Palatal Volume Changes in Unilateral Cleft Lip and Palate Paediatric Patients

Abstract

Cleft lip and/or palate (CL/P) are the most common craniofacial abnormalities. CL/P therapy involves also orthopedic and surgical treatments. In particular, the orthopedic treatment can help to align the cleft segments and facilitate surgery. Traditionally, facial and palatal structures have been analyzed by 2D methods, omitting information of volume bone defects. A pre-surgical volume estimation can be useful to determine the anatomical boundaries of the alveolar bone defect; subsequently, volume assessments can appreciate the outcome of secondary alveolar bone grafting. In the present study, we developed a 3D stereophotogrammetric technique for volume estimation of the dental arches of children with CL/P. The method was employed to assess the 3D changes occurring in the maxillary arch of unilateral CLP (UCLP) patients with the use of plates before the first year of life. We collected 96 palatal casts of 32 neonatal patients with UCLP. Palatal casts were obtained before orthopedic treatment, before cheiloplasty, and after cheiloplasty. Half patients were treated with an active plate, half with a passive one. Casts were marked with a set of landmarks, digitized using a stereophotogrammetric system, and then analyzed. Volumes of the greater and the minor alveolar segments were separately assessed, and compared with a 3-w repeated measures ANOVA. Method accuracy was assessed using objects of known size, while repeatability was evaluated using Student's t test and technical error of measurements. Volume estimates were accurate, without systematic errors; random errors were lower than 5% of the total variance. Significant effects of alveolar segment and time were observed (p<0.0001). Instead, no differences were found for the kind of plate. In conclusion, stereophotogrammetric systems can be a valid instrument to estimate palatal volumes of patients with CL/P during treatment, that can be followed up in a safe, rapid and non-invasive way.

Prospective cohort 3D study of dental arches in children with bilateral orofacial cleft: Assessment of volume and superimposition

“…The following linear measurements were analysed: C–C′ (Intercanine distance)—transversal line between the eruption points of the primary canine; T–T′ (Intertuberosity distance)—transversal line between the left and right tuberosity; I–C′ (Left anterior intersegment length)—from the interincisive point to the eruption point of the left primary canine; I–C (Right anterior intersegment length)—from the interincisive point to the eruption point of the right primary canine; I–T′ (Left anteroposterior intersegment length)—from the interincisive point to the left tuberosity; I–T (Right anteroposterior intersegment length) from the interincisive point to the right tuberosity 1‐5,16,17 . The volume of the palatal bone shelves was analysed according to the methodology of the study of Pucciarelli et al, 2015, 18 whereas the area of the palatal bone shelves was evaluated according to Carrara et al, 2016 1 and Ambrosio et al, 2018 2 (Figure 1). One trained and calibrated examiner performed all morphometric analyses 1‐3,5,16,17 .…”

“…The images of the dental arches at T2 were superimposed to those at T1, of the same participant. Firstly, the palatal bone shelves were delimited—alveolar bone ridge and maxilla 18,19 . Then, the software calculated the point‐by‐point distance, expressed by Root Mean Square (RMS) in mm.…”

Three-dimensional evaluation of surgical techniques in neonates with orofacial cleft

“…[ 4 5 6 7 10 11 12 ] The virtual analysis of the dental arch morphology from birth to skeletal maturity is easy, favors the diagnosis, and enables to tailor the therapeutic planning during the anatomic-functional rehabilitation. [ 13 ] Thus, this study aimed to evaluate the dimensional alterations of the dental arches of neonates with unilateral complete cleft lip and palate before and after two different primary surgery techniques.…”

The Application of 3D Image Acquisition Systems to Palatal Rugae: A Technical Improvement for Personal Identification?

“…A hand may be given from modern 3D image acquisition systems which have enabled researchers to improve the morphological and metrical assessment [11]: some examples are the measurements of surfaces and volumes of the palate in growing subjects [12]. In the field of congenital pathological abnormalities, the 3D approach was used to explore the metrical modifications of cleft palate [13][14][15]. Other applications in orthodontics concern the assessment of palatal linear modifications after maxillary expansion therapy [16][17][18].…”