Palatal development of preterm and low birthweight infants compared to term infants – What do we know? Part 3: Discussion and Conclusion

Abstract

BackgroundIt has been hypothesized that prematurity and adjunctive neonatal care is 'a priori' a risk for disturbances of palatal and orofacial development which increases the need for later orthodontic or orthognathic treatment. As results on late consequences of prematurity are consistently contradictory, the necessity exists for a fundamental analysis of existing methodologies, confounding factors, and outcomes of studies on palatal development in preterm and low birthweight infants.MethodA search of the literature was conducted based on Cochrane search strategies including sources in English, German, and French. Original data were recalculated from studies which primarily dealt with both preterm and term infants. The extracted data, especially those from non-English paper sources, were provided unfiltered in tables for comparison (Parts 1 and 2).ResultsMorphology assessment of the infant palate is subject to non-standardized visual and metrical measurements. Most methodologies are inadequate for measuring a three-dimensional shape. Several confounding factors were identified as causes contributing to disturbances of palatal and orofacial development.ConclusionTaking into account the abovementioned shortcomings, the following conclusions may be drawn for practitioners and prospective investigators of clinical studies. 1) The lack of uniformity in the anatomical nomenclature of the infant's palate underlines the need for a uniform definition. 2) Metrically, non-intubated preterm infants do not exhibit different palatal width or height compared to matched term infants up to the corrected age of three months. Beyond that age, no data on the subject are currently available. 3) Oral intubation does not invariably alter palatal morphology of preterm and low birthweight infants. 4) The findings on palatal grooving, height, and asymmetry as a consequence of orotracheal intubation up to the age of 11 years are inconsistent. 5) Metrically, the palates of orally intubated infants remain narrower posteriorly, beginning at the second deciduous molar, until the age of 11 years. Beyond that age, no data on the subject are currently available. 6) There is a definite need for further, especially metrical, longitudinal and controlled trials on palatal morphology of preterm and low birthweight infants with reliable measuring techniques. 7) None of the raised confounding factors for developmental disturbances may be excluded until evident results are presented. Thus, early orthodontic and logopedic control of formerly premature infants is recommended up to the late mixed dentition stage.

Adverse pregnancy outcomes and occlusal traits in the primary dentition: A prospective cohort (BRISA)

“…Evidence that children with APO are exposed to many risk factors for malocclusions supports this hypothesis. They have poor skull growth and morphological changes in orofacial structures, especially in the palate, 11,12,19‐21 dental enamel development defects, 21,22 tooth loss, 24 changes in the timing and sequence of tooth eruption 14,34 . However, in this study, there was no significant indirect association between APO and any of the occlusal traits investigated mediated by the growth indicator (GRO).…”

“…As a result, these children would remain shorter and continue to have a relatively smaller craniofacial and body size in infancy. Thus, it seems plausible that birth changes can impact the growth of other craniofacial structures in older children, possibly inducing malocclusions 14,19 . However, as previously stated, cephalometric measurements were not available in this study.…”

“…Thus, it seems plausible that birth changes can impact the growth of other craniofacial structures in older children, possibly inducing malocclusions. 14,19 However, as previously stated, cephalometric measurements were not available in this study.…”

Adverse pregnancy outcomes and occlusal traits in the primary dentition: A prospective cohort (BRISA)

“…Evidence that children with APO are exposed to many risk factors for malocclusions supports this hypothesis. They have poor skull growth and morphological changes in orofacial structures, especially in the palate, 11,12,19‐21 dental enamel development defects, 21,22 tooth loss, 24 changes in the timing and sequence of tooth eruption 14,34 . However, in this study, there was no significant indirect association between APO and any of the occlusal traits investigated mediated by the growth indicator (GRO).…”

“…As a result, these children would remain shorter and continue to have a relatively smaller craniofacial and body size in infancy. Thus, it seems plausible that birth changes can impact the growth of other craniofacial structures in older children, possibly inducing malocclusions 14,19 . However, as previously stated, cephalometric measurements were not available in this study.…”

“…Thus, it seems plausible that birth changes can impact the growth of other craniofacial structures in older children, possibly inducing malocclusions. 14,19 However, as previously stated, cephalometric measurements were not available in this study.…”

Associated factors and persistence of palatal groove in preterm infants: a cohort study

“…It is likely that more severely affected children did not breastfeed. So, along with a more consistent inclusion of the mode of feeding in future studies on palatal morphology of preterm infants [ 13 ], this result should also be verified in a study with a larger sample size.…”

Risk Factors for High-Arched Palate and Posterior Crossbite at the Age of 5 in Children Born Very Preterm: EPIPAGE-2 Cohort Study

“…Comparing the frequency of high-arched palate, we observed with that in the literature is difficult because of no standard definition (40). The previous studies among preterm or lowbirth-weight infants have been conducted in the United States (26,27), Brazil (28), and Japan ( 29), but included only small samples (37 to 74 children).…”

Adverse pregnancy outcomes and occlusal traits in the primary dentition: A prospective cohort (BRISA)

“…Evidence that children with APO are exposed to many risk factors for malocclusions supports this hypothesis. They have poor skull growth and morphological changes in orofacial structures, especially in the palate, 11,12,19‐21 dental enamel development defects, 21,22 tooth loss, 24 changes in the timing and sequence of tooth eruption 14,34 . However, in this study, there was no significant indirect association between APO and any of the occlusal traits investigated mediated by the growth indicator (GRO).…”

“…As a result, these children would remain shorter and continue to have a relatively smaller craniofacial and body size in infancy. Thus, it seems plausible that birth changes can impact the growth of other craniofacial structures in older children, possibly inducing malocclusions 14,19 . However, as previously stated, cephalometric measurements were not available in this study.…”

“…Thus, it seems plausible that birth changes can impact the growth of other craniofacial structures in older children, possibly inducing malocclusions. 14,19 However, as previously stated, cephalometric measurements were not available in this study.…”

Associated factors and persistence of palatal groove in preterm infants: a cohort study

“…It is likely that more severely affected children did not breastfeed. So, along with a more consistent inclusion of the mode of feeding in future studies on palatal morphology of preterm infants [ 13 ], this result should also be verified in a study with a larger sample size.…”

Risk Factors for High-Arched Palate and Posterior Crossbite at the Age of 5 in Children Born Very Preterm: EPIPAGE-2 Cohort Study

“…Comparing the frequency of high-arched palate, we observed with that in the literature is difficult because of no standard definition (40). The previous studies among preterm or lowbirth-weight infants have been conducted in the United States (26,27), Brazil (28), and Japan ( 29), but included only small samples (37 to 74 children).…”

Adverse pregnancy outcomes and occlusal traits in the primary dentition: A prospective cohort (BRISA)

“…Evidence that children with APO are exposed to many risk factors for malocclusions supports this hypothesis. They have poor skull growth and morphological changes in orofacial structures, especially in the palate, 11,12,19‐21 dental enamel development defects, 21,22 tooth loss, 24 changes in the timing and sequence of tooth eruption 14,34 . However, in this study, there was no significant indirect association between APO and any of the occlusal traits investigated mediated by the growth indicator (GRO).…”

“…As a result, these children would remain shorter and continue to have a relatively smaller craniofacial and body size in infancy. Thus, it seems plausible that birth changes can impact the growth of other craniofacial structures in older children, possibly inducing malocclusions 14,19 . However, as previously stated, cephalometric measurements were not available in this study.…”

“…Thus, it seems plausible that birth changes can impact the growth of other craniofacial structures in older children, possibly inducing malocclusions. 14,19 However, as previously stated, cephalometric measurements were not available in this study.…”

Associated factors and persistence of palatal groove in preterm infants: a cohort study

“…It is likely that more severely affected children did not breastfeed. So, along with a more consistent inclusion of the mode of feeding in future studies on palatal morphology of preterm infants [ 13 ], this result should also be verified in a study with a larger sample size.…”

Risk Factors for High-Arched Palate and Posterior Crossbite at the Age of 5 in Children Born Very Preterm: EPIPAGE-2 Cohort Study

“…Comparing the frequency of high-arched palate, we observed with that in the literature is difficult because of no standard definition (40). The previous studies among preterm or lowbirth-weight infants have been conducted in the United States (26,27), Brazil (28), and Japan ( 29), but included only small samples (37 to 74 children).…”