Publication: Three-dimensional evaluation of skeletal, dental and soft tissue parameters in unilateral and bilateral cleft lip and palate patients with or without nasoalveolar molding
Abstract
Amaç: Ameliyat öncesi bebek ortopedisi, dudak damak yarıklı (DDY) hastaların tedavisinde yarım yüzyıldır kullanılmaktadır. Dudak ameliyatı öncesi uygulanan çeşitli yöntemler bulunmaktadır fakat nazoalveolar şekillendirme (NAŞ) protokolü en çok tercih edilen yöntemdir. Literatürde NAŞ uygulanmış (NAŞ+) ve uygulanmamış (NAŞ-) hastaların iskeletsel, dişsel ve yumuşak doku yapılarını karşılaştıran çalışma bulunmamaktadır. Bu nedenle retrospektif ve kesitsel olarak hazırlanan çalışmamızın amacı konik ışınlı bilgisayarlı tomografi (KIBT) yardımı ile NAŞ’ın uzun dönem etkinliğini değerlendirmektir. Materyal ve yöntemler: Marmara Üniversitesi, Diş Hekimliği Fakültesi, Ortodonti DDY arşivinde bulunan tüm KIBT görüntüleri taranmıştır. NAŞ+ 16 tek taraflı, 13 çift taraflı DDY, NAŞ- ise 8 tek taraflı, 8 çift taraflı DDY içermekte olup 6 Sınıf I hasta kontrol grubunu oluşturmuştur. Grupların yaş ortalaması, NAŞ uygulanmış tek taraflı ve çift taraflı DDY, NAŞ uygulanmayan tek ve çift taraflı DDY ve kontrol grupları için sırasıyla 10,08±1,66; 10,44±1,72; 9,35±1,63; 10,66±2,01 ve 10,13±2,71 yıldır. Ölçümler MIMICs 19.0 yazılımı ile yapılmış olup 63 adet parametre ölçülmüştür. İstatistiksel değerlendirme için SPSS kullanılmıştır. Shapiro Wilks ve Mann Whitney U testi uygulanmıştır. Bulgular: Tek taraflı DDY hastalarında NAŞ uygulanan ve uygulanmayanlar arasında istatiksel olarak bir fark gözlemlenmemiştir. Çift taraflı DDY hastalarında ise SNA değeri anlamlı derecede azalırken, üst intermolar genişlik anlamlı derecede atmıştır. Tüm DDY hastalarında iskeletsel nazal genişliğin kontrol grubuna oranla daha fazla olduğu; üst keser açısı ve yumuşak doku konveksitesinin ise daha az bulunmuştur. Sonuçlar: DDY hastalarda uzun dönem sonuçlarını etkileyen çok fazla faktör bulunması, NAŞ tedavisinin etkinliğinin belirlenmesini zorlaştırmaktadır. Bu nedenle NAŞ uygulanan ve uygulanmayan hastalar arasında fark olmadığı sonucuna varılamaz.
Aim: Presurgical infant orthopedics (PSIO) has been part of the treatment of cleft lip and palate (CLP) patients for about half a century. Several approaches can be performed before lip surgery but nasoalveolar molding (NAM) is the most preferred one. In literature, there are no studies comparing skeletal, dental and soft tissue structures of patients who had NAM in their infancy with those who did not. Therefore, the aim of this retrospective and cross-sectional study was to evaluate long-term effects of NAM using cone-beam computed tomography (CBCT). Materials and methods: CBCTs were collected from the cleft archive of Marmara University, Faculty of Dentistry, Department of Orthodontics. Samples consisted of 16 NAM+ and 8 NAM- unilateral cleft lip and palate (UCLP), 13 NAM+ and 8 NAM- bilateral cleft lip and palate (BCLP) and 6 non-cleft control patients. Mean ages were 10.08±1.66; 9.35±1.63; 10.44±1.72; 10.66±2.01 and 10.13±2.71 years, respectively. Measurements of 63 parameters were done using MIMICs 19.0 software. SPSS program was used for statistical analysis. Shapiro Wilks and Mann Whitney U tests were performed. Results: No statistically significant differences were found between UCLP NAM+ and NAM- groups. In BCLP NAM+ group, SNA decreased significantly while upper intermolar width increased significantly. Skeletal nasal widths and soft tissue convexity were higher, while upper incisors inclinations and upper lip length were lower in all cleft groups compared to control group. Conclusion: Due to many factors influencing the efficiency of NAM, it was not possible to accurately assess the differences between NAM+ and NAM- groups.
Aim: Presurgical infant orthopedics (PSIO) has been part of the treatment of cleft lip and palate (CLP) patients for about half a century. Several approaches can be performed before lip surgery but nasoalveolar molding (NAM) is the most preferred one. In literature, there are no studies comparing skeletal, dental and soft tissue structures of patients who had NAM in their infancy with those who did not. Therefore, the aim of this retrospective and cross-sectional study was to evaluate long-term effects of NAM using cone-beam computed tomography (CBCT). Materials and methods: CBCTs were collected from the cleft archive of Marmara University, Faculty of Dentistry, Department of Orthodontics. Samples consisted of 16 NAM+ and 8 NAM- unilateral cleft lip and palate (UCLP), 13 NAM+ and 8 NAM- bilateral cleft lip and palate (BCLP) and 6 non-cleft control patients. Mean ages were 10.08±1.66; 9.35±1.63; 10.44±1.72; 10.66±2.01 and 10.13±2.71 years, respectively. Measurements of 63 parameters were done using MIMICs 19.0 software. SPSS program was used for statistical analysis. Shapiro Wilks and Mann Whitney U tests were performed. Results: No statistically significant differences were found between UCLP NAM+ and NAM- groups. In BCLP NAM+ group, SNA decreased significantly while upper intermolar width increased significantly. Skeletal nasal widths and soft tissue convexity were higher, while upper incisors inclinations and upper lip length were lower in all cleft groups compared to control group. Conclusion: Due to many factors influencing the efficiency of NAM, it was not possible to accurately assess the differences between NAM+ and NAM- groups.