Long-term follow-up of mandibular dental arch changes in patients with complete non-syndromic unilateral cleft lip, alveolus, and palate

Abstract

Background Treatment of cleft lip and palate (CLP) requires a comprehensive interdisciplinary approach and long-term follow-up. Only a few studies are available that reported on changes after treatment, which showed that in particular the transverse dimension, in patients with CLP is prone to changes after treatment. However, those studies did not pay attention to concomitant changes in the mandibular arch that occur after treatment. Objectives To evaluate mandibular transverse dental arch dimensions and interarch transverse changes in patients with complete non-syndromic unilateral cleft lip, alveolus, and palate (CUCLAP) up to five years after treatment. Material and Methods Retrospective longitudinal study in 75 consecutive patients with CUCLAP directly after comprehensive treatment (T0), two (T2), and 5 years after treatment (T5). Great Ormond Street, London and Oslo (GOSLON) scores were available for all patients. Three-dimensional scans of all dental casts were made. Inter premolar and intermolar distances between the mandibular contralateral teeth were measured. The modified Huddart Bodenham (MHB index) was applied to assess the transverse interarch relationship. Paired t-tests and ANOVA were used to analyze transverse and interarch transverse changes. Linear regression analysis was done to define contributing factors. Results Paired t-tests showed a significant decrease of the mandibular inter first and second premolar distances (p < 0.05) and an increase of the inter second molar distance, whilst the MHB Index deteriorated at all time points for all segments and for the total arch score (p < 0.05). Linear regression showed no significant contributing factors on the decrease of the transverse distances. However, inter arch transverse relationship was significantly affected by age at the end of treatment, missing maxillary lateral incisor space closure, and the GOSLON Yardstick score at the end of treatment (p < 0.05), especially during the first two years after treatment. Conclusions Changes occurred in the mandibular arch expressed as changes in the transverse dimensions and interarch relationship measured by the MHB Index. A younger age at the end of treatment, space closure for a missing maxillary lateral incisor and a higher GOSLON score at the end of treatment negatively influence the interarch transverse deterioration especially in the first two years after treatment. For the transverse dimensional changes in the mandibular arch such influencing factors could not be determined.

Predictors for long-term relapse of orthodontic treatment in patients with cleft lip and palate. A clinical follow-up study

“…The aim of the present study was to identify factors that influence the likelihood of relapse of the orthodontic treatment outcome in patients with CLP. There are only few long-term studies in the literature on the stability of orthodontic treatment outcomes in patients with CLP [ 17 ]. Some studies mainly described the morphology of the relapse [ 6 , 15 ].…”

“…Palatal scar tissue probably compromises stability in patients with CLP [ 16 ]. In patients with unilateral CLP, Sumardi et al identified the following factors for a long-term relapse: age at the end of treatment, gap closure in agenesis of the lateral incisor and occlusion at the end of treatment [ 17 ]. The existing literature concerning the pathogenesis of orthodontic long-term relapse in patients with uni- and bilateral CLP is incomplete.…”

Interdisciplinary management of Class III malocclusion with cleft lip and palate

“…13 Another study following 75 patients with a complete unilateral CLP until five years posttreatment showed that the transverse relationship deteriorated further if maxillary expansion was performed during treatment than in patients without expansion. 14 However, more long-term studies are needed to assess the stability of this approach.…”

Evaluating Dental Arch Relationships in Indonesian Patients with Operated Bilateral Cleft Lip and Palate Using Modified Huddart/Bodenham Index and Bauru-bilateral cleft lip and palate (BCLP) Yardstick

“…In addition to the Bauru-BCLP yardstick, the modified Huddart and Bodenham (MHB) index is often utilized to assess DARs for BCLP cases. This system was originally used to assess unilateral cleft in patients by considering the buccopalatal relationship based on the frequency and severity of anterior and buccal crossbites to assess maxillary arch constriction in the primary dentition period ( 15 - 20 ). The main advantages of the MHB index are its ease of use, which requires no calibration, its adaptability in assessing various types of CLP, and its numerical score that favors statistical inference ( 17 ).…”

“…The main advantages of the MHB index are its ease of use, which requires no calibration, its adaptability in assessing various types of CLP, and its numerical score that favors statistical inference ( 17 ). Heidbuchel and Kuijpers-Jagtman (1997) then modified the MHB index by adding more scoring categories for the buccal segment, the canines, and molars ( 20 , 21 ). Tothill and Mossey (2007) reported using the MHB index to assess dental arch constriction in BCLP patients.…”