Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: impact of maxillary dental agenesis on craniofacial growth and dental arch relationship in 8 year olds

Rizell, Sara; Küseler, Annelise; Heliövaara, Arja; Skaare, Pål; Brinck, Eli; Bellardie, Haydn; Mooney, Jeanette; Mølsted, Kirsten; Karsten, Agneta; Sæle, Paul; Chalien, Midia Najar; Marcusson, Agneta; Eyres, Philip; Shaw, William C.; Semb, Gunvor

doi:10.1093/ejo/cjab007

Cited by 3 publications

(2 citation statements)

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“…Besides surgical iatrogenesis, genetics, congenital dysmorphology of the midface, other variations intrinsically associated with the cleft and functional adaptations may interfere with the normal growth pattern in individuals with clefts ( 26 ). An interesting recent finding with this same Scandcleft material is that agenesis of teeth at the age of 8 years has a significant impact on craniofacial growth and dental arch relationships ( 27 ). The number of individuals with GOSLON score 4–5 was 47.2% in the group with ≥2 missing maxillary teeth compared with those with no or only one missing maxillary tooth (26.1% and 26.3%, respectively).…”

Section: Discussionmentioning

confidence: 89%

Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: comparison of dental arch relationships and dental indices at 5, 8, and 10 years

Heliövaara

Küseler

Skaare

et al. 2021

European Journal of Orthodontics

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Summary Background and trial design The Scandcleft intercentre study evaluates the outcomes of four surgical protocols (common method Arm A, and methods B, C, and D) for treatment of children with unilateral cleft lip and palate (UCLP) in a set of three randomized trials of primary surgery (Trials 1, 2, and 3). Objectives To evaluate and compare dental arch relationships of 5-, 8-, and 10-year-old children with UCLP after four different protocols of primary surgery and to compare three dental indices. The results are secondary outcomes of the overall trial. Methods Study models taken at the ages of 5 (n = 418), 8 (n = 411), and 10 years (n = 410) were analysed by a blinded panel of orthodontists using the Eurocran index, the 5-year-olds’ (5YO) index, and the GOSLON Yardstick. Student’s t-test, Pearson’s correlation, chi-square test, and kappa statistics were used in statistical analyses. Results The reliability of the dental indices varied between moderate and very good, and those of the Eurocran palatal index varied between fair and very good. Significant correlations existed between the dental indices at all ages. No differences were found in the mean 5-, 8-, and 10-year index scores or their distributions within surgical trials. Comparisons between trials detected significantly better mean index scores in Trial 2 Arm C (at all ages) and in Trial 1 Arm B (at 5 and 10 years of age) than in Trial 3 Arm D. The mean Eurocran dental index scores of the total material at 5, 8, and 10 years of age were 2.50, 2.60, and 2.26, and those of the 5YO index and GOSLON Yardstick were 2.77, 2.90, and 2.54, respectively. At age 10 years, 75.8% of the patients had had orthodontic treatment. Conclusions The results of these three trials do not provide evidence that one surgical method is superior to the others. The reliabilities of the dental indices were acceptable, and significant correlations existed between the indices at all ages. The reliability of the Eurocran palatal index was questionable. Trial registration ISRCTN29932826.

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Section: Discussionmentioning

confidence: 89%

Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: comparison of dental arch relationships and dental indices at 5, 8, and 10 years

Heliövaara

Küseler

Skaare

et al. 2021

European Journal of Orthodontics

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“…Surgical techniques, age at cleft repair, and surgeon experience can interfere in the outcomes related to speech, nasolabial aesthetics, and maxillary growth and have motivated intercleft center studies around the world (Molsted et al 2005). Maxillary growth outcomes in individuals born with cleft lip and/or palate may be affected by cleft type and severity (Antonarakis, Adibfar, et al 2015; Botticelli et al 2020), dental agenesis (Meazzini et al 2011; Antonarakis and Fisher 2015; Rizellet al 2021), and cranial base configuration (Meazzini et al 2011).…”

Section: Introductionmentioning

confidence: 99%

Dental Anomalies and Genetic Polymorphisms as Predictors of Maxillofacial Growth in Individuals Born with Cleft Lip and Palate

Lacerda

Vieira

2023

J Dent Res

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Cleft lip and palate have a complex inheritance, and 90% of its variation in the population is due to genetic contributors. The impact of surgical procedures on maxillofacial growth is well known, but the interference of intrinsic factors in these growth outcomes is not elucidated. The present study aimed to analyze genetic polymorphisms and frequency of dental anomalies as predictors of maxillofacial growth in patients born with cleft lip with or without cleft palate. From a cohort of 537 individuals, operated on by the same surgeon, 121 were analyzed 2 times, to define changes in maxillary growth prognosis by occlusal scores in a minimum 4-y follow-up. In a second step, a subset of 360 individuals had maxillofacial growth outcomes evaluated using Wits, nasion perpendicular to point A, and occlusal scores. The markers MMP2 rs9923304, GLI2 rs3738880 and rs2279741, TGFA rs2166975, and FGFR2 rs11200014 and rs10736303 were genotyped, and frequency of dental anomalies and cleft severity were determined to define evidence of overrepresentation of alleles associated with maxillofacial growth outcomes. Age and age at primary surgical treatment, sex, and cleft laterality were variables adjusted in the analysis. We found an association between the frequency of dental anomalies and the maxillofacial growth in unilateral ( P = 0.001) and bilateral ( P = 0.03) individuals with clefts. MMP2 rs9923304 and maxillofacial growth were associated ( P < 0.0001). There was also an association between GLI2 rs3738880 and TGFA rs2166975 and maxillary outcomes in individuals born with unilateral cleft lip and palate ( P = 0.003 and P = 0.004, respectively), as well as between FGFR2 rs11200014 and maxillary outcomes regardless of cleft type ( P = 0.005). Statistical evidence of an interaction between MMP2 rs9923304 and GLI2 rs3738880 was observed ( P < 0.0001). Presence of dental anomalies and genetic variation in MMP2, GLI2, TGFA, and FGFR2 were associated with worse maxillofacial growth outcomes in individuals born with clefts.

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Relationship between the Goslon Yardstick and Lateral Cephalometric Analysis Values after Palatoplasty in Unilateral Cleft Lip and Palate Patients

et al. 2021

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At our institution, patients undergo temporary cleft palate surgery by onestage palatoplasty (Wardill method) and twostage palatoplasty (Perko method) . In the Wardill method, the palate is moved backward using the mucoperiosteal valve technique at 1 year 6 months, whereas in the Perko method, the soft palate is moved backward using the mucoperiosteal valve technique at 1 year 6 months, followed by hard palatoplasty at 4, 5, and 6 years (1, 2) . This is because the maxilla develops to 5/6 th of its adult size by the age of 4 years 6 months (3) .Previous studies have shown that the Perko method results in better jaw development than the Wardill method (4 -8) .In our previous study, we evaluated the anteroposterior and lateral jaw development of the upper and lower jawbones at the beginning of orthodontic treatment in patients using the Wardill and Perko method, using the Goslon Yardstick 5point score rating by Mars et al. (9) We found no significant difference in the anterior growth.In addition, the Perko method was reported to be more advantageous than the Wardill method for lateral growth (10) . However, though the lateral growth of the maxilla can be laterally expanded by orthodontic treatment, pa-Correspondence to：

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Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: impact of maxillary dental agenesis on craniofacial growth and dental arch relationship in 8 year olds

Cited by 3 publications

References 42 publications

Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: comparison of dental arch relationships and dental indices at 5, 8, and 10 years

Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: comparison of dental arch relationships and dental indices at 5, 8, and 10 years

Dental Anomalies and Genetic Polymorphisms as Predictors of Maxillofacial Growth in Individuals Born with Cleft Lip and Palate

Relationship between the Goslon Yardstick and Lateral Cephalometric Analysis Values after Palatoplasty in Unilateral Cleft Lip and Palate Patients

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