The protruding and deviated premaxilla in bilateral complete cleft lip and palate (BCL/P) patients causes a perplexing problem in achieving a tension-free primary lip closure. An innovative noninvasive active intraoral Fixed Pre-Surgical Cleft Orthopedic (FPSCO) appliance is presented that has enabled to successfully reposition the premaxillary segment to a more favorable position prior to the surgical repair in 4 BCL/P patients, who reported late for treatment with a mean age of 18 ± 3 months. All the patients had at least 1 deciduous tooth erupted in 3 cleft segments, 1 premaxilla (PM), and 2 lateral maxillary (LM) segments. This innovative approach is a noninvasive method of getting the cleft segments closer prior to chelioplasty, where conventional presurgical nasoalveolar molding (PNAM) is not possible, which needs to be done early in life as it requires circulating maternal estrogen levels to achieve results preferably possible in patients younger than 3 to 6 months. Bonding to erupted teeth with glass ionomer cement was implemented to secure the appliance. Nickel-titanium (Ni-Ti) closed-coil springs were used that delivered continuous forces of 150 g/5 oz per side to retract the premaxillary segment. The mean active period of treatment time was 3.5 ± 1.6 months and the retention period was 1.2 ± 0.6 months, following which cheiloplasty was performed.
As compared to other ethnic groups relatively few measurements on tooth size have been made on Indian population. Hence, a study was carried out in Department of Orthodontics, Saveetha Dental College, Chennai, to discern the average clinical crown dimensions for cervicoincisal heights (CIH) and mesiodistal widths (MDW), permanent dentition for the local population, to find out the amount of variation in CIH and MDW between males and females, between right and left sides and tooth showing maximum and minimum variation. The study was carried out on study models of 100 patients who visited the OPD of the above college, and measurements were done using Digital Vernier calipers. The results showed that CIH and MDW are generally larger for male teeth compared to female and left side 2nd molars showed clinically significant variation in CIH. The study also showed that in both sexes and arches maximum variation in CIH was for central incisor and minimum for 2nd molar. In MDW, maximum variation is for 2nd molar and minimum for 2nd premolars in both arches.The study is helpful in establishling Bolton's standards for assessing tooth size discrepancy and also in application of mixed dentition model analysis and bracket positioning chart for preadjusted edgewise appliance for the local population.
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