OBJECTIVE: The aim of this study was to evaluate the stress distributions and possible amount of movement in the maxillofacial region resulting from different maxillary advancement protocols in patients with unilateral cleft lip and palate.
METHODS: A unilateral cleft lip and palate model (CLP model) with Goslon score 4 was created for finite element analysis. Three different protocols were compared: Group 1: usage of a face mask with elastics placed at a 30? angle to the occlusal plane over a conventional acrylic plate; Group 2: usage of a face mask with elastics placed at a 30? angle to the occlusal plane over miniplates placed in the infrazygomatic crest region; Group 3: usage of elastic from the menton plate placed in the mandible to the infrazygomatic plates in the maxilla.
RESULTS: Dental effects were greater in the maxillary protraction protocol with a face mask over a conventional acrylic plate (Von Misses Stress Values; Group 1?=?cleft side:0.076, non-cleft side:0.077; Group 2?=?cleft side:0.004, non-cleft side: 0.003; Group 3?=?cleft side:0.0025; non-cleft side:0.0015), whereas skeletal effects were greater in maxillary protraction protocols with face mask using skeletal anchorage (Von Misses Stress Values; Group 1:0.008; Group 2:0.02; Group 3:0.0025). The maximum amount of counterclockwise rotation of the maxilla as a result of protraction was observed in traditional acrylic plate face mask protocol, and the minimum amount was observed by using elastics between infrazygomatic plates and menton plate.
CONCLUSIONS: In individuals with unilateral cleft lip and palate with Goslon score 4, it was observed that the skeletally anchored face mask caused more skeletal impact and displacement than both the traditional acrylic plate face mask model and the pure skeletally supported maxillary protraction model.
CONCLUSIONS: When planning maxillary protraction treatment in patients with cleft lip and palate, it should be considered that more movement in the sagittal plane might be expected on the cleft side than the non-cleft side, and miniplate and screws on the cleft side are exposed to more stress when using infrazygomatic plates as skeletal anchorage.

OBJECTIVE: To identify predictors for long-term relapse of orthodontic therapy in patients with cleft lip and palate (CLP).
METHODS: Patients with uni- and bilateral non-syndromal CLP were followed up at least two years after completion of their orthodontic therapy. Plaster casts of the start of treatment (T1), after completion of treatment (T2), and at follow-up (T3) were measured using the modified Huddart Bodenham Index. Characteristics of multidisciplinary therapy were taken from the patient files. Potentially influencing factors of relapse were investigated using logistic regression analyses and Spearman correlations.
RESULTS: In total 58.07% of the included 31 patients showed a stable treatment outcome at follow-up after an average of 6.9 years. Even if relapse occurred, 61.54% of these patients still showed improvement regarding their occlusion compared to baseline. Predictors for the occurrence of relapse were the severity of dysgnathia at baseline (p = 0.039) and the extent of therapeutic change (p = 0.041). The extent of therapeutic change was additionally a predictor for the extent of post-therapeutic relapse (ρ = 0.425; p = 0.019).
CONCLUSIONS: Patients with CLP benefit from their orthodontic therapy in the long term despite an increased tendency to relapse.
CONCLUSIONS: Results of this long-term study could be used to adapt the treatment concept for patients with CLP and reinforce the significance of a patient-centered orthodontic treatment concept for affected patients.

BACKGROUND: Cleft lip and palate (CLP) are the most common congenital craniofacial deformities that can cause a variety of dental abnormalities in children. The purpose of this study was to predict the maxillary arch growth and to develop a neural network logistic regression model for both UCLP and non-UCLP individuals.
METHODS: This study utilizes a novel method incorporating many approaches, such as the bootstrap method, a multi-layer feed-forward neural network, and ordinal logistic regression. A dataset was created based on the following factors: socio-demographic characteristics such as age and gender, as well as cleft type and category of malocclusion associated with the cleft. Training data were used to create a model, whereas testing data were used to validate it. The study is separated into two phases: phase one involves the use of a multilayer neural network and phase two involves the use of an ordinal logistic regression model to analyze the underlying association between cleft and the factors chosen.
RESULTS: The findings of the hybrid technique using ordinal logistic regression are discussed, where category acts as both a dependent variable and as the study\'s output. The ordinal logistic regression was used to classify the dependent variables into three categories. The suggested technique performs exceptionally well, as evidenced by a Predicted Mean Square Error (PMSE) of 2.03%.
CONCLUSIONS: The outcome of the study suggests that there is a strong association between gender, age, and cleft. The difference in width and length of the maxillary arch in UCLP is mainly related to the severity of the cleft and facial growth pattern.

BACKGROUND: The study evaluates the position and displacement tendency of unerupted maxillary canines in orthodontic patients with non-syndromic craniofacial disorders (CD) compared to a control (C) group.
METHODS: Canine position and displacement tendency were evaluated using panoramic radiographs (PAN) examined with parameters such as sector classification (sectors 1-5) and inclination angles (α and β). The displacement tendency was defined as the positioning of the tip in sectors 1 or 2, as well as its combination with increased angles (α > 30° and β > 39°). In addition, the correlation of the tooth position and agenesis, cleft side, and sex was assessed.
RESULTS: A total of 116 pre-treatment PAN, divided into the CD group (n = 50; mean age 8.32 ± 2.27 years) and the C group (n = 66; mean age 10.80 ± 2.82 years), were evaluated in this study. The sector classification showed no displacement tendency in both groups. Inclination angles α/β showed a statistically significant higher displacement tendency (p = 0.01) of the CD group (n = 5) on the right side, compared to healthy subjects (n = 1). Male CD patients had a statistically significant higher displacement tendency on the right side (p = 0.03). A statistically significant correlation between cleft and non-cleft-side (p = 0.03) was found.
CONCLUSIONS: Patients with CD showed a statistically significant higher displacement tendency of the maxillary canine affected by the cleft side. The inclination angle was found to be the better predictor compared to the sector classification which should be considered in the orthodontic treatment planning.

Introduction Modern treatments still aim to keep the impact of surgical intervention low and the outcome of surgeries as good as a surgeon can. Assessing the long-term nasolabial appearance of patients who underwent cleft lip (CL) repair surgery is one of the methods of evaluating the outcomes of cleft surgery. Methods This is a retrospective cross-sectional descriptive study of data records of unilateral CL patients. The data records of all patients who underwent unilateral CL repair by the reconstructive science unit at Hospital Universiti Sains Malaysia (HUSM) within the first two years of their lives and whose current age is 14 years or above were accessed and analyzed. Results The data records of 50 patients were analyzed, including 13 (26%) males and 37 (74%) females. The surgeons opined that 28% of the patients had an acceptable nasolabial appearance, while there were 10 (20%) patients whose nasolabial appearance was considered unacceptable by the reviewing surgeons. Fifteen (30%) patients were described as having an acceptable lip appearance with secondary nasal deformity, and 11 (22%) patients had an acceptable nasal appearance with secondary lip deformity. There were no surgical modifications or postoperative complications among the patients. None of our variables reported a significant association with long-term nasolabial appearance. Conclusion The long-term evaluation of the nasolabial appearance in individuals with CL following surgical correction significantly improves the service and care provided to patients to achieve optimum results. Although our results showed no relationship between gender, age at operation, type or diagnosis of cleft, and family history and long-term nasolabial appearance, frequent assessments will enhance surgical results.

Introduction Cleft of the lip and/or the palate is commonly inherited defect which involves cleft of lip and palate. Maxillary second molar inclination has been studied in various malocclusion. Every abnormality in body is compensated to some extend by compensation. Our objectives were to evaluate maxillary second molar inclination in Angle\'s Class I, Class III malocclusion, and unilateral cleft lip and palate (UCLP) patients in transverse plane and to compare variation in maxillary second molar inclination in Angle\'s Class I, Class III malocclusion, and UCLP cases buccopalatally in transverse plane. Material and method Model of 45 subjects were analyzed. The maxillary second molar inclination was measured using aid of protractor fixed on the surveyor. Axis under consideration was the axis along the long axis of the central fossa of maxillary second molar. Various standardization regarding measurement of second molar inclination were set. The maxillary second molar inclination was compared among 3 groups Angle\'s Class I, Class III malocclusion, and UCLP cases. Results Data was analyzed using one-way analysis of variance (ANOVA) and post-hoc Tukey test. There was a significant difference between inclination of maxillary second molar when Angle\'s Class I malocclusion was compared with Angle\'s Class III malocclusion and UCLP cases (p = 0.003 and p = 0.011, respectively). There was not a significant difference between Angle\'s Class III malocclusion and UCLP cases (p = 0.87). Conclusion Amongst Class III patients and UCLP patients the inclination of maxillary second molar had greater buccal inclination. Maxillary second molar correction would alleviate the effect of deleterious force on periodontium and bone generated by malpositioned teeth.

Introduction  Maxillary canines are the most commonly impacted teeth, second only to third molars. Cleft lip and palate patients have a higher chance of impacted canines due to defects in bone formation and the soft tissue enclosing it. Various authors have used two-dimensional radiographs and developed grading systems to streamline treatment modalities to deal with the impacted canines. Material and Methods A study was conducted in the Department of Orthodontics and Dentofacial Orthopaedics. Children aged nine to 12 were selected for this evaluation based on both clinical and radiographic examination. Four different parameters were set to evaluate the impacted canine location. which was based on angulation, vertical height, root apex location, and defect area involved. Result Based on these evaluations, a classification was developed by the present authors, and later the cases were assessed as per the new system that we named Kumar and Daigavane\'s (KD) Impacted Maxillary Canine Grading System which we developed to give us more clarity for treatment and prognosis for treatment of cleft lip and palate. Conclusion A three-dimensional evaluation is also advised for a better understanding of the impacted canines. Many of the shortcomings of the two-dimensional assessment can be diminished. This new grading system will improve cleft diagnosis and prognosis in patients with cleft lips and/or palates.

OBJECTIVE: The study objective was to evaluate the tooth agenesis in German orthodontic patients with non-syndromic cleft lip and/or palate and Robin sequence compared to a control group without craniofacial disorder.
METHODS: A total of 108 panoramic radiographs were examined using the binary system of Tooth Agenesis Code (TAC) (excluding the third molar). Patients were divided into the craniofacial disorder group 1 (n = 43) and the healthy control group 2 (n = 65). Parameters such as skeletal class malformation, sex, localization of the cleft, craniofacial disorder, and interobserver reliability were assessed.
RESULTS: Permanent tooth agenesis was observed in 44% of group 1 and 14% in group 2 with a statistically significant higher prevalence (p = 0.00162 (χ2)). Fourteen different TAC patterns were observed in group 1, ten of these occurring only once in separate patients. The distribution of the TAC codes in group 2 showed nine different possibilities of TAC code patterns; seven TACs were unique. In group 1, the most frequently absent teeth were the maxillary lateral incisor of the left side (30%); in group 2, the second premolar of the lower jaw on the right side (9%). Male patients with craniofacial disorder showed a higher percentage of tooth agenesis than female.
CONCLUSIONS: The data presented here shows a statistically significant higher prevalence of tooth agenesis in German patients with non-syndromic craniofacial disorder.
CONCLUSIONS: Radiographic evaluation enables the diagnosis of tooth agenesis. Recognizing early on the higher prevalence of tooth agenesis in patients exhibiting a craniofacial disorder is an important issue when developing long-term and comprehensive interdisciplinary treatment.

The study aims at assessing wound healing and safety of single-stage two-layers continuous closure in patients with unilateral cleft lip and palate (UCLP). In this retrospective, descriptive cohort study, we assessed wound healing without fistula formation at 1, 3, and 6 months after a single-stage two-layer UCLP repair, in which the midline suture is continuously circular all along the oral and nasal sides. We examined lengths of hospital stay and the incidence of intra- and postoperative adverse events. Furthermore, we compared the cleft width at birth and on the day of surgery, after presurgical orthopaedics. Eleven UCLP patients underwent one cleft surgery between July 2016 and June 2018 at the age of 8-9 months. Full primary healing occurred in all patients without fistulas. Median length of post-operative hospital stay was 5 days (range = 4-9 days). No intra- or postoperative adverse events above Grade I (according to ClassIntra and Clavien-Dindo, respectively) occurred. Median and interquartile range (IQR) of the palatal cleft width decreased significantly from birth to surgery, i.e., from 12.0 mm (10.8-13.6 mm) to 5.0 mm (4.0-7.5 mm) anteriorly and from 14.0 mm (11.5-15.0 mm) to 7.3 mm (6.0-8.5 mm) posteriorly (p = 0.0033 in both cases). Given these preliminary results, the concept of single-stage continuous circular closure in UCLP has potential for further investigation. However, it remains to be proven that there are no relevant adverse effects such as inhibition of maxillary growth. Registered in clinicaltrials.gov:NCT04108416.

UNASSIGNED: To investigate intrinsic palatal and alveolar tissue deficiency in patients with unilateral cleft lip and palate (UCLP) as compared to age-matched individuals without UCLP using surface area measurements on 3D scans of plaster casts.
UNASSIGNED: 22 maxillary casts of infants with UCLP from the Wyss Department of Plastic Surgery of NYU Langone Medical Center and 37 maxillary casts from infants without clefts from Sillman\'s longitudinal study were scanned by Ortho Insight 3D by Motion View Software, LLC (Chattanooga, TN) and measured using Checkpoint software (Stratovan, Davis, CA). The palatal and alveolar surface areas of each cast were measured. The most superior point of the alveolar ridge in front of the incisive papilla and the most superior point of each maxillary tuberosity were connected by a line that ran along the highest part of the alveolar ridge. This line was used to set boundaries for the palatal surface area measurements. The surface areas of greater and lesser segments were measured independently on UCLP casts. A total palatal surface area for the UCLP sample including width of the cleft gap was also measured.
UNASSIGNED: There was a statistically significant difference in surface area (P > .001) when we compared the UCLP area of the cleft segments alone with the non-cleft sample. There was a positive correlation (determine the statistical significance) between the surface area of the cleft segments and cleft gap. In addition, there was a statistically significant difference between UCLP plus cleft area and the non-cleft samples in surface area (P < .0001).
UNASSIGNED: An intrinsic palatal and alveolar tissue deficiency exists in patients born with UCLP. The amount of tissue deficiency for a patient with UCLP should be considered when developing and executing a patient-specific treatment plan.