Alveolar bone grafting in the mixed dentition stage is an accepted step in the management of cleft alveoli, providing maxillary arch support for dentition and mastication. Points of contention regarding best practices remain, including specific timing, perioperative orthodontic management, bone harvest and substitutes, pain management, and outcomes evaluations. SCOPUS and MEDLINE were searched for articles about alveolar bone grafting, which were read independently by two authors and selected for inclusion on the basis of relevance and merit. Articles on which recommendations were based were rated using the methodological index for non-randomized studies criteria. Three hundred thirty-three distinct articles were found, of which 64 were found to be suitable and relevant for inclusion. The average methodological index for non-randomized studies score was 10.39, with an interrater weighted kappa of 0.7301. Prospective comparative studies about alveolar bone grafting are rare, but available evidence suggests grafting before canine eruption with targeted preoperative orthopedic interventions, the continued use of iliac crest corticocancellous autologous graft, and adjunctive pain control methods. Greater consensus must be reached about valuable outcome measures for research, including use of imaging and indications for regrafting following graft failure.

ObjectivesThe authors performed a systematic review to evaluate the potential beneficial effects of the nasoalveolar molding appliance on nonsyndromic unilateral clefts of the lip and/or palate prior to primary lip repair.Material and MethodsA literature search was performed using three electronic databases (PubMed, Embase, Web of Science) and three journals (“Cleft Palate-Craniofacial Journal”, “Plastic and Reconstructive Surgery Journal” and “American Journal of Orthodontics and Dentofacial Orthopaedic”) from January 1980 to April 2017. Data extraction was performed with tables treating different subjects: surgical, aesthetical, functional, socio-economical effects of nasoalveolar molding (NAM) appliances and the evolution of NAM appliances, especially three-dimensional technology.ResultsOf the 145 articles retrieved in the literature surveys, 28 were qualified for the final analysis and 20 studies were excluded because of their small sample size (less than 10 patients) and/or too long follow-up (exceeded 18 months). Four randomized controlled trials were available. Although literature allowed discussing the short-term benefits of NAM appliance and the three-dimensional technology, scientific evidence is lacking.ConclusionsBased on the results, nasoalveolar molding appliances have positive surgical, aesthetical, functional and socio-economical effects on unilateral clefts of the lip and/or palate treatment before the primary repair surgeries. Three-dimensional technology results in a more efficient and predictable nasoalveolar molding appliance treatment. However, nasoalveolar molding appliance effect in a short term remains unclear with the available literature. Further studies that integrate three-dimensional technology in a large scale are still needed.

Objective: To compare the forces generated by 14 different 9 mm springs supplied by five different companies. Materials and Methods: Five replicates of 14 different 9 mm springs were evaluated, resulting in 70 total specimens. Each was extended once from its resting length to 12 mm and then was deactivated. All tests were performed in a 37ЊC water bath. Forces were recorded at the 12 mm extension and deactivation distances of 9 mm, 6 mm, 3 mm, and 1 mm using an MTS force gauge. Data were collected with Testworks software, version 4.0, and were analyzed by analysis of variance (ANOVA) with one factor alternated. Results: Mean peak load forces at 12 mm were significantly different between springs, and these forces varied from 147 to 474 grams. Mean unload forces measured at 9 mm, 6 mm, and 3 mm of deactivation values were highly variable, and only 6 of the 14 springs exhibited a ''physiologic'' mean unload force of 50 grams or less over the total deactivation range. Conclusions: Few springs tested exhibited physiologic peak load forces and constant deactivation forces. This study suggests that labeling of nickel titanium closed coil springs is confusing and misleading. (Angle Orthod. 2010;80:182-187.)

IMPORTANCE Many individuals with a cleft palate also have an associated craniofacial syndrome or anomaly.OBJECTIVE To investigate the predictive associations of persistent palatal fistulas in patients with previously repaired cleft palate. DESIGN, SETTING, AND PARTICIPANTSWe performed a case-control study of patients with cleft palate repairs from January 1, 1986, through December 31, 2000, at a major tertiary care hospital center in the Bronx, New York. The study population consisted of patients who had their primary surgery before the age of 3 years and had all their cleft-related treatment completed at the same hospital center. Palatal fistula was defined as a breakdown of the primary surgical repair of the palate, resulting in persistent patency between the oral and nasal cavities. Data collection was conducted by using the hospital centers' electronic medical records and patient tracking systems and confirmed by review of hard copies of patient records. MAIN OUTCOMES AND MEASURESThe Veau classification system was used to classify the preoperative cleft severity.RESULTS A total of 130 patients were identified-23 patients with palatal fistula and 107 controls. A total of 12 girls and 11 boys were identified in the palatal fistula group and 56 girls and 51 boys in the control group. The mean patient age at the time of palatoplasty was 12.6 and 14.5 months in the palatal fistula and control groups, respectively. A statistically significant association was found between the outcome of fistula and severity of cleft, as defined by the Veau classification system (P = .01). Furthermore, for each Veau class increase, the odds of a palatal fistula increased by 2.64 (95% CI, 1.35-5.13; P = .004). No statistically significant associations were found between the outcome of fistula and the following independent variables: patient sex (P = .98), patient age at palatoplasty (P = .82), type of palatoplasty (P = .57), surgeon (P = .15), orthodontic treatment (P = .59), ear infection (P = .30), or clefts associated with syndromes (P = .96). CONCLUSIONS AND RELEVANCEPalatal fistulas are reliably associated with severity of cleft, as defined by the Veau classification system. This knowledge gives the health care professional a more reliable method of preoperatively assessing the risk of postoperative palatal fistula in the cleft palate population.LEVEL OF EVIDENCE 3.

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IntroductionChronic kidney disease (CKD), a progressive loss of renal function, can lead to serious complications if underdiagnosed. Many studies suggest that the oral microbiota plays important role in the health of the host; however, little is known about the association between the oral microbiota and CKD pathogenesis.MethodsIn this study, we surveyed the oral microbiota in saliva, the left and right molars, and the anterior mandibular lingual area from 77 participants (18 with and 59 without CKD), and tested their association with CKD to identify microbial features that may be predictive of CKD status.ResultsThe overall oral microbiota composition significantly differed by oral locations and was associated with CKD status in saliva and anterior mandibular lingual samples. In CKD patients, we observed a significant enrichment of Neisseria and depletion of Veillonella in both sample types and a lower prevalence of Streptococcus in saliva after adjustment for other comorbidities. Furthermore, we detected a negative association of Neisseria and Streptococcus genera with the kidney function as measured by estimated glomerular filtration rate. Neisseria abundance also correlated with plasma interleukin-18 levels.ConclusionWe demonstrate the association of the oral microbiome with CKD and inflammatory kidney biomarkers, highlighting a potential role of the commensal bacteria in CKD pathogenesis. A better understanding of the interplay between the oral microbiota and CKD may help in the development of new strategies to identify at-risk individuals or to serve as a novel target for therapeutic intervention.

Objective: Alterations of the oral microbiome have been associated with obesity, possibly based on inflammatory processes mediated by bacteria. Specific bacterial strains have been associated with obesity and periodontal disease. Little is known about the oral microbiome in children. Understanding the relationship between oral health and childhood growth could help identify preventable factors contributing to obesity and related conditions, including onset of menarche which is associated with obesity. Methods: In this pilot study, we investigated the saliva microbiome among 25 girls 7–15 years old (mean 11.1) and their mothers in an inner city dental clinic in New York City. The main outcome measures were body size, presence or absence of menarche and dental practices. We examined associations of microbiome richness, diversity, and relative abundance with pubertal and demographic factors and oral health. Results: Girls had good dental health and a typical rich oral microbiome, based on the Shannon Index of all species detected. Older girls flossed more often and younger girls had more frequent dental check–ups. Microbiome richness among girls was similar to their mothers’, but diversity was greater among mothers than girls. Richness was reduced among mothers with gum bleeding, flossing and increased teeth brushing. Overweight girls had greater diversity and less richness than normal weight girls. Certain bacterial species differed in abundance with respect to whether girls had reached menarche (Flavobacteria, Actinobacteria), overweight (Megasphaera, Lactorbacillales, Lactobacillus) and gingivitis in the girls (Scardovia, Bifidobacteriales, Gemellaceae). Conclusions: Differences found in specific bacteria in the oral microbiome were related to body size and menarche. With increasing interest on studying microbiome variability related to the multifactorial etiology of obesity in children, saliva is capable of providing clinically informative markers of this and related conditions.

Introduction The purpose of this study was to evaluate the association between maternal tobacco exposure and development of orofacial clefts (OFCs) in the child in a Pakistani population. Methods A case-control study was conducted at the Cleft Hospital and Bashir Hospital in Gujrat, Pakistan, from December 2015 to December 2016. All new cases of OFC at the Cleft Hospital were included. Patients at Bashir Hospital younger than 3 years and without congenital malformations were selected as control subjects. Risk factors associated with OFC were identified through bivariate analyses. Multiple logistic regression was then performed to calculate adjusted odds ratios (ORs) of developing OFC according to various risk factors. Results The study included 297 patients with OFC and 131 control subjects. Upon univariable analysis, the following were associated with OFC: maternal tobacco exposure (P < 0.001), complications during pregnancy (P < 0.001), maternal hypertension (P = 0.01), mother not on physician-recommended medications (P < 0.001), mother not receiving vaccinations (P < 0.001), consanguineous marriage (P < 0.001), and lower socioeconomic status (P < 0.001). Upon multivariable analysis, having a smoking parent (OR, 1.89; 95% confidence interval [CI], 1.10–3.26), complications during pregnancy (OR, 2.36; 95% CI, 1.43–3.88), and consanguineous marriage (OR, 1.79; 95% CI, 1.13–2.85) were associated with increased odds of development of OFC; receiving vaccinations (OR, 0.31; 95% CI, 0.16–0.63) and higher socioeconomic status (OR, 0.20; 95% CI, 0.05–0.74) were protective. Conclusions Patients with OFC were nearly twice as likely to have a parent who smokes as those without. Efforts to reduce tobacco consumption among prospective parents, such as perinatal tobacco cessation counseling programs, should be evaluated in this population.