing either one - (Wardill technique) or two-stage palatoplasty (Perko technique). Correlations between Goslon Yardstick scores and orthodontic appliances used and whether an osteotomy was performed were investigated. No differences were observed between the two types of palatoplasty in terms of Goslon Yardstick scores. A palatal expander and protraction facemask were used in Phase I of orthodontic treatment. The palatal expander was selected for most patients with UCLP in Phase I, regardless of the surgical technique used. A protraction facemask was used in patients undergoing the Wardill procedure who had a Goslon Yardstick score placing them in Group 3 or 4. In contrast, a protraction facemask was used in patients undergoing the Perko procedure who had a Goslon Yardstick score placing them in Group 4. No significant differences were observed in the Goslon Yardstick scores yielded by either type of procedure. The Goslon Yardstick score in relation to whether an osteotomy was performed in Phase II as part of orthodontic treatment was determined, focusing on the relationship between that score and the palatoplasty method used. A protraction facemask was used in patients undergoing the Perko procedure, which eliminated the need for an osteotomy at a future date. However, a protraction facemask was also used in patients undergoing the Wardill option, and those patients were likely to require an osteotomy. In other words, the results suggest that the type of palatoplasty selected will determine the effectiveness of any orthodontic appliances used.

Objective: The aim of this study was to validate the clinical use of the modified Huddart and Bodenham scoring system for the measurement of maxillary arch constriction in children born with cleft lip and/or palate., Design: The study design consisted of a reliability assessment between clinical and study model scoring., Setting: The study was carried out in cleft clinics at three hospital-based orthodontic units., Participants: A total of 53 subjects were recruited when attending routine clinic appointments and gave informed consent to participate., Intervention: The modified Huddart and Bodenham scoring system was applied to study models for 53 subjects by all examiners; whereas, one examiner scored 53 subjects clinically, the other two examiners scored 25 and 28 subjects, respectively, on two occasions at least 1 month apart., Main Outcome Measure: Reliability of modified Huddart and Bodenham scoring clinically and on study models was compared., Results: When scoring clinically with the modified Huddart and Bodenham index on two occasions, the intraexaminer and interexaminer intraclass correlation coefficients (ICC) indicated a high level of repeatability and reliability (ICC range, 0.941 to 0.989). The Bland-Altman plots did not show any areas of systematic bias. The ICC between clinical and model scores for each examiner ranged between 0.923 and 0.959. The Bland-Altman plots did not show any areas of systematic bias. The ICC between clinical and model scores for each examiner ranged between 0.923 and 0.959. Canines had lower reliability than molars and incisors., Conclusions: There was excellent intraexaminer and interexaminer agreement both on study models and in the intraoral scoring using the modified Huddart and Bodenham index. In addition, there was a high degree of correlation between study model and clinical scores using this index.

Objective: Palate and lip repair have great influence on the sagittal and transverse growth of the maxilla. The correlation between arch widths and sagittal interarch relationships in operated patients with complete unilateral cleft lip and palate (UCLP) in the mixed dentition is not clear. The aim of this study was to compare the maxillary arch widths of patients with UCLP and different interarch relationships (GOSLON Yardstick index)., Methods: The study sample consisted of 144 pairs of dental casts of patients with complete UCLP from 8 to 10 years of age, from a single center. These dental casts were divided into three groups: group I (patients with GOSLON Yardstick 1 and 2 interarch relationships), group II (GOSLON Yardstick 3), and group III (GOSLON Yardstick 4 and 5). The control group consisted of 40 pairs of dental casts of noncleft Class I patients at the same age range. The maxillary and mandibular arch widths were measured at canine, deciduous molars, and permanent first molar regions. Intergroup comparisons were performed by analysis of variance followed by Tukey tests (P < .05)., Results: Maxillary arch widths were significantly smaller in all three groups with repaired UCLP compared to the control group. Group III showed reduced intercanine and second deciduous molar widths compared to group I. No intergroup differences were observed for mandibular arch widths., Conclusions: Operated UCLP patients with more severe sagittal discrepancies tend to show more severe transverse maxillary arch deficiencies.

This case report presents the management of a female patient with unilateral cleft lip and palate presenting with skeletal Class III malocclusion and a narrow upper dental arch with a midline deviation. The treatment plan involved asymmetric transverse distraction osteogenesis of the maxilla to make the upper dental midline coincident with the facial midline. After the treatment, a good facial profile and a close intercuspation of teeth were achieved. Occlusion remained stable with normal overjet and overbite after 2-year retention.

Objective: To determine the relationship between infant cleft size and dental arch relationship in the mixed dentition in patients with complete unilateral cleft lip and palate., Design: Retrospective analysis of mixed longitudinal records., Patients: A total of 29 consecutively enrolled patients with unilateral cleft lip and palate participated in a longitudinal study that included dental casts prior to lip surgery (T1: age 1 month), prior to palate surgery (T2: age 10 months), and in mixed dentition (T3: age 9 years)., Interventions: All infants were managed with lip repair (2.5 months), hard palate repair (12 months), and soft palate repair (16 months) but without any presurgical orthopedic treatment and no orthodontic intervention prior to mixed dentition records., Main Outcome Measures: The outcome measures included determination of an infant cleft severity ratio, defined as the ratio of palatal cleft area to palatal surface area, at both T1 and T2, and the 9-year-old (T3) dental arch relationship as determined using the GOSLON Yardstick. The correlation between the infant cleft severity ratio at T1 and T2 and the later GOSLON Yardstick score at T3 was determined using Pearson r. The intrarater reliability of the infant cleft severity ratio was assessed with Pearson r and the interrater reliability of the GOSLON Yardstick ratings, by weighted kappa., Results: Reliability for the infant cleft severity ratio method was r = .92 to .95, and for GOSLON ratings κ = .81 to .91. There was no significant correlation between 1-month infant cleft severity ratio and GOSLON (r = .3) and 10-month infant cleft severity ratio and GOSLON (r = .1)., Conclusions: Cleft size versus the amount of palatal tissue available for repair and concern over more scarring with a greater infant cleft severity ratio were not factors in affecting the eventual dental arch relationship.

Objective: The aim of this study is to evaluate the nasopharyngeal airway volumes of patients with unilateral cleft lip and palate (UCLP) with different GOSLON scores., Methods: The study sample consisted of 34 patients with UCLP and 20 controls with no cleft history. In the UCLP group, three experienced examiners used the GOSLON Yardstick to rate dental arch relationships, and the sample was divided into three groups as GOSLON 2 (G2) (n = 13), GOSLON 3 (G3) (n = 10), and GOSLON 4 (G4) (n = 11). Airway volumes were constructed using three-dimensional computed tomography data and divided into four compartments named the nasal airway, and superior, middle, and inferior pharyngeal airways., Results: No statistically significant difference was detected among G2, G3, and G4 between the constitutive airway departments of the nasopharyngeal region. However, nasal airway volumes were significantly higher in the control group when compared with the UCLP group., Discussion: Although there was no correlation among the investigated parameters, it is also a fact that airway capacities display a great variability among patients when investigated three dimensionally., Conclusion: Although the severity of GOSLON scores might predetermine the extent of which the airways are affected from the cleft, a larger sample size is needed in future studies.

Objective: To investigate associations between anthropometric lip measurements and dental arch relationships in patients with complete unilateral cleft lip and palate (CUCLP)., Design: Retrospective cross-sectional study., Patients: Children with CUCLP., Methods: Anthropometric lip measurements, made immediately prior to lip repair, were available for each patient. The dental arch relationships were evaluated on dental study casts (8.6 ± 0.9 years) taken prior to any orthodontic treatment and prior to alveolar bone graft, using the modified Huddart and Bodenham (MHB) scoring system. The presence of associations between anthropometric lip measurements and dental arch relationships was determined using linear regression analysis., Results: In the 63 patients included in the study, the cleft lateral lip element was deficient in height in 87% and in transverse width in 86% of patients. Patients with more deficient cleft-side lateral lip height were more likely to present with more negative MHB scores (r = .443; P < .001). Conversely, patients with more deficient cleft-side lateral lip transverse width more often presented with more positive MHB scores (r = .281; P = .025)., Conclusions: In patients with CUCLP, there is a wide variability in the degree of deficiency of the cleft-side lateral lip element, both in the vertical and in the transverse dimension. The extent of this deficiency may, in part, predict the resulting dental arch relationships.

Objective: To compare dental arch relationship outcomes following one- and two-stage palatal repair., Design: Nonrandomized, clinical trial with concurrent control., Setting: Hokkaido University Hospital., Patients: Sixty-eight consecutively treated Japanese patients with complete unilateral cleft lip and palate., Interventions: Thirty-one of the 68 patients underwent two-stage palatoplasty with delayed hard palate closure, and 37 patients underwent one-stage pushback palatoplasty., Main Outcome Measures: Dental casts were taken at 4.9 to 6.3 (mean: 5.2) years of age in the two-stage group and at 4.0 to 6.3 (mean: 5.1) years of age in the one-stage group, and dental arch relationships were assessed using the 5-Year-Olds' Index (5-Y) by four raters and the Huddart/Bodenham Index (HB) by two raters., Results: Intrarater and interrater reliabilities evaluated using weighted kappa statistics were good or better for the 5-Y and HB ratings. The mean 5-Y score was 2.94 in the two-stage group and 3.13 in the one-stage group (P value was not significant). However, there was a significant difference in distributions between the groups (P < .05). The HB scores of molars were significantly greater in the two-stage group than in the one-stage group (P < .05). The rank correlation coefficients between the 5-Y and total HB score (ρ = -0.840, P < .01) and between the 5-Y and the score of the incisors in the HB (ρ = -0.814, P < .01) were significantly increased., Conclusions: These results suggest that the anteroposterior relationship was not significantly different between the groups, but the transversal relationship was better in the two-stage group than in the one-stage group.

Objective : To investigate the change in occlusal evaluations from the 5-year-olds' index to the Goslon Yardstick and to compare the relationship between the evaluations and maxillofacial growth in patients with complete unilateral cleft lip and palate (UCLP). Design : A prospective longitudinal study. Subjects : The sample consisted of 85 patients with complete UCLP who underwent surgery from 1969 to 1994 and were treated at the Kyushu University Hospital in Fukuoka, Japan. Subjects had two serial dental casts performed at the ages of 5 and 10 years. Furthermore, each patient had lateral cephalographs taken at the age of 5 years, 76 of 85 subjects had films taken at the age of 10 years, and 54 subjects also had lateral cephalograms taken after the age of 15 years. Methods : Every dental cast was evaluated by the 5-year-olds' index and the Goslon Yardstick, respectively. The lateral cephalographs were traced and digitized, and angular dimensions were calculated. Outcomes were compared using Spearman's rank-order correlation analysis and the Kruskal-Wallis analysis. Results and Conclusion : Dental arch relationships were evaluated and rated as 2.96 in the 5-year-olds' index and 2.85 in the Goslon Yardstick, respectively. Both groupings showed a significant relationship, and they showed no change in 36 out of 85 subjects (42.3%), significant improvement in 30 (35.3%), and deterioration in 19 (22.3%). Two occlusal groupings and maxillofacial morphology on the cephalographs indicated that the grouping reflected the anteroposterior position of the mandible. Moreover, both groupings showed some relation to previous maxillofacial growth, but they did not show any relationship with future growth. The Goslon Yardstick may not predict maxillofacial morphology in adulthood.

Unlabelled: This review examined differences in functional outcomes and patient satisfaction when shortened dental arches are left untreated compared to their restoration to complete arch lengths with different prosthodontic interventions., Methods: A protocol was developed according to the criteria for a systematic review. All relevant databases were searched to identify appropriate clinical trials regardless of language or publication status. Predetermined eligibility criteria were applied, trial quality assessed and data extracted for each study. Relevant outcomes assessed were: functioning ability, patient satisfaction and harmful effects on oral structures., Results: Searches yielded 101 articles: 81 from electronic databases and 20 from reference lists of retrieved articles (PEARLing searches). Sixty-nine citations were assessed for eligibility after removing 32 duplicate records. After reading titles and abstracts, a total of 41 records were excluded and the full-texts of the remaining 28 records were read. Only 21 records were included for the SR because 7 records were excluded after reading the full-text reports. These 21 records report the outcomes of four randomized controlled trials (RCTs) and one non-randomized clinical trial (CT) which were pre-specified and used for this review. No on-going studies were found and no eligible studies were excluded for failure to report the reviewer's pre-specified outcomes. Outcomes were reported in the retrieved 21 articles. A narrative explanation of the pre-specified outcomes is reported for the 3 comparison groups (which were based on the different interventions used for the individual clinical trials). The shortened dental arch as a treatment option is encouraging in terms of functioning, patient satisfaction and cost-effectiveness. By using only high quality studies it was expected that the results would be more reliable when making conclusions and recommendations, but some of the included studies had to be downgraded due to methodological errors.

Introduction: Patients with bilateral cleft lips and palates have premaxillary protrusion and characteristic jaw deformities involving three-dimensional malposition of the premaxilla and bilateral maxillary bone segments. This study examined patients with bilateral cleft lips and palates who had deviation and hypoplasia of the premaxillas and bilateral maxillary segments. Before bone grafting, the patients were treated with special distraction performed separately for each bone segment using a halo-type external device. This report describes this novel treatment method which produced good results., Material and Methods: The subjects were five patients with severe jaw deformities due to bilateral cleft lip and palate. They were treated with maxillary Le Fort I osteotomy and subsequent distraction performed separately for each bone segment using a halo device. In three of five patients, premaxillary osteotomy was not performed, and osteotomy and distraction were performed only for the right and left lateral segments with severe hypoplasia., Results: All patients achieved distraction close to the desired amount. The widths of the alveolar clefts were narrowed, and satisfactory occlusion and maxillary arch form were achieved. After the surgery, three of five patients underwent bone grafting for bilateral alveolar cleft defects and the bone graft survival was satisfactory., Conclusions: This method had many benefits, including narrowing of alveolar clefts, improvement of maxillary hypoplasia, and achievement of a good maxillary arch form. In addition, subsequent bone grafting for alveolar cleft defects was beneficial, dental prostheses were unnecessary, and frequency of surgery and surgical invasiveness were reduced. This method is a good surgical procedure that should be considered for patients with bilateral cleft lips and palates who have premaxillary protrusion and hypoplasia of the right and left lateral segments., (Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Objective: To compare the dental arch relationships of Turkish patients with complete unilateral cleft lip and palate (UCLP) with the results reported for participants in the Eurocleft study., Patients: Study models of 109 patients with complete UCLP from five university clinics in Turkey were evaluated (clinic A = 25 patients, clinic B = 23 patients, clinic C = 20 patients, clinic D = 21 patients, and clinic E = 20 patients). The mean age of the patient cohort was nine years old (range = 8-11 years old), and the cohort was born between 1976 and 1990., Methods: The examiners rated the three-dimensional (3D) models using the GOSLON Yardstick. The scores were compared with those from the Eurocleft centers: E1(B), E2(E), E3(A), E4(F), E5(C), and E6(D). Intra- and interexaminer agreements were evaluated using weighted kappa statistics., Results: The mean GOSLON scores for the Turkish clinics were as follows: clinic A = 3.16, clinic B = 3.13, clinic C = 3.25, clinic D = 3.67, and clinic E = 3.70. Scores for three of the Turkish clinics (A, B, and C) were significantly worse than the scores for the three best Eurocleft centers, E1(B), E2(E), and E3(A) (P < .001, P < .001, and P < .05, respectively). Scores for two of the Turkish clinics (D and E) were similar to those for Eurocleft center E6(D) but worse than the scores for the other Eurocleft centers (P < .01, P < .001, respectively)., Conclusions: This was the first study in which three-dimensional models were used to derive scores to compare with those of the Eurocleft centers. According to the results of analysis of 109 3D models, 50.4 % of the patients in Turkey were classified as GOSLON score 4 and 5. This may have been attributable to poor surgical procedures, low-volume surgeons, and the decentralized treatment approach in Turkey between 1985 and 2000. Further research is needed to assess the situation in Turkey in more recent years.

Closure of large alveolar clefts and restoration by a fixed bridge supported by implants is a challenge in cleft alveolus treatment. A major aesthetic concern with distraction osteogenesis is obtaining a predictable position of the implant in relation to the newly generated bony alveolar ridge. We describe the treatment of a large cleft alveolus and palate reconstruction by distraction osteogenesis utilizing temporary anchorage devices (TADs) followed by a fixed implant-supported bridge. The method consists of segmental bone transport by distraction osteogenesis using a bone-borne distractor to minimize the alveolar cleft, followed by closure of the residual small defect by bone grafting three months later. During the active transport distraction, TADs were used exerting multidirectional forces to control the distraction vector forward and laterally for better interarch relation. A vertical alveolar distraction of the newly reconstructed bone of 15 mm facilitated optimal implant placement. The endosseous implants were osteointegrated and supported a fixed dental prosthesis. In conclusion, the large cleft alveolus defect was repaired in three dimensions by distraction osteogenesis assisted by TADs, and the soft tissues expanded simultaneously. Endosseous implants were introduced in the newly reconstructed bone for a fixed dental prosthesis enabling, rehabilitation of aesthetics, eating and speaking., (Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

The aim of this project was to study the impact from Turner syndrome (TS) karyotype and age on dental arch morphology and palatal height and to compare the variables in TS with reference data from non-TS females with normal occlusion. Plaster casts from 76 females with TS (6-50 years) were analysed with respect to dentoalveolar arch dimensions and palatal height. The TS females were divided into the karyotype categories: i) 45,X ii) 45,X/46,XX iii) isochromosome, and iv) other. The 45,X/46,XX karyotype exhibited fewer statistically significant variables differing from the reference group compared with other karyotypes. TS females showed increased dentoalveolar depths, decreased maxillary but increased mandibular width, decreased posterior segments, and decreased mandibular circumference compared with the reference group. In opposition to previous reports, the palatal height did not differ compared with non-TS females. Age had an impact on nine of the variables. We conclude that the present dental arch deviations are reflecting the high frequency of malocclusions reported in TS and the subsequent need for orthodontic treatment, which might possibly be lower in the 45,X/46,XX karyotype. The palatal height did not differ from the reference group, but instead the narrow maxilla might contribute to an illusion of a higher palate. We therefore suggest using the nomination 'narrow palatal vault' instead of the commonly used term 'high palatal vault'.

The inferior alveolar nerve is the mandibular division of the trigeminal nerve. Studies have documented variations in the course and branching pattern of the nerve. Here the author reports a case of developmentally missing mental foramen in an individual with normal sensory function. Identification of variations in the nerve pathway is essential for treatment planning in the area.

The aim of this study was to compare changes in dental arch morphology between patients with Crouzon syndrome or Apert syndrome and controls. Children between 4 and 14 yr of age with Crouzon syndrome (n = 40) or Apert syndrome (n = 28) were compared with non-syndromic controls (n = 457) in terms of arch widths, depths, and length dimensions. Multilevel statistical modeling techniques were used to evaluate changes over time. Dental arch dimensions were found to be smaller in patients with Crouzon syndrome or Apert syndrome compared with control subjects. Maxillary intercanine width for patients with Apert syndrome were increased, whilst other arch width variables showed no change. Patients with Crouzon syndrome showed increases in maxillary intercanine width, whilst intermolar width showed no change over time. Dental arch dimensions in syndromic patients were thus found to be consistently smaller than in control subjects between 4 and 14 yr of age, implying that patients with Crouzon syndrome and Apert syndrome had a diminished growth potential., (© 2013 Eur J Oral Sci.)

It has been shown that children born extremely preterm (EPT) often suffer from medical complications and growth restrictions in early childhood. Catchup growth diminishes these effects but the children are known to have lower weight, height, and head circumference as school children. Effects on enamel development have been shown. How this affects the dento-alveolar outcome during adolescence is not known. Forty EPT children with a gestational age (GA) of less than 29 weeks, at 12-16 years of age, and matched healthy controls born at term, with a GA of 37-43 weeks, were examined. Data from the clinical examination, dental casts, and bitewing radiographs were collected and compared. Malocclusion was noted, and dento-alveolar length, width, palatal height, and mesio-distal tooth width were measured. Medical diagnoses, neurological, and neuropsychiatric disturbances were noted at the time of the survey. The two groups were compared with an epidemiological normal reference material. The results showed no differences between the controls and reference material. Angle Class II was the most frequent malocclusion associated with morbidity, neurological, and neuropsychiatric disturbances, followed by deep bite and overjet. Three or more malocclusions were almost twice as common among the EPT children compared with the controls. Significantly smaller incisors, canines, and first molars were found. In summary, the EPT children, during adolescence, had medical aberrations as well as dento-alveolar effects opposed to the healthy children born at term. Dentists should be aware of this and treatment plans should be made in due time.

This case report describes a new surgical orthodontic approach involving alveolar bone distraction osteogenesis for correction of an asymmetric maxillary dental arch. The treatment was combined with conventional orthognathic surgery to improve the mandibular lateral deviation. This new treatment strategy produced an ideal dental arch and a symmetric facial appearance efficiently and effectively., (Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Background and Objective: Malocclusion, the body posture, and the breathing pattern may correlate, but this issue is still controversial. The aim of the study was to examine the relationship between the type of malocclusion, the body posture, and the nasopharyngeal obstruction in 12-14-year-old children., Material and Methods: The study group consisted of 76 orthodontic patients (35 boys, 41 girls) aged 12-14 years (mean age, 12.79 years [SD, 0.98]). All the patients were examined by the same orthodontist (study model and cephalometric radiograph analysis), the same orthopedic surgeon (body posture examined from the front, the side, and the back), and the same otorhinolaryngologist (anterior and posterior rhinoscopy and pharyngoscopy) in a blind manner., Results: The prevalence of a poor body posture and a nasopharyngeal pathology was high in the present study. In total, 48.7% of the orthodontic patients had a kyphotic posture and 55.3% a rib hump in the thoracic region. The nasopharyngeal pathology was diagnosed in 78.9% of the patients. The patients with the kyphotic posture had a higher mandibular plane angle (MP-SN) and a lower sagittal position of the mandible SNB angle. A deeper overbite correlated with shoulder and scapular asymmetry. The kyphotic posture was diagnosed in 55.0% of the patients with the nasopharyngeal pathology., Conclusions: The sagittal body posture was related to the vertical craniofacial parameters and hypertrophy of the tonsils and/or the adenoids. The study showed no relationship between the degree of crowding, the presence of a posterior cross bite, orthopedic parameters, and a breathing pattern.

Nine cleft lip and palate patients aged 17-32 years were included in the study, all having significant maxilla alveolar bone defects. Oral rehabilitation was possible by means of bone augmentation with iliac crest graft, soft tissue plasty and subsequent dental implantation (3 to 6 months after first-step procedures).

Bone grafting is a successful protocol for cleft repair but it is very challenging to close large gaps using local gingival tissue. In the last decade, interdental distraction osteogenesis has been introduced as a successful treatment protocol for repairing such large clefts. In this article a new method for closing the alveolar cleft is introduced and one case is presented. A tooth supported distractor which was specially designed to be inserted on to the main arch wire was used for the distraction. The aim was to distract the tooth segments through the curve of the dental arch and achieve complete closure of the gaps. The distractor introduced had several advantages: it is simple to apply, activate and remove; there is no need for a second operation; it is an outpatient procedure. In the case reported, a very large gap was successfully closed using this protocol whilst maintaining the ideal arch form and generating new bone behind the distracted segments., (Copyright © 2011 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

The overall aim of this thesis was to study dentofacial morphology in Turner syndrome (TS) versus controls and the influence hereupon from karyotype. One hundred thirty two TS females (5-66 years of age), from Göteborg, Uppsala and Umeå were participating. Cephalometric analysis, cast model analysis concerning palatal height, dental arch morphology and dental crown width were performed. Eighteen primary teeth were analysed in polarized light microscopy, scanning electron microscopy, microradiography and X-ray microanalysis were performed. The TS females were divided according to karyotype into: 1 45,X; 2 45,X/46,XX; 3 isochromosome; 4 other. Compared to healthy females, TS were found to have a flattened cranial base as well as small and retrognathic jaws with a posterior inclination. The maxillary dentoalveolar arch was narrower and longer, while the mandibular dental arch was wider and longer in TS compared to controls. The palatal height did not differ comparing TS and healthy females. The dental crown width was smaller in TS for both permanent and primary teeth. Aberrant elemental composition, prism pattern and lower mineral density were found in TS primary enamel compared to enamel in primary teeth from healthy girls. Turner syndrome karyotype was found having an impact on craniofacial morphology, with the mosaic 45,X/46,XX exhibiting a milder mandibular retrognathism as well as fewer cephalometric variables differing from controls compared to other karyotypes. Also for the dentoalveolar arch morphology the 45,X/46,XX group had fewer variables differing from healthy females. The isochromosome TS group exhibited the smallest dental crown width for several teeth, while 45,X/46,XX hade the largest dental crown with for some teeth and fewer teeth than both 45,X and isochromosomes that differed from controls. Thus, the mosaic 45,X/46,XX seemed to exhibit a milder phenotype, possibly due to presence of healthy 46,XX cell lines.

The aim of this survey was to investigate the quality of prescription for the fabrication of cobalt chromium removable partial dentures (RPDs) that are used to extend the shortened dental arches (SDAs). A survey of four commercial dental laboratories located in northern England was conducted. The target of this survey was cobalt chromium RPDs that were requested to restore SDAs comprising the anterior teeth and 2-4 premolars. Dentists' prescriptions were scrutinised, and a special data collection form was completed accordingly. A total of 94 dentists' prescriptions and associated SDA casts were examined. Almost all the requested cobalt chromium RPDs were clasp-retained RPDs (97%). Scrutinising the 91 prescriptions for clasp-retained cobalt chromium RPDs showed that dentists' prescriptions did not have any instructions about the design of the partial denture in a considerable proportion of the cases (32%). Teeth to be clasped were identified clearly in 45% of the prescriptions. A majority of the dentists (64%) failed to provide any instructions about the design of the rests to be placed on the most posterior premolar abutment teeth. A considerable proportion of the dentists delegated the task of selecting the type of the major connector to the dental technician (41%). Only 21 (23%) of the examined casts had clearly defined rest seat preparation. The outcome of this pilot survey shows inadequate quality of prescription in designing RPDs for patients with SDAs. This finding has an ethical and clinical bearing and does not fit with current legal guidelines relevant to designing RPDs., (© 2010 Blackwell Publishing Ltd.)

The aim of this study was to identify the factors related to prosthetic restoration in patients with shortened dental arches (SDA). SDA patients with 2-12 missing occlusal units were consecutively enrolled from seven university-based dental hospitals in Japan. Of the 145 subjects (mean age; 63·4 years), 41% chose no treatment and 59% sought to replace their edentulous spaces with removable partial dentures or implant-supported fixed partial dentures. Restoration decisions were related to tooth loss patterns. Only 3% of subjects missing just second molar(s) sought to receive prosthetic treatment, while the percentage increased to 58% in subjects who were missing first and second molars and 93% in subjects missing premolar(s). Logistic regression analyses found that young age, increased number of missing occlusal units, asymmetric arch and presence of chewing complaint were significant predictors for prosthetic restoration (P<0·05). Increased number of missing occlusal units and asymmetric arch were significant predictors for the presence of chewing complaint (P<0·05). These results suggest that perceived impairment of chewing ability owing to missing occlusal units is a critical factor for prosthetic restoration in SDA patients., (© 2010 Blackwell Publishing Ltd.)

This article describes a case report of a patient treated by the modified version of the Hyrax rapid palatal expander described by Farronato et al. in 2009. This device can be utilized for the treatment of patients in mixed dentition who, due to the maxillary hypoplasia and to the premature exfoliation of some deciduous teeth, manifest a migration of the permanent incisors with a reduction or closure of the space for the permanent teeth substituting those previously exfoliated. This expander presents a vestibular arm for correcting maxillary asymmetric transverse discrepancies. The activation method, the therapeutic benefits as well as the clinical advantages are described. The use of this appliance allows to restore the correct transverse maxillary diameters, to regain space and at the same time to restore the symmetry of the midlines up to 5-6 mm. Moreover, a recovery of the arch length can be obtained, as demonstrated by the case report presented. The expander with vestibular arm represents an interceptive treatment which can reduce the duration of the orthodontic therapy with fixed appliances.