Background Among the recent modalities introduced to accelerate orthodontic tooth movement (OTM) is micro-osteoperforations (MOPs), in other words, bone puncturing. The aim of this split-mouth trial was to investigate the effects of MOPs on the rate of OTM. Methods Eighteen patients requiring bilateral first premolar extraction and upper canine retraction with maximum anchorage were enrolled in this study. Immediately before canine retraction, three MOPs were randomly allocated to either the right or left sides. MOPs were performed using a mini-screw (1.8 mm diameter, 8 mm length) distal to the canine. Canine retraction continued for 4 months. Data were collected from monthly digital models, in addition to pre- and post-retraction maxillary CBCT images . The primary outcomes were the rate of canine retraction per month and the total distance moved by the canines. The secondary outcomes were the effect of MOPs on anchorage loss, canine root resorption, and pain. Results The mean rate of canine retraction in both sides was 0.99 ± 0.3 mm/month. The total distance moved by the canine cusp tip was greater in the MOP than the control side (mean difference 0.06 ± 0.7 mm), which was statistically insignificant ( P > 0.05(. The total distances moved by the canine center and apex were significantly greater in the MOP than the control side (mean difference 0.37 ± 0.63 mm ( P < 0.05) and 0.47 ± 0.56 mm ( P < 0.01) respectively). Insignificant differences were detected regarding anchorage loss and root resorption between both sides ( P > 0.05). Mild to moderate pain was experienced following the MOP procedure, which rapidly faded away within 1 week. Conclusions Micro-osteoperforations were not able to accelerate the rate of canine retraction; however, it seemed to facilitate root movement.

Objective: The aim of the systematic review is to evaluate the effects of gingivoperiosteoplasty (GPP) on alveolar bone quality and facial growth in patients with cleft lip and palate (CLP). Search Methods: Electronic and manual search was done up to October 2017. Eligibility Criteria: Clinical and observational studies that compared GPP to control; patients without GPP evaluated either before or after the age for secondary bone graft (SBG). Data Collection and Analysis: Studies selection was done by 2 authors independently. Risk ratio and mean difference with 95% confidence intervals (CIs) were calculated using random-effects models. Results: Thirteen articles were included in the review. All studies were at high risk of bias. Poorer alveolar bone quality was found in the GPP group compared to the SBG group. The pooled data showed a statistically significant increase in the incidence of Bergland type III in the GPP group compared to SBG (risk ratio: 11.51, 95% CI: 3.39-35.15). As for facial growth, GPP group resulted in a more retruded maxillary position (as indicated by “Sella-Nasion-Subspinale” angle [SNA value]) compared to control group by −1.36 (CI: −4.21 to 1.49) and −1.66 (CI: −2.48 to −0.84) when evaluated at 5 and 10 years, respectively. The protocol for presurgical infant orthopedics used in conjunction with the GPP procedure might have affected the results of the alveolar bone and facial growth outcomes. Conclusions: Definitive conclusions about the effectiveness of GPP cannot be drawn. Very weak evidence indicated that GPP might not be an efficient method for alveolar bone reconstruction for patients with unilateral and bilateral CLP. Gingivoperiosteoplasty surgery could lead to maxillary growth inhibition in patients with CLP.

Objective: The aim is to compare between the clinical effectiveness of nasoalveolar molding (NAM) versus the computer-aided design NAM (CAD/NAM) in patients with bilateral clefts. Design: The trial is a randomized comparative trial with 1:1 allocation ratio. Participants: Thirty infants with bilateral complete cleft lip and palate were recruited. Interventions: Patients were randomized between NAM and CAD/NAM groups. The treatment steps described by Grayson were followed for the NAM group. In the CAD/NAM group, digitized maxillary models were made to create series of modified virtual models which were used to fabricate the molding plates using 3-dimensional printing technology. The nasal stents were then added to the plates following Grayson method. The study lasted for 4 months. Main Outcomes: The primary outcome was to evaluate the changes in the intersegment cleft gap. Secondary outcomes included the analysis of the maxillary arch in transverse, anteroposterior, and vertical dimensions as well as the premaxillary deviation and rotation. Chair side time was assessed for both methods. Results: Both modalities decreased the intersegment cleft gap. The CAD/NAM plates caused more reduction in the total arch length by 1.99 mm (−3.79 to 0.19, P = .03) as compared to the NAM treatment. No differences were found between groups in the transverse and vertical maxillary arch changes. Conclusions: Both interventions were effective in narrowing the cleft gap. Similar maxillary changes were found in both groups. The CAD/NAM modality required less chair side time compared to the NAM treatment.

Objective The aim is to compare the facial esthetics following nasoalveolar molding (NAM) versus computer-aided design NAM (CAD/NAM) in patients with bilateral cleft lip/palate (CLP). Design The trial is a randomized comparative trial with a 1:1 allocation ratio. Participants Thirty infants with bilateral complete cleft lip and palate were recruited. Interventions Patients were randomized between NAM and CAD/NAM groups. The treatment steps described by Grayson were followed for the NAM group. In the CAD/NAM group, digitized maxillary models were made to create a series of modified virtual models, which were used to fabricate the molding plates using 3-dimensional printing technology. The nasal stents were then added to the intraoral plates following the Grayson method. The study lasted for 4 months. Main Outcomes The assessment of the changes observed in the interlabial gap and nasolabial esthetics was done using standardized 2-dimensional photographs. The correlation between dental arch changes and extraoral facial esthetics was studied. Results Both modalities showed improvement in nasolabial esthetics before the lip surgery. No statistically significant difference was found between NAM and CAD/NAM groups in any of the assessed variables. Conclusions Both interventions were effective in the management of infants with bilateral CLP.