Benny S. Latief

Dental Cast Study of Adult Patients with Untreated Unilateral Cleft Lip or Cleft Lip and Palate in Indonesia Compared with Surgically Treated Patients in The Netherlands

To determine differences in maxillary and dentoalveolar relationships between untreated and treated patients having unilateral clefts of the lip and alveolus (UCLA) or lip and palate (UCLP), dental cast assessments were done on 70 untreated adult Indonesian patients (UCLA-I, UCLP-I) and 67 Dutch patients, surgically treated in infancy (UCLA-D, UCLP-D). The Indonesian group consisted of 44 UCLA-I and 26 UCLP-I patients, and the Dutch group of 24 UCLA-D and 43 UCLP-D patients. In the UCLA-I patients, deformities occurred in that part of the dentoalveolar complex that surrounds the cleft. Lip repair in the UCLA-D group more frequently caused deformities in the incisor and buccal areas on the cleft side. In the UCLP-I patients, deformities were present in the incisor and cuspid areas on the cleft side. The buccal segments showed collapse both on the cleft and noncleft sides. Lip and palate repair in the UCLP-D group caused significantly more deformities in the incisor, cuspid, and buccal areas up to the level of the first molars, both on the cleft and noncleft sides. Surgical treatment seems to cause maxillary and dentoalveolar deformities up to the first molars more frequently, but these are not as pronounced as one would expect: following the practiced surgical regimen, the deformities were usually mild. Negative effects of surgical intervention seem to be antagonized by the restored integrity of the lip and palate leading to orientation of maxillary parts and correction of tongue position, which in turn has a molding effect on the maxilla and mandible.

Width and elevation of the palatal shelves in unoperated unilateral and bilateral cleft lip and palate patients in the permanent dentition.

Patients with cleft left lip and palate (CLP) normally require extensive surgery from an early age up to the end of adolescence. These surgeries affect the growth of the maxillofacial complex. The degree to which the cleft itself affects growth of the maxillofacial complex remains poorly understood. By analysing the width and elevation of the palatal shelves in unoperated adolescents and adults with unilateral and bilateral cleft lip and palate (UCLP and BCLP, respectively) and a non‐cleft control group, it is possible to gain more insight into the real intrinsic growth potential of the maxillary structures. In this study, dental casts of the full permanent dentition of individuals with unrepaired UCLP (n = 68) and BCLP (n = 13) and non‐cleft controls (n = 24) from the same area of Indonesia were digitized three‐dimensionally. Maxillary arch width in the canine, premolar and molar regions, and the width and elevation of the palatal shelves were measured. Results showed that in patients with UCLP, the width of the palatal shelves on the cleft side in all regions, and on the non‐cleft side in the canine/first premolar region, was significantly smaller compared with the control group. BCLP subjects showed similar deviations. In the UCLP group, the palatal shelves were rotated cranially and positioned more vertically. In the BCLP group, the palatal shelves were inclined by almost 10 ° more than the control group. The width of the palatal shelf and width of the maxillary arch positively correlated in the canine and first premolar regions for both the cleft and non‐cleft side in patients with UCLP, and in the canine region for patients with BCLP. This means that the wider the palatal shelf, the wider the maxillary arch. The elevation of palatal shelves correlated with the maxillary arch width in all regions in patients with UCLP, and only in the premolar region in the control group. Thus, the wider the arch width, the smaller the elevation angle (the maxillary shelves are less vertical). No correlations between palatal shelf elevation and maxillary arch width were found in the BCLP group. This shows that the intrinsic growth potential in patients with UCLP and BCLP is affected by a smaller palatal shelf width and larger elevation of the shelves. These deviations may result in a wider cleft.

Maxillary arch width in unoperated adult of the unilateral cleft lip and alveolus patients

BackgroundThe transversal measurement on the dento-alveolar fragments of the maxilla, in the unoperated adult patients with unilateral cleft lip and alveolus are rare and have not been well documented and archived in the scientific journals. The effect of the congenital malformation is obvious in the Unilateral Cleft Lip and Alveolus (UCLA) patients and is well documented.ObjectivesThe aim of this study is to investigate whether there are any influences of the final transversal development of the maxilla based on the location and extent of the defect in patients with UCLA.Methods168 adult unoperated UCLA patients (study group) and 24 non cleft patients (control group) participated in this study. Plaster of Paris (POP) casts were made of the maxillary dentition and mesurement were taken using coordinate measuring machine (CCM) (Zeiss Numere, Carl Zeiss, Stuttgart, Germany).ResultThe mean values of maxillary transverse measurement of first premolar through the second molar of the UCLA and control group patients showed no statistically significant difference. The inter-canine distance was significantly smaller in the UCLA patients than non-cleft patientsConclusionsThe maxillary inter-canine distance in untreated UCLA patients were significantly different from that of non cleft patients. There is narrow and constricted maxillary growth in UCLA patients causing maxillary morphological changes and cosmetic facial changes.

Subphenotyping and Classification of Cleft Lip and Alveolus in Adult Unoperated Patients: A New Embryological Approach

Objective: Previously, a new embryological classification was introduced subdividing oral clefts into fusion and/or differentiation defects. This subdivision was used to classify all subphenotypes of cleft lip with or without alveolus (CL±A). Subsequently, it was investigated whether further morphological grading of incomplete CLs is clinically relevant, and which alveolar part is deficient in fusion/differentiation defects. Design: Observational cohort study. Setting: Three hundred fifty adult unoperated Indonesian cleft patients presented themselves for operation. Cephalograms, dental casts, and intraoral and extraoral photographs—eligible for the present study—were used to determine morphological severity of CL±A. Patients: Patients with unilateral or bilateral clefts of the primary palate only were included. Main Outcome Measures: Clefts were classified—according to developmental mechanisms and timing in embryogenesis—as fusion and/or differentiation defects. Grades of incomplete CLs were related to the severity of alveolar clefts (CAs) and hypoplasia, and permanent dentition was used to investigate which alveolar part is deficient in fusion/differentiation defects. Results: One hundred eight adult patients were included. All subphenotypes—96 unilateral and 12 bilateral clefts—could be classified into differentiation (79%), fusion (17%), fusion-differentiation (2%), or fusion and differentiation (2%) defects. The various grades of incomplete CLs were related to associated CAs and hypoplasia, and all alveolar deformities were located in the premaxillae. Conclusions: This study showed that all CL±A including the Simonart bands can be classified, that further morphological grading of incomplete CLs is clinically relevant, and that the premaxilla forms the deficient part in alveolar deformities.