Facial Growth Changes Induced by Orthodontic Treatment in Patients With Unilateral Cleft Lip and Palate

Abstract

The aim of this study was to investigate the effect of orthodontic treatment on the maxillofacial growth of patients with unilateral cleft lip and palate. The Great Ormond Street, London and Oslo (GOSLON) yardstick was used for a longitudinal evaluation of 24 patients with cleft lip and palate treated at the Cleft Center of the Lauro Wanderley University Hospital, Paraiba State, northeastern Brazil. Dental casts were evaluated by 3 orthodontists and classified according to the GOSLON yardstick. The evaluation was performed at 2 different stages: T1 (before orthodontic treatment) and T2 (follow-up evaluation) after a 6-year mean follow-up interval. The Kappa test was used to evaluate intra- and interexaminer agreement, and paired t-test was used to compare the differences between T1 and T2, with a 99% confidence interval. The average intraexaminer Kappa was 0.979, ranging from 0.971 to 0.990. The interexaminer Kappa value was 0.926 at T1, ranging from 0.885 to 0.964, and 0.896 at T2, ranging from 0.696 to 1.0. The mean GOSLON yardstick found at T1 was 2.5 ± 1.18 with 50% in G1 + G2, 29.18% in G3, and 20.82% in G4 + G5. At T2, the GOSLON average was 1.71 ± 1.12, with 79.18% in G1 + G2, 12.5% in G3, and 8.32% in G4 + G5. A statistically significant difference was found between T1 and T2. The results suggest that orthodontic treatment improves facial growth in patients with unilateral cleft lip and palate.

Craniofacial Growth Analysis of Individuals With and Without Cleft Lip and Palate in Colombia

“…A decrease in skeletal differences between patients with CLP and without CLP during and at the end of the growth period was observed in this study, finding that can be explained because growth can be slower in patients with CLP and, additionally, maxillary orthopedic treatments stimulate growth and can help in approaching craniofacial conditions to normality (Cassi et al, 2017; Lacerda Filho et al, 2018). However, studies such as the one reported by Crês et al (2016) did not find differences in pubertal development among adolescents with and without CLP.…”

“…The relationship between shape and size is called “allometry” which is a form of morphological integration (Larson et al, 2018). The impact of environmental factors, including orthodontic treatment, can lead to changes in pre-established genetic programming and modification of craniofacial growth (Cassi et al, 2017; Lacerda Filho et al, 2018).…”

“…In relation with the epigenetic theory, orthodontic treatment for patients with CLP during periods of decidua and mixed dentition can provide more favorable growth conditions of the middle facial third and regularize the intermaxillary basal relationships, preventing or eliminating functional alterations. Early therapies improve the dental arch relationships (Cassi et al, 2017; Lacerda Filho et al, 2018).…”