Effectiveness of pre‐surgical infant orthopedic treatment for cleft lip and palate patients: a systematic review and meta‐analysis

Papadopoulos, Moschos A.; Koumpridou, E. N.; Vakalis, M. L.; Papageorgiou, Spyridon N.

doi:10.1111/j.1601-6343.2012.01552.x

Cited by 65 publications

(57 citation statements)

References 81 publications

(266 reference statements)

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“…Two recent systematic reviews concluded that existing evidence cannot support the short- or long-term effectiveness of IO in UCLP patients due to the variety of treatment outcomes in RCTs, small sample sizes, and missing information on sample selection [14, 15]. …”

Section: Introductionmentioning

confidence: 99%

Transverse dental arch relationship at 9 and 12 years in children with unilateral cleft lip and palate treated with infant orthopedics: a randomized clinical trial (DUTCHCLEFT)

et al. 2015

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ObjectiveA long-term evaluation to assess the transverse dental arch relationships at 9 and 12 years of age in unilateral cleft lip and palate treated with or without infant orthopedics (IO). The hypothesis is that IO has no effect on the transverse dental arch relationship.Material and methodsA prospective two-arm randomized controlled trial (DUTCHCLEFT) in three academic cleft palate centers (Amsterdam, Nijmegen and Rotterdam, the Netherlands). Fifty-four children with complete unilateral cleft lip and palate and no other malformations were enrolled in this evaluation. One group wore passive maxillary plates (IO+) during the first year of life, and the other group did not (IO−). Until the age of 1.5, all other interventions were the same. Hard palate was closed simultaneously with bone grafting according to protocol of all teams. Orthodontic treatment was performed when indicated. The transverse dental arch relationship was assessed on dental casts using the modified Huddart/Bodenham score to measure the maxillary arch constriction at 9 and 12 years of age.ResultsNo significant differences were found between the IO+ and IO− groups. Differences between the centers increased from 9 to 12 years of age.ConclusionsTransverse dental arch relationships at 9 and 12 years of age do not differ between children with UCLP treated with or without IO.Clinical relevanceThere is no orthodontic need to perform IO as applied in this study in children with UCLP.

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Section: Introductionmentioning

confidence: 99%

Transverse dental arch relationship at 9 and 12 years in children with unilateral cleft lip and palate treated with infant orthopedics: a randomized clinical trial (DUTCHCLEFT)

et al. 2015

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“…The available empirical evidence suggests that intervention effects in orthodontic research seem to differ in non-RCTs compared to RCTs [72]. The two systematic reviews published recently that evaluated PSIO appliances in general [11, 12], also included non-RCTs. Furthermore, neither attempted to summarize the quality of available evidence and thus provide an insight into the strength of the relevant recommendations, as was carried out in the present systematic review based in the GRADE approach [20].…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly however, this practice still remains a subject of controversy [9]. Two systematic reviews evaluating PSIO in general [10, 11], and one assessing growth and development outcomes after various feeding interventions in infants with cleft lip and/or palate [12] have been published recently. However, neither of these attempted to summarize the available quality of evidence and thus provide an insight into the strength of the relevant recommendations.…”

Section: Introductionmentioning

confidence: 99%

Treatment outcomes of pre-surgical infant orthopedics in patients with non-syndromic cleft lip and/or palate: A systematic review and meta-analysis of randomized controlled trials

2017

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BackgroundNon-syndromic clefts lip and/or palate (CL/P) defects may have manifold significant and detrimental consequences for the affected individuals and their family environment. Although the use of pre-surgical infant orthopedics (PSIO) was introduced as a means to improve management and treatment outcomes, there still remains a controversy.ObjectiveTo investigate the effectiveness of PSIO in patients with non-syndromic CL/P and evaluate the quality of the available evidence.Search methodsSearch without restrictions, together with hand searching, until May 2016.Selection criteriaRandomized clinical trials investigating the effects of pre-surgical infant orthopedic appliances.Data collection and analysisFollowing study retrieval and selection, data extraction and individual study risk of bias assessment using the Cochrane Risk of Bias Tool took place. The overall quality of the available evidence was assessed with the Grades of Recommendation, Assessment, Development and Evaluation approach.ResultsFinally 20 papers (3 unique trials) were identified, involving a total of 118 patients with unilateral complete CL/P and 16 with cleft of the soft and at least two thirds of the hard palate. Eight publications were considered as being of low, four of unclear and eight of high risk of bias. In general, the investigated appliances did not present significant effects when compared to each other or to no treatment in terms of feeding and general body growth, facial esthetics, cephalometric variables, maxillary dentoalveolar variables and dental arch relationships, speech and language evaluation, caregiver-reported outcomes, economic evaluation, as well as, adverse effects and problems. Overall, the quality of the available evidence was considered low.ConclusionsThe aforementioned findings could provide initial guidance in the clinical setting. However, given the multitude of parameters, which may have affected the results, good practice would suggest further research, in order to reach more robust relevant recommendations for management decisions in individual cases.

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“…c Mit 6 Monaten. Für diese Effekte gibt es nach heutigem Stand der Forschung -außer einer vorübergehenden Verbesserung der Sprache -keine Evidenz für eine Verbesserung der Behandlungsergebnisse [23,24].…”

Section: Allgemeines Zur Therapieunclassified

Orofaziale Spalten

Daratsianos¹,

Mangold²,

Martini³

2014

Zahnmedizin up2date

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Einleitung Orofaziale Spalten gehören zu den häufigsten angeborenen Missbildungen. Die häufigste Variante ist eine Verbindung von Mund-und Nasenhöhle im Bereich der Lippen, des Kiefers und des Gaumens. Die Lippen-, Kiefer-, Gaumenspalten (LKG) können eine Reihe an Beeinträchtigungen und Folgeerkrankungen hervorrufen. Im Einzelnen können dies eine Neigung zu entzündlichen Mittelohrerkrankungen, eine Behinderung der Laut-und Stimmbildung sowie der Sprachentwicklung und Hörbehinderungen sein. Zudem treten immer Malokklusionen und Dysgnathien sowie ästhe-tische Beeinträchtigungen auf. Das soziale Verhalten wird dadurch maßgeblich beeinflusst. Darüber hinaus gibt es Kombinationen mit zusätzlichen Fehlbildungen (z. B. im Rahmen eines Syndroms), die schwerwiegende funktionelle Störungen mit sich bringen können, wie akute Ateminsuffizienz, Ernährungsprobleme, geistige Behinderung, Herzfunktionsstörungen u. a. Aufgrund von embryonalen und epidemiologischen Daten können die Spalten in vier Formen unterteilt werden [1]: n Lippenspalten n Lippenspalten mit Gaumenbeteiligung n isolierte Gaumenspalten n seltene Gesichtsspalten Die Lippen-, Kiefer-, Gaumenspalten können einseitig oder beidseitig auftreten. Ausnahme: Spalten im weichen Gaumen sind immer median. Sie variieren zwischen Minimalvarianten (z. B. eine Lippenkerbe oder eine gespaltene Uvula) und Maximalvarianten (durchgängige Spalten des weichen und harten Gaumens, des Alveolarfortsatzes und der Lippe bis in den Naseneingang). Die klinisch-morphologische Klassifikation der Lippen-, Kiefer-, Gaumenspalten nach der internationalen LAHSHAL-Kodierung [2] gibt dem Kliniker ein wichtiges Instrument in die Hand, die Spalte zunächst nach dem Phänotyp zu beschreiben (Abb. 1). Zusammen mit den syndromalen Formen wird die Prä-valenz auf 1 : 600 lebenden Geburten weltweit geschätzt und schwankt in Abhängigkeit von der ethnischen Zugehörigkeit stark. Schätzungsweise sind orofaziale Spalten bei 30 -50% der Patienten Teil eines übergeord-neten Syndroms. Für die nicht syndromalen Formen in den Europäischen Populationen wird die Prävalenz auf 1 : 1000 für Lippenspalten mit oder ohne Gaumenbeteiligung und auf 1 : 2400 für isolierte Gaumenspalten geschätzt [3]. Männer sind häufiger bei Lippenspalten mit oder ohne Gaumenbeteiligung und Frauen häufiger bei isolierten Gaumenspalten betroffen [4].Die Ätiologie der orofazialen Spalten ist komplex und multifaktoriell im Sinne von genetischen Einflüssen mit

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Effectiveness of pre‐surgical infant orthopedic treatment for cleft lip and palate patients: a systematic review and meta‐analysis

Cited by 65 publications

References 81 publications

Transverse dental arch relationship at 9 and 12 years in children with unilateral cleft lip and palate treated with infant orthopedics: a randomized clinical trial (DUTCHCLEFT)

Transverse dental arch relationship at 9 and 12 years in children with unilateral cleft lip and palate treated with infant orthopedics: a randomized clinical trial (DUTCHCLEFT)

Treatment outcomes of pre-surgical infant orthopedics in patients with non-syndromic cleft lip and/or palate: A systematic review and meta-analysis of randomized controlled trials

Orofaziale Spalten

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