Evaluation of Postorthodontic Changes in the Treatment of Cleft Lip and Palate Patients Using the PAR Index

Trimetsuntorn, Kunakorn; Manosudprasit, Amornrut; Manosudprasit, Aggasit; Phaoseree, Natthawee; Pisek, Araya; Pisek, Poonsak

doi:10.1177/1055665619860038

Cited by 8 publications

(11 citation statements)

References 21 publications

(21 reference statements)

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“…In the absence of a midpalatal suture posterior to the incisive foramen in patients with cUCLP, expansion prior to bone grafting only enhances the distance from the lesser segment to the nasal septum. Stability becomes an issue ( Marcusson & Paulin, 2004 ; Li & Lin, 2007 ; Trimetsuntorn et al, 2020 ), and inversion of the conventional treatment protocol with palatal expansion after bone grafting has been proposed, showing opening of the intermaxillary suture in the premaxilla in 43% of cases ( Da Silva Filho et al, 2009 , Garib et al, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, in both of these studies, at the time of evaluation, there were several patients still needing maxillary osteotomies, meaning that the overall treatment had not yet been completed and thus final posttreatment occlusion could not be assessed. Few recent studies assessing posttreatment occlusion, including combined orthodontic/surgical cases, are available in the literature ( Marcusson & Paulin, 2004 ; Trimetsuntorn et al, 2020 ); nevertheless, the latter sample consisted of different cleft types with few participants in each subgroup.…”

Section: Introductionmentioning

confidence: 99%

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Final Posttreatment Occlusion in Patients With Unilateral Cleft Lip and Palate

Staudt

Bollhalder

Eichenberger

et al. 2021

The Cleft Palate-Craniofacial Journal

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Objective: To evaluate final posttreatment occlusion in patients with complete unilateral cleft lip and palate (cUCLP) by comparing (1) 3 treatment centers, (2) males and females, (3) cleft and noncleft sides, (4) right- and left-sided clefts, and (5) orthodontic treatment with/without orthognathic surgery (OS). Design: Retrospective cohort study. Patients: Blinded posttreatment dental casts of 56 patients (19.4 ± 1.4 years) with cUCLP from 3 centers in Switzerland. Main Outcome Measure: Occlusal assessment using the modified Huddart/Bodenham (MHB) index. Results: Our sample comprised 35 males and 21 females, 46 with left- and 10 with right-sided clefts, of which 32 had undergone OS. The final posttreatment occlusion showed a median MHB score of 0 (interquartile range: −1.0 to 2.0) in the total sample and did not seem to depend on treatment center, sex, or OS. The MHB scores for the anterior buccal and the buccal segments were more negative on the cleft than on the noncleft side ( P = .002 and P = .006, respectively). When the cleft was on the left side, the MHB score tended to be more positive in the labial ( P = .046) and anterior buccal segments ( P = .034). Conclusions: This study shows a very satisfactory final posttreatment occlusion in patients with cUCLP. The more constricted buccal occlusion on the cleft side emphasizes the attention that should be given in correcting the more medially positioned lesser maxillary segment. The influence of cleft-sidedness should be analyzed further on a sample including more patients with right-sided clefts.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Final Posttreatment Occlusion in Patients With Unilateral Cleft Lip and Palate

Staudt

Bollhalder

Eichenberger

et al. 2021

The Cleft Palate-Craniofacial Journal

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“…Mean PAR outcomes also do not account for this individual variation and may explain some of the differences in reported outcomes depending on the population from which the sample was drawn. A recent retrospective study of occlusal outcomes in 18 patients with CL/P found a mean reduction in PAR score of 29.33; however, this was higher in patients who underwent joint-orthognathic treatment, with a reduction of 32 (Trimetsuntorn et al, 2020). A similar study of 34 patients with UCLP found a mean PAR score reduction of 29.59, but a greater reduction of 37.43 for patients who underwent orthognathic correction (Manosudprasit et al, 2011).…”

Section: Outcome Comparisonsmentioning

confidence: 99%

Occlusal Outcome of Orthodontic Treatment for Patients With Complete Cleft Lip and Palate

Stonehouse-Smith

Rahman

Mooney

et al. 2021

The Cleft Palate-Craniofacial Journal

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Aim: To assess occlusal outcomes of orthodontic treatment for patients with complete cleft lip and palate. Design: Retrospective assessment using the Peer Assessment Rating (PAR) index. Setting: Consecutive patients treated by one consultant orthodontist at a tertiary care cleft center. Participants: One hundred twenty-seven patients with either complete unilateral cleft lip and palate (UCLP) or bilateral cleft lip and palate (BCLP) consecutively treated with fixed appliances. Intervention: Fixed orthodontic appliance treatment and orthognathic surgery when required. Outcomes: The PAR index assessment was carried out by a calibrated-independent assessor. Treatment duration, the number of patient visits, and data on dental anomalies were drawn from patient records and radiographs. Results: One hundred two patients’ study models were assessed after exclusions. Mean start PAR score for UCLP (n = 71) was 43.9 (95% CI, 41.2-46.6, SD 11.5), with a mean score reduction of 84.3% (95% CI, 81.9-86.7, SD 10.1). The UCLP mean treatment time was 23.7 months with 20.1 appointments. Mean start PAR score for BCLP (n = 31) was 43.4 (95% CI, 39.2-47.6, SD 11.4), with a mean score reduction of 80.9% (95% CI, 76.3-85.5, SD 12.5). The BCLP mean treatment time was 27.8 months with 20.5 appointments. Conclusion: These results compare well with other outcome reports, including those for patients without a cleft, and reflect the standard of care provided by an experienced cleft orthodontist. As with high-volume surgeons, orthodontic treatment for this high need group is favorable when provided by a high-volume orthodontist. These findings may be used for comparative audit with similar units providing cleft care.

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“…The mean PAR reduction was 87% at completion of treatment, reducing to 73% after two years of retention. This negative change in PAR after treatment was found to be statistically significant (Trimetsuntorn et al, 2020). The later study also acknowledged that there was some overlap in the samples investigated in these studies.…”

Section: Introductionmentioning

confidence: 94%

“…An overall PAR reduction of 69% ± 22% was suggested as a benchmark for fixed appliance therapy in ULCP patients (Deacon et al, 2007). In two studies of cleft patients in Thailand, pre- and post-treatment PAR scores were also investigated (Manosudprasit et al, 2011, Trimetsuntorn et al, 2020). In the first of these studies, the records of 34 CLP patients, including seven who were treated with a joint orthodontic/orthognathic approach, were examined (Manosudprasit et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Peer Assessment Rating (PAR) scoring of cleft patients treated within a regional cleft centre in the United Kingdom

Furness¹,

Veeroo

Kidner

et al. 2021

J Orthod

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Objective: To assess static occlusal outcomes for patients with cleft lip and/or palate (CLP) and cleft palate (CP) managed within a UK Regional Cleft Service and to compare with previously published Peer Assessment Rating (PAR) scores from a non-cleft population of patients treated within a UK consultant-led hospital service. Design: Retrospective multicentre study. Setting: Eight orthodontic hospital units within the Spires Cleft Service, UK. Participants: Patients born with CLP or CP between 1985 and 1995 treated within the service. Methods: Patients were assigned to groups by cleft type and whether they were treated by orthodontics only or a combination of orthodontics and orthognathic surgery. PAR was recorded before and after treatment from study models. Results: Data were collected for 171 patients included in the study. Median pre-treatment PAR was 42 and post-treatment 11. Median percentage change in PAR for all patients was 73%, although 12% of cleft patients had a PAR improvement that was worse or no different. Median change in PAR score was 71% for those treated with orthodontics only and 83% for those who had an osteotomy. Median PAR improvement for those treated with orthodontics only was 73% in the cleft lip group, 77% in the CP group, 66% in the unilateral CLP group and 53% in the bilateral CLP group. Median pre- and post-treatment PAR for the cleft group was higher and PAR reduction lower than those published for non-cleft patients. Conclusion: These data demonstrate high severity of malocclusion, complexity of orthodontic treatment and difficulty in achieving an ideal static occlusion for cleft patients. If PAR is to be used to assess orthodontic outcomes in cleft patients the findings of this study should be considered. A higher proportion of cases are likely to be classed as ‘worse or no different’, and a lower percentage change will be expected.

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Evaluation of Postorthodontic Changes in the Treatment of Cleft Lip and Palate Patients Using the PAR Index

Cited by 8 publications

References 21 publications

Final Posttreatment Occlusion in Patients With Unilateral Cleft Lip and Palate

Final Posttreatment Occlusion in Patients With Unilateral Cleft Lip and Palate

Occlusal Outcome of Orthodontic Treatment for Patients With Complete Cleft Lip and Palate

Peer Assessment Rating (PAR) scoring of cleft patients treated within a regional cleft centre in the United Kingdom

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