Gingival esthetics and oral health-related quality of life
Stelzle F, Rohde M, Oetter N, Krug K, Riemann M, Adler W, et al. Gingival esthetics and oral health-related quality of life in patients with cleft lip and palate. Int J Oral Maxillofac Surg 2017 Apr 7 [Epub ahead of print]
One challenge in treating patients with cleft lip and palate is how to deal with missing teeth, extra teeth, and malformed teeth in the area of the cleft. Patients’ and parents’ decisions to treat the cleft site via orthodontic alignment, implant restorations, or traditional prosthetic options are often made with little knowledge of the differences in esthetic outcomes. Despite many rating criteria to assess the success of treatment for cleft lip and palate, objectively successful treatment does not necessarily equal satisfied patients. The condition and shape of the gingival margin is a main criterion for an esthetic oral appearance. The goal of this study was to evaluate the soft tissue characteristics in the treated cleft area to investigate whether gingival esthetics correlate with oral health-related quality of life, and which treatment options are most likely to positively influence the esthetic appearance. Thirty-six patients with unilateral or bilateral cleft lip and palate who had undergone secondary bone grafting were included. The gingival esthetic appearance was measured using 7 variables to establish a “clinical esthetic score.” Patients with their own teeth in situ had a significantly higher clinical esthetic score than those treated with implants and fixed prosthetics. The best oral health-related quality of life values were also achieved by patients with their own teeth integrated into the cleft area, followed by patients with implants and prosthetics. Greater esthetics was achieved by retaining and integrating the patient’s teeth into the cleft site, rather than relying on restorations. These considerations should be taken into account when determining treatment for patients with cleft lip and palate, when multiple treatment options are feasible.
Reviewed by Leah Peres
Unfavorable dental arch relationships in nonsyndromic children with unilateral cleft lip and palate
Haque S, Alam MK, Khamis MF. Factors responsible for unfavorable dental arch relationship in non syndromic unilateral cleft lip and palate children. J Clin Pediatr Dent 2017;41:236-42
Treatment of patients with unilateral cleft lip and palate (UCLP) frequently involves correcting Class III skeletal discrepancies. Often, this Class III relationship is considered a result of early surgical procedures, but these authors explored other factors that may contribute to the tendency in this population. They used records of 84 children with nonsyndromic UCLP from Bangledesh. Each subject had previously undergone cheiloplasty and palatoplasty procedures. By analyzing dental models with the GOSLON Yardstick, they split the sample into 2 groups. GOSLON Yardstick categories of excellent, good, and fair were considered favorable, and categories of poor and very poor were considered unfavorable. The authors concluded that family history of Class III malocclusion was a significant fact or in unfavorable jaw relationships. They also noted that complete UCLP was more likely to end up with an unfavorable relationship, although this was not statistically significant compared with incomplete UCLP. They found that 68% of their sample fell into the fair or poor categories, which were the less extreme examples of favorable and unfavorable. This may have contributed to the authors’ inability to find significant results in relation to age, sex, side, family history of cleft, and surgical technique. Overall, this study emphasized that all UCLP patients are not the same and do not have the same prognosis. Thorough diagnosis and history are needed to appropriately plan treatment for these patients based on expectations of treatment results. The greatest implication of this would be in planning for surgical or nonsurgical patients.
Reviewed by Patrick W. Scannell
Unfavorable dental arch relationships in nonsyndromic children with unilateral cleft lip and palate
Haque S, Alam MK, Khamis MF. Factors responsible for unfavorable dental arch relationship in non syndromic unilateral cleft lip and palate children. J Clin Pediatr Dent 2017;41:236-42
Treatment of patients with unilateral cleft lip and palate (UCLP) frequently involves correcting Class III skeletal discrepancies. Often, this Class III relationship is considered a result of early surgical procedures, but these authors explored other factors that may contribute to the tendency in this population. They used records of 84 children with nonsyndromic UCLP from Bangledesh. Each subject had previously undergone cheiloplasty and palatoplasty procedures. By analyzing dental models with the GOSLON Yardstick, they split the sample into 2 groups. GOSLON Yardstick categories of excellent, good, and fair were considered favorable, and categories of poor and very poor were considered unfavorable. The authors concluded that family history of Class III malocclusion was a significant fact or in unfavorable jaw relationships. They also noted that complete UCLP was more likely to end up with an unfavorable relationship, although this was not statistically significant compared with incomplete UCLP. They found that 68% of their sample fell into the fair or poor categories, which were the less extreme examples of favorable and unfavorable. This may have contributed to the authors’ inability to find significant results in relation to age, sex, side, family history of cleft, and surgical technique. Overall, this study emphasized that all UCLP patients are not the same and do not have the same prognosis. Thorough diagnosis and history are needed to appropriately plan treatment for these patients based on expectations of treatment results. The greatest implication of this would be in planning for surgical or nonsurgical patients.
Reviewed by Patrick W. Scannell
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