Objective: To determine the incidence of nonsyndromic cleft lip and/or palate in the Czech Republic among infants born during 1994 -2008 as well as to defi ne the ratio per live births and sex ratios. Another aim was to determine whether there was any trend in the incidence in this time period. Design: Retrospective study. Setting: Prague Center for the Treatment of Congenital Facial Anomalies. Material and methods: Data were collected from the National Birth Defects Register (Institute of Health Information and Statistics), the Czech Statistical Offi ce and the Czech Health Statistics Yearbooks. The incidence, ratios per live births and sex differences were calculated. Possible trends in the data series were investigated. Results: Totally 2417 infants with a cleft defect were found among 1 471 789 newborns in time period 1994-2008. The overall incidence was 1.64 per 1000 live births or 1 in 600 live births. The incidence of cleft lip was 0.39/1000, the incidence of cleft palate was 0.68/1000 and the incidence of cleft lip and palate was 0.57/1000. The ratio per live births was 1 in 2648 in cleft lip, 1 in 1801 in cleft lip and palate and 1 in 1505 in cleft palate. The incidence was much higher among male babies in cleft lip patients (male to female ratio 2.07) and in patients with cleft lip and palate (males to females ratio 1.85). The male to female ratio in cleft palate newborns was 0.92. No traceable trend was found in the incidence. Conclusions: In the Czech Republic, every year approximately 170 infants with cleft lip and/or palate were born, the incidence was 1.64 per 1000 live born infants during considered period. Males were affected more frequently with isolated cleft lip and cleft lip and palate, on the other hand, in cleft palate patients, there was a slight dominance of females. Further long-term studies are necessary in order to elucidate reasons of the oscillations in incidence of cleft anomalies, to identify possible teratogens and to give a starting indication for planning health service resource requirements for this group of affected infants (Tab. 3, Fig. 4

Objective: To compare the influence of 3 different time protocols of cleft lip and palate operations on the growth of the dentoalveolar arch in patients with unilateral cleft lip and palate (UCLP). Materials and Methods: We evaluated 64 plaster casts of 8-year-old boys with UCLP operated on according to 3 different time protocols: lip repair at the age of 6 months and palate repair at 4 years, lip repair at 3 months and palate repair at 9 months, and neonatal lip repair and palate repair at 9 months. The control group contained 13 plaster casts of 8-year-old boys. The dentoalveolar arch width was measured between deciduous canines and between the second deciduous molars; the length was measured between incisive papilla and the line connecting both tuber maxillae. Results: All measured distances were statistically significantly smaller in boys with UCLP than in the control group. Intercanine width was not statistically significantly different between the patients operated on according to the different time protocols. In comparison to the lip repair at 6 months and palate repair at 4 years, the intermolar width was statistically significantly smaller in the group with neonatal lip repair; the alveolar arch length was statistically significantly shorter in both groups with lip repair performed neonatally or at 3 months. Conclusions: The length of the dentoalveolar arch is shorter after surgical repair of cleft lip neonatally or at the age of 3 months. Cleft palate repair at 9 months can contribute to a reduction in the width of the dentoalveolar arch.

Bone grafting of maxillary alveolus cleft defect followed by insertion of dental implant may be a good alternative to conventional prosthetic treatment. The principle is the formation of stable alveolar crest with a sufficient three-dimensional volume. The problems are lack and quality of mucoperiosteum for the reconstruction of shell and bone gap characteristics for bone graft intake. The procedure was carried out by a single surgeon (MD) in 45 patients between 29 August 2001 and 30 June 2006, with an 86.7% success rate. The success was defined as completed process with dental implant insertion and its loading by a prosthetic suprastructure without a failure for at least 15 months from that last step. The success rate mainly depends on 1) good alveolar arch flow of maxilla segments in both horizontal and vertical planes; 2) the height of osseous poles of at least 12 mm and onlay augmentation of built-up section does not work; 3) adequate volume of cancellous bone graft, 3.7 cm on average. On the basis of histologic verification and clinical findings, the bone graft is matured enough to ensure a primary stability of a fixture in 12.5 weeks after reconstruction. Early load may prevent bone resorption. Prediction of complications are as follows: 1) graft resorption increases according to gap size and low possibility of revascularization; 2) a higher number of complications are linked to presence of oronasal fistula and to scarring of soft tissues; 3) because of more gracile skeleton and female metabolism, the risk is higher in women.

Dental development is frequently used to estimate age in many anthropological specializations. The aim of this study was to extract an accurate predictive age system for the Czech population and to discover any different predictive ability of various tooth types and their ontogenetic stability during infancy and adolescence. A cross-sectional panoramic X-ray study was based on developmental stages assessment of mandibular teeth (Moorrees et al. 1963) using 1393 individuals aged from 3 to 17 years. Data mining methods were used for dental age estimation. These are based on nonlinear relationships between the predicted age and data sets. Compared with other tested predictive models, the GAME method predicted age with the highest accuracy. Age-interval estimations between the 10th and 90th percentiles ranged from -1.06 to +1.01 years in girls and from -1.13 to +1.20 in boys. Accuracy was expressed by RMS error, which is the average deviation between estimated and chronological age. The predictive value of individual teeth changed during the investigated period from 3 to 17 years. When we evaluated the whole period, the second molars exhibited the best predictive ability. When evaluating partial age periods, we found that the accuracy of biological age prediction declines with increasing age (from 0.52 to 1.20 years in girls and from 0.62 to 1.22 years in boys) and that the predictive importance of tooth types changes, depending on variability and the number of developmental stages in the age interval. GAME is a promising tool for age-interval estimation studies as they can provide reliable predictive models.

No abstract

The removal of certain facial-bone defects is a prerequisite to restoration of function, stability, and appearance. Synthetic bone substitutes are beneficial in cases where other operative techniques would be an unacceptable burden for a patient. Satisfactory results can be achieved in one surgical intervention with low costs and low demand on technical equipment. Osteoconductive, biocompatible, non-resorbable glass-ceramic implants based on oxyfluoroapatite and wollastonite permit osteointegration--a direct physical and chemical bond between live bone tissue and the implant without formation of a fibrous capsule. They display better stress durability in simulated body fluid than hydroxyapatite implants do. This material was used for facial skeletal framework, contour restoration in 44 cases under conditions where other solutions were doubtful. Patients were observed for 24.8 months. Immediate healing occurred without any adverse reaction. The main problem was extrusion, observed in 20.45% cases over a 2-3 month period after the implantation. All cases, with one exception, were solved with a satisfactory final result by reoperation, implant size reduction, and increased soft tissue cover. This approach was found to be a suitable technique, especially for patients exhausted by prior incompetent treatment but still dissatisfied with their appearance. Successful reconstruction with a bone substitute may remarkably increase quality of life for affected persons and, at the same time, reduce surgery-related time and costs.

A dental implant may be used in prosthetic tooth reconstruction in cleft patients. There are three main indications for this approach: substitution of a missing single tooth, an abutment for the framework, and an abutment for a fixed dental prosthesis (we designate these as defect types I, II, and III). A clinical report about prosthetic rehabilitation using dental implants instead of a fixed or removable partial prosthesis is presented. A patient with a unilateral cleft defect was treated at the University Hospital in Prague, Czech Republic. Together with a missing lateral incisor, the defect was associated with agenesis of the two upper canines and three second premolars. The treatment was completed by prosthetic dental reconstruction using the framework with a dental implant as an abutment. This approach allowed minimizing the preparation of adjacent teeth to a single tooth functioning as the second abutment. If classical fixed prosthodontics had been performed, the preparation would have involved a larger group of intact teeth with the risk of their viability loss. The procedure had no complications. The outcome was of high quality and brought satisfaction to the patient.

Patients for whom pre-treatment ASAP is < 773 mm2, < 863.9 mm2, and < 881.1 mm2 at levels 0, 2, and 4 mm, respectively, should be described as having a "thin" alveolar morphotype. In these patients, extraction treatment, associated with a decrease in the alveolus area, should be exercised with caution.