Abstract This study aimed to evaluate the influence of cleft width on dental arch symmetry of children with unilateral cleft lip and palate. Forty-one children were subjected to impression preoperatively (T1; mean age = 0.31 ± 0.07 years) and postoperatively (T2; mean age = 6 .73 ± 1.02 years). Eighty-two digitized dental casts were analyzed by stereophotogrammetry software. The cleft palate width was measured in the anterior (P-P’), middle (M-M’), and posterior (U-U’) regions. Also, the following measurements were obtained: anterior intersegment (I-C’) and intrasegment (I-C); total intersegment (I-T’) and intrasegment (I-T); cleft-side (C’-T’) and non-cleft-side (C-T) canine tuberosity. Paired t test and Pearson correlation coefficient were applied (α = 5%). Cleft width had the following means: 10.16 (± 3.46) mm for P-P’, 12.45 (± 3.00) mm for M-M’, and 12.57 (± 2.71) mm for U-U’. In the longitudinal analysis, I-C’ had a significant reduction, while the other measurements significantly increased (p < 0.001). Asymmetry was verified in the following analyses at T1: I-C’ vs. I-C and I-T’ vs. I-T (p < 0.001); at T2, only in I-C’ vs. I-C (p < 0.001). At T1, P-P’ vs. I-C’ (r = 0.722 and p < 0.001), P-P’ vs. I-T’ (r = 0.593 and p < 0.001), M-M’ vs. I-C’ (r = 0.620 and p < 0.001), and M-M’ vs. I-T’ (r = 0.327 and p < 0.05) showed a positive and significant correlation. At T2, there was a correlation between M-M’ and I-C’ (r = 0.377 and p < 0.05). In conclusion, the anterior and middle cleft widths influenced palatal asymmetry in the first months of life, while middle width influenced residual asymmetry. Fortyone Forty one T1 T (T1 031 0 31 0.3 007 07 0.0 years T2 (T2 73 .7 102 1 02 1.0 years. . Eightytwo Eighty two software PP, PP P , (P-P’) MM, MM M (M-M’) UU U (U-U’ regions Also obtained IC I C (I-C’ (I-C) IT (I-T’ (I-T) cleftside side CT (C’-T’ noncleftside non (C-T tuberosity α 5%. 5 5% 5%) means 1016 10 16 10.1 ( 3.46 346 3 46 1245 12 45 12.4 3.00 300 00 1257 57 12.5 2.71 271 2 71 UU. U-U’ analysis reduction 0.001. 0001 0.001 001 0.001) vs P-P r 0722 722 0.72 0.001, 0593 593 0.59 M-M 0620 620 0.62 0327 327 0.32 0.05 005 05 0377 377 0.37 0.05. conclusion life (T 03 0. 7 1. (P-P’ (M-M’ (U-U (I-C (I-T (C’-T 101 10. 3.4 34 4 124 12. 3.0 30 125 2.7 27 U-U 000 0.00 072 72 0.7 059 59 0.5 062 62 0.6 032 32 037 37 (P-P (M-M 3. 2. 06

Aim to evaluate the surgical effects of two rehabilitation protocols on dental arch occlusion of 5-year-old children with or without cleft lip and palate. Methods this is a retrospective longitudinal study the sample comprised 45 digitized dental casts divided into followed groups: Group 1 (G1) – children who underwent to cheiloplasty (Millard technique) at 3 months and to one-stage palatoplasty (von Langenbeck technique) at 12 months; Group 2 (G2) – children who underwent to cheiloplasty (Millard technique) and two-stage palatoplasty (Hans Pichler technique for hard palate closure) at 3 months and at 12 months to soft palate closure (Sommerlad technique); and Group 3 (G3) – children without craniofacial anomalies. Linear measurements, area, and occlusion were evaluated by stereophotogrammetry software. Shapiro-Wilk test was used to verify normality. ANOVA followed by posthoc Tukey test and Kruskal-Wallis followed by posthoc Dunn tests were used to compared groups. Results For the measures intercanine distance (C-C’), anterior length of dental arch (I-CC’), and total length of the dental arch (I–MM’), there were statistical differences between G1x G3 and G2xG3, the mean was smaller for G1 and G2. No statistically significant differences occurred in the intermolar distance and in the dental arch area among groups. The occlusion analysis revealed significant difference in the comparison of the three groups (p=0.0004). Conclusion The surgical effects of two rehabilitation protocols affected the occlusion and the development of the anterior region of the maxilla of children with oral clefts when compared to children without oral clefts.

Abstract Oral cleft surgical repairs are performed using different techniques worldwide. Objective To evaluate and compare the development of the dental arches of children with unilateral cleft lip and palate before and after the primary surgeries performed with different techniques at the first months and six years of life. Methodology This is a retrospective longitudinal study. The sample comprised 56 dental casts divided int the following groups: Group 1 (G1) – cheiloplasty (Millard technique) at three months and one-step palatoplasty (von Langenbeck technique) at 12 months; and Group 2 (G2) – cheiloplasty (Millard technique) and two-step palatoplasty: anterior hard palate closure (Hans Pichler technique) at three months and posterior soft palate closure (Sommerlad technique) at 12 months. The digitized dental casts were evaluated at three months – pre-surgical (T1) and six years of life– post-surgical (T2). The following linear measurements were analyzed: intercanine (C–C’), intertuberosity (T–T’) distances; anterior dental arch (I–CC’), anterior intersegment (I–C’), and total arch (I–TT’) lengths. The palate area was also measured. Parametric and non-parametric tests were applied (p<0.05). Results In G1, the intragroup comparison showed statistically significant smaller I–CC’ and I–C’ at T2 (p=0.001 and p<0.001, respectively), while T–T’, I–TT’, and area comparisons were significantly greater (p<0.001, p=0.002, and p<0.001, respectively). In G2, the intragroup comparison exhibited statistically significant smaller C–C’ and I–C’ at T2 (p=0.004, for both), whereas T–T’, I–TT’ and area comparisons were significantly greater (p<0.001, p=0.004, and p<0.001, respectively). At T2, the intergroup analysis revealed that G1 had a statistically significant smaller I–CC’ (p=0.014). The analysis of the intergroup differences (∆=T2–T1) showed that G1 had a statistically smaller I–CC’ (p=0.043). Conclusion The two-step palatoplasty showed a more favorable prognosis for the maxillary growth than one-step palatoplasty in children with oral clefts.

Resumo O objetivo deste estudo foi analisar o crescimento e desenvolvimento maxilar de crianças com fissuras orais por meio de um método inovador da técnica de sobreposição 3D-3D. Participaram do estudo crianças com fissura unilateral completa de lábio (FL) e fissura unilateral de lábio e palato (FLP). As moldagens dos arcos dentários foram realizadas 1 dia antes e 1 ano após o reparo cirúrgico labial. Um scanner a laser 3D digitalizou os modelos dentários e o software do sistema de estereofotogrametria analisou as sobreposições 3D-3D em dois grupos correspondentes (mesmo indivíduo, FL e FLP) e um grupo não-correspondente (indivíduos diferentes). As diferenças foram avaliadas pelo Root Mean Square (RMS) e expressas em milímetros (mm). O teste de Kruskal-Wallis seguido do teste post-hoc de Dunn e teste de MannWhitney foram avaliados para comparar os grupos (α=5%). RMS foi de 1.34 mm (± 0.37) no grupo FL, 1.41 mm (± 0.32) no grupo FLP e 3.38 mm (± 1.28) no grupo não-correspondente. RMS foi significativamente maior no grupo não-correspondente (p <0.0001). Não houve diferenças estatisticamente significativas entre os gêneros. A técnica de sobreposição 3D-3D evidenciou o desenvolvimento da maxila após a cirurgia labial na região anterior do palato. Assim, sugere-se que a amplitude da fenda e a proporção dos segmentos palatinos influenciam na heterogeneidade morfológica e, consequentemente, no desenvolvimento e crescimento maxilar de crianças com fissura orofacial

Abstract This study aimed to analyze the maxillary growth and development of children with oral clefts using the innovative method of 3D-3D superimposition technique. Children with unilateral complete cleft lip (UCL) and unilateral cleft lip and palate (UCLP) participated in the study. The impressions of the dental arches were executed 1 day before and 1 year after lip repair surgery. A 3D laser scanner digitized the dental models and the stereophotogrammetry system software analyzed the 3D-3D superimpositions in two groups of matches (same child, UCL and UCLP) and one group of mismatches (different individuals). The differences were evaluated by Root Mean Square (RMS) and expressed in millimeters (mm). Kruskal-Wallis test followed by post-hoc Dunn test and Mann-Whitney test were assessed to compare the groups (α=5%). RMS was 1.34 mm (± 0.37) in UCL group, 1.41 mm (± 0.32) in UCLP group, and 3.38 mm (± 1.28) in mismatches group. RMS was significantly greater in mismatches than in matches groups (p<0.0001). No statistically significant differences occurred between genders. The 3D-3D superimposition technique showed the maxillary development after lip repair surgery in the anterior region of the palate. Thus, it is suggested that the cleft amplitude and the palatal segments proportion influenced the morphological heterogeneity and, consequently, the development and maxillary growth of children with orofacial cleft.

Abstract Oral health problems can influence people's Quality of Life (QoL) because of pain, discomfort, limitations, and other esthetics problems, affecting their social life, feeding, daily activities, and the individual's well-being. Objective: To compare oral health-related quality of life (OHRQoL) of children with and without oral clefts and their families. Materials and Methods: 121 children aged from 2 to 6 years, from both sexes, enrolled in the treatment routine of the Pediatric Dentistry Clinics of a Dental School and a Hospital for Cleft Treatment were divided into two groups: Group 1 - children with cleft lip and palate; Group 2 - children without cleft lip and palate. The OHRQoL was assessed using the validated Portuguese version of the Early Childhood Oral Health Impact Scale (B-ECOHIS). The questionnaire was answered individually, only once, at a private place. Mann-Whitney U test was used to verify differences between groups. Spearman's Rho test was used to associate sex and age with quality of life. The level of significance was set at 5% (p<0.05). Results: According to the parents’ perception on the OHRQoL of children with and without cleft lip and palate, oral health of children with oral clefts (Group 1) had a statistically significant impact on OHRQoL. The correlation of sex with impact on OHRQoL did not show statistically significant differences. On the other hand, the higher the age the higher the impact on QoL. Conclusions: The group comparison revealed that the cleft lip and palate negatively impacted on OHRQoL of 2 to 6-year-old children and their parents.

Abstract This study aimed at monitoring the maxillary growth of children with cleft lip/palate in the first two years of life, and to evaluate the effects of primary surgeries on dental arch dimensions. The sample consisted of the three-dimensional digital models of 25 subjects with unilateral complete cleft lip and palate (UCLP) and 29 subjects with isolated cleft palate (CP). Maxillary arch dimensions were measured at 3 months (before lip repair), 1 year (before palate repair), and at 2 years of age. Student’s ttest was used for comparison between the groups. Repeated measures ANOVA followed by Tukey’s test was used to compare different treatment phases in the UCLP group. Paired ttest was used to compare different treatment phases in the CP group. P<0.05 was considered statistically significant. Decreased intercanine distance and anterior arch length were observed after lip repair in UCLP. After palate repair, maxillary dimensions increased significantly, except for the intercanine distance in UCLP and the intertuberosity distance in both groups. At the time of palate repair and at two years of age, the maxillary dimensions were very similar in both groups. It can be concluded that the maxillary arches of children with UCLP and CP changed as a result of primary surgery.

O propósito deste trabalho foi mensurar e comparar as dimensões dos arcos dentários em modelos digitais tridimensionais de crianças com ou sem fissuras de lábio e palato antes das cirurgias primárias. A amostra foi composta de 223 modelos de gesso de crianças, de 3 a 9 meses, divididas em 5 grupos: sem deformidades craniofaciais, fissura pré-forame incompleta, fissura pré-forame completa, fissura transforame unilateral e fissura transforame bilateral. Modelos de gesso dos arcos dentários superiores das crianças foram utilizados para avaliação. Os modelos passaram por um processo de digitalização, por meio de escâner 3D e as medidas utilizadas para a correlação entre os grupos foram realizadas diretamente nas imagens escaneadas. A análise estatística foi realizada por meio do teste t e ANOVA seguido pelo teste de Tukey. Os resultados mostraram que a distância intercaninos e a amplitude anterior da fissura foram maiores nas crianças com fissura transforame unilateral. A distância intertuberosidades e a amplitude posterior da fissura foi maior nas com fissura transforame bilateral entre os grupos estudados. As crianças com fissura de lábio e palato apresentam as dimensões dos arcos maxilares maiores que as crianças sem fissura labiopalatina antes das cirurgias primárias.

The aim of this study was to measure and compare the dimensions of the dental arches on three-dimensional digital study models in children with and without cleft lip and palate before the primary surgery. The sample consisted of 223 digital models of children aged 3-9 months, divided into 5 groups: without craniofacial deformities, unilateral and bilateral incomplete cleft lip and alveolus, unilateral and bilateral complete cleft lip and alveolus, unilateral cleft lip and palate, and bilateral cleft lip and palate. Dental casts of the maxillary dental arches of the children were used. The dental casts underwent a process of scanning through 3D scanner and the measurements used for the correlation among groups were made on the scanned images. Statistical analysis was performed by t test and ANOVA followed by Tukey test. The results showed that the intercanine distance and anterior cleft width was wider in children with unilateral cleft lip and palate. The intertuberosity distances and posterior cleft width was wider in children with bilateral cleft lip and palate among the groups. Children with cleft lip and palate before the primary surgery had wider maxillary arch dimensions than the children without cleft lip and palate.

This study aimed at evaluating how well dentists understand medical emergency/urgency procedures and issues during dental treatment at a hospital specialized in cleft lip and palate. It comprised a hundred dentists from the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Brazil, from different dental specialties. A questionnaire was applied to evaluate their knowledge of medical emergencies/urgencies from June through September 2011. The questionnaire was anonymous, confidential and constructed with closed questions and either yes-no or multiple-choice responses. Results showed that most professionals (87%) were trained in basic life support (BLS), but only 43% considered themselves capable of providing first aid and performing the necessary maneuvers. Most participants (94%) claimed that they knew the difference between medical urgencies and emergencies, and 69% had BLS training in their undergraduate courses, as opposed to 37%, during their specialization. Some participants (23%) mentioned that they had received knowledge of the subject during extracurricular courses and/or graduate courses (12%). Only 9% had not been educated on the subject; however, all participants showed interest in attending a course in BLS. In regard to assessing training that dentists who attended BLS courses received, 49% were satisfied and 42% were dissatisfied. Results of the present study emphasize that dentists from HRAC/USP have little knowledge about BLS procedures to perform them. Dentists must gain adequate education and training to minimize possible technical, ethical and legal problems associated with dental practice. It is necessary to improve both knowledge and practice in order to become well-qualified practitioners.