Introduction The aim of this study was to 3-dimensionally assess the treatment outcomes of bone-anchored maxillary protraction (BAMP) in patients with unilateral cleft lip and palate. Methods The cleft group comprised 24 patients with unilateral cleft lip and palate and Class III malocclusion with mean initial and final ages of 11.8 and 13.2 years, respectively. The noncleft group comprised 24 noncleft patients with Class III malocclusion with mean initial and final ages of 11.9 and 12.9 years, respectively. Cone-beam computed tomography examinations were performed before and after BAMP therapy in both groups and superimposed at the cranial base. Three-dimensional displacements of maxillary landmarks were quantified and visualized with color-coded maps and semitransparent superimpositions. The t test corrected for multiple testing (Holm-Bonferroni method), and the paired t test was used for statistical comparison between groups and sides, respectively (P < 0.05). Results BAMP produced anterior (1.66 mm) and inferior (1.21 mm) maxillary displacements in the cleft group with no significant differences compared with the noncleft group. The maxillary first molars of the cleft group showed significantly greater medial displacement than did those in the noncleft group. The zygoma showed significantly greater lateral displacement at the cleft side compared with the noncleft side. Conclusions BAMP caused similar amounts of maxillary protraction in patients with and without unilateral cleft lip and palatem with discrete differences between the cleft side and the noncleft side.

The objective of the current study was to assess the outcome of the alveolar bone grafting (ABG) in patients with cleft palate. Thirty-one patients with complete unilateral cleft lip and palate were prospectively divided into 2 groups according to the timing of surgery: (1) secondary ABG (SABG), undertaken during mixed dentition (n = 16); and (2) tertiary ABG (TABG), undertaken during permanent dentition (n = 15). Septum height was assessed using cone beam computed tomography in 3 views (buccal, intermediate, palatal) and classified according to the modified Bergland Index, which scores the results into 5 types according to the height of the neoformed bone septum (excellent: septum with a normal height; good: septum with minor deficiency; regular: marginal defect of >25% of the root length; bad: bone deficiency on the nasal aspect; and failure). In the SABG group, 6 to 12 months postoperatively, 75% of the patients were classified as having excellent/good conditions and 25% as having regular/bad conditions. No patients were observed as having failure conditions. In the TABG group, 53% of the patients were classified as having excellent/good, 21% were classified as having regular/bad conditions, and 26% were classified as having failure conditions. Significantly better outcomes were observed for the SABG group when compared with the TABG group. In conclusion, the age at which ABG is performed is a factor that impacts on the surgical outcome. Specifically, increasing age is associated with worse outcomes.

Objectives The aim of this study was to evaluate the cephalometric outcome of bone- anchored maxillary protraction (BAMP) in individuals with unilateral complete cleft lip and palate (UCLP). Material and methods The experimental group (EG) comprised 23 individuals (17 males and 6 females) with UCLP and a mean age of 11.7 years. At least 6 months after secondary alveolar bone grafting, Bollard miniplates were installed in the posterior region of the maxilla and in the anterior region of the mandible. Class III elastics were recommended to be worn for 24 hours/day for a mean time of 18 months. Cone beam computed tomography (CBCT) was obtained before (T1) and after treatment (T2). The control group (CG) consisted of 23 individuals with UCLP matched by initial age and gender with the EG and without any orthopaedic or surgical intervention performed between T1 and T2. The interval between T1 and T2 observations was 18 months for both groups. Twenty-one cephalometric variables were analysed. Intra- and intergroup comparisons were performed using paired and independent t-tests, respectively (P &lt; 0.05). Results BAMP caused a greater maxillary protrusion (SNA) and a greater decrease of Class III maxillomandibular discrepancy (ANB and Wits appraisal) compared with the CG. BAMP also caused a counterclockwise rotation of the occlusal plane (Occ Plane to FH) and an improvement in the molar relationship compared with controls. Conclusions BAMP therapy demonstrated a significant orthopaedic maxillary protraction and an improvement in the Class III skeletal pattern in UCLP.

Objective To assess mandibular and glenoid fossa (GF) changes after bone-anchored maxillary protraction (BAMP) therapy in patients with unilateral complete cleft lip and palate (UCLP). Materials and Methods The cleft group (CG) comprised 19 patients with (mean initial age of 11.8 years). The noncleft group (NCG) comprised 24 patients without clefts (mean initial age of 11.7 years). Both groups had Class III malocclusion and were treated with BAMP therapy for 18 and 12 months, respectively. Cone-beam computed tomography (CBCT) exams were performed before and after treatment and superimposed on the anterior cranial fossa (ACF). Mandibular rotations and three-dimensional linear displacements of the mandible and GF were quantified. A t-test corrected for multiple testing (Holm-Bonferroni method) and a paired t-test were used to compare, respectively, the CG and NCG and cleft vs noncleft sides (P < .05). Results Immediately after active treatment, the GF was displaced posteriorly and laterally in both groups relative to the ACF. The overall GF changes in the CG were significantly smaller than in the NCG. Condylar displacement was similar in both groups, following a posterior and lateral direction. The gonial angle was displaced similarly posteriorly, laterally, and inferiorly in both groups. The intercondylar line rotated in opposite directions in the CG and NCG groups. In the CG, most changes of the GF and mandible were symmetrical. Conclusions Overall GF and mandibular changes after BAMP therapy were similar in patients with and without clefts. The exception was the posterior remodeling of the GF that was slightly smaller in patients with UCLP.

This prospective study aimed at evaluating the surgical outcomes of alveolar bone grafting (ABG) in subjects with bilateral cleft lip and palate treated at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil, by means of cone-beam computed tomography. Twenty-five patients with bilateral complete cleft lip and palate, resulting in 50 clefts, were analyzed. Subjects were divided into 2 groups according to the dentition status at the time of surgery: (1) SABG group: subjects with mixed dentition operated on before or immediately after eruption of the permanent canine (10Y13 years); (2) TABG group: subjects with permanent dentition (15Y23 years). Cone-beam computed tomography analysis was performed in the buccal, intermediate, and palatal views, 2 and 6 to 12 months postoperatively. In the SABG group, 96% of the grafts were classified as successful, and no failure cases were observed. In the TABG group, successful cases decreased to 65%, and failures were seen in 27% of the cleft sites. In both postoperative periods, significantly better outcomes (lower mean scores) were observed for the SABG group in all the cone-beam computed tomography views (P G 0.05). Results show that the timing of surgery is an important factor in determining the outcomes of ABG in patients with bilateral cleft lip and palate, with increasing age being associated with the worse outcomes.