Diapositiva 1 - American Association of Orthodontists -- Maxillary Morphology in...16/04/2015 2 CLP...
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16/04/2015 1 CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION outline 1. Literature Review 2. 3D Evaluation Approach 3. Maxillary Morphology Comparison: Cleft vs Non-Cleft Subjects 4. Clinical Cases www.ortodonzia.unina2.it
Transcript of Diapositiva 1 - American Association of Orthodontists -- Maxillary Morphology in...16/04/2015 2 CLP...
16/04/2015
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CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION outline
1. Literature Review
2. 3D Evaluation Approach
3. Maxillary Morphology
Comparison: Cleft vs Non-Cleft
Subjects 4. Clinical Cases
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CLP is a craniofacial malformation
due to the failure of fusion
of the maxillary processes or palatal shelves
4th - 12th week of embryogenesis
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION definition and timing
Mossey et al, 2009 Martinez-Ten et al, 2012 www.ortodonzia.unina2.it
CLP reflects the complexity and diversity of the mechanisms
involved at molecular level during embryogenesis
Hayes, 2002 Murray, 2002
Czeizel and Bànhidy, 2010
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION etiology
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genetic and environmental factors often act in association
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION etiology
Czeizel and Bànhidy, 2010 Bezerra et al, 2014
MTHFR 677T allele Folic acid deficiency
Hayes, 2002 Murray, 2002
Alcohol consumption MTHFR 1298C allele
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1. CLEFT OF PRIMARY PALATE (lip - alveolus)
2. CLEFT OF PRIMARY AND SECONDARY PALATE (lip - alveolus hard palate)
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION classification
ICPR, 2006
3. CLEFT OF THE SECONDARY PALATE (hard - soft)
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CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION epidemiology
Cleft is the most common craniofacial malformation that an orthodontist will encounter
Kawakami et al, 2002
Incidence
Mossey and Castillia, 2003
Bernheim et al, 2006 www.ortodonzia.unina2.it
1/1000 1/700
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION prevalence
Cleft palate 45.5%
Cleft lip & palate 33%
Cleft lip 21.5%
Rodriguez et al, 2009 Thornton et al, 1996 www.ortodonzia.unina2.it
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c
from birth until adulthood
Christensen et al, 2004 Okada et al, 2014
necessary to achieve a proper occlusion and better esthetics
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION multidisciplinary approach
General Practitioner
Gynecologist
Sonographer
Neonatologist
Pediatrician
Geneticist
Psychologist
Social Worker
Nutritionist
Otorhinolaryngologist
Speech Therapist
Plastic Surgeon
Maxillofacial surgeon
Anesthetist
Radiologist
Pedodontist
Orthodontist
Periodontist
Implantologist
Prosthodontist
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…children without smiles
are like a garden without flowers!
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION orthodontic treatment
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Kinnebrew and Kent, 1983
Vig and Turvey, 1985
Trankmann, 1989
Okazaki et al, 1991
Tindlund et al, 1982, 1993, 1994
Kilpelainen et al, 1996 a, 1996 b
Vlachos, 1996
Braumann et al, 2003
Lehner et al, 2003
Lo et al, 2003
Smahel et al, 2003, 2004, 2009
Figueroa et al, 2004
Schliephake, 2006
Holberg et al, 2007
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION orthodontic treatment… If?
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Li and Lin, 2007
Weiran et al, 2007
Jia et al, 2008
Nishikubo et al, 2009
Tindlund et al, 2009
da Luz Vieira et al, 2009
Takigawa et al, 2010
Bejedova et al, 2011
Ruskova et al, 2012
Mello et al, 2013
De Oliveira Façanha et al, 2014
Figueiredo et al, 2014
Huang Li et al, 2014
Trindade- Suedam et al, 2015
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION orthodontic treatment
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CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION orthodontic treatment…When?
Age Author
6-7 Tindlund et al, 1982, 1993, 1994, 2009
8-10 Jia et al, 2008 da Luz Vieira et al, 2009 Trindade-Suedam et al, 2015
10-12 Li and Lin, 2007 da Luz Vieira et al, 2009 De Oliveira Façanha et al, 2014 Figueiredo et al, 2014 Trindade-Suedam et al, 2015
adults Case reports Holberg et al, 2007 Tai et al, 2012 Gautam et al, 2011 Ma et al, 2014 Okada et al, 2012 Rocha et al, 2012 Silveira et al, 2014
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CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION orthodontic treatment...When?
Dentition Author
Deciduous
Tindlund et al, 1982, 1993, 1994
Early mixed Tindlund, 1982, 1993, 1994 Jia et al, 2008 Trindade-Suedam et al, 2015
Late mixed Li and Lin, 2007 da Luz Vieira et al, 2009 De Oliveira Façanha et al, 2014 Figueiredo et al, 2014 Trindade-Suedam et al, 2015
Permanent Case reports Holberg et al, 2007 Tai et al, 2012 Gautam et al, 2011 Ma et al, 2014 Okada et al, 2012 Rocha et al, 2012 Silveira et al, 2014
AS SOON AS THE CLASS III IS
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION When?
As soon as the malocclusion is diagnosed Marco, 6 yrs Tindlund, 2009
AS SOON AS THE CLASS III IS DIAGNOSED
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION When?
As soon as the patient is able to cooperate Silvia, 7 yrs
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION orthodontic treatment
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1. To improve facial esthetics
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION orthodontic treatment... Why?
treatment does not always improve facial appearance cleft patients are considered less attractive even after treatment patients and parents are more satisfied with the outcome
Gkantidis et al, 2012 Foo et al, 2013
Eichenberger et al, 2014
Marcusson et al, 2002 Sinko et al, 2005 Meyer-Marcotty et al, 2010, 2011b
Before After
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CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION orthodontic treatment… Why?
2. To improve dental esthetics
an interdisciplinary treatment protocol can significantly improve occlusion
Ma et al, 2014 www.ortodonzia.unina2.it
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION orthodontic treatment… Why?
There is a clear need for psychological support
3. To avoid psychological problems
CLP children suffer psychosocial consequences due to their facial appearance
Meyer-Marcotty et al, 2010
Stock et al, 2015
CLP faces are looked at differently
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Speech is one of the most important issues for cleft children
4. To improve speech
Lambrecht et al, 2014
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION orthodontic treatment…Why?
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Cleft children are more susceptible to caries and periodontal diseases have poor oral hygiene have unmet needs
5. To decrease risk of decay
Wells et al, 2007 Cheng et al, 2007
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION orthodontic treatment…Why?
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6. To make surgery less invasive
Long et al, 2000 Pavone et al, 2005
Sugawara et al, 2012
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION orthodontic treatment… Why?
major ortho-surgery can generate psychological disorders
incertepting early reduces the risk of future major surgery
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7. To achieve dento-skeletal sagittal changes
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION orthodontic treatment… Why?
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Author No Cleft Age Treatment Time (mo)
SNA (°)
ANB (°)
U1 (°)
Tindlund et al 1993
98 Uni/Bi 6.1 QH/FM 13.0 0.9 2.3 8.8
Tindlund et al 1994
72 Uni/Bi 6.7 QH/FM 13.0 1.3 3.3 9.0
Jia et al 2008
18 Uni 9.5 Hyrax/FM 9.2 1.5 3.8 3.2
da Luz Vieira et al 2009
20 Uni 10.4 Haas/FM 6.0 2.2
Figueiredo et al 2014
30
Uni 11.3 10.5 12.3
Hyrax Fan-type Mini Hyrax
3.0 -0.1 -0.5 1.2
0.8 3.6
-1.1
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Author
No Cleft Age Treatment Time (mo)
3 - 3 (mm)
4 - 4 (mm)
6 - 6 (mm)
Tindlund et al 1993
112 Uni/Bi
6.9 QH 12 10.6
Weiran et al 2007
20 Uni 14.7 QH fixed app
21 5.5 5.8 3.2
15 -1.3 -1.5 -0.9
Façanha et al 2014
25 23
Uni 10.8 10.6
Haas Hyrax
6 4.8 5.9
6.7 7.1
6.1 7.6
Figueiredo et al 2014
30 Uni 11.3 10.5 12.3
Hyrax Fan-type Mini Hyrax
3 4.7 6.1 3.9
4.7 3.2 0.4
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION orthodontic treatment… Why?
7. To achieve dento-skeletal transversal changes
-25% LONG TERM OUTCOME
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CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION orthodontic treatment
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Phase I: Maxillary Expansion + Maxillary Protraction
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION orthodontic treatment... How?
Phase II: Fixed appliances Class II or III elastics Extractions when needed
Phase III: Retention Upper lingual arch retainer
Lower fixed retainer
QH Tindlund et al, 1993, 1994, 2009; Li and Lin, 2007
Hyrax Trindade-Suedam et al, 2015
Hyrax + Delaire or TPA Jia et al, 2008; Façanha et al, 2014; Figueiredo et al, 2014
Inv mini Hyrax + TPA Figueiredo et al, 2014
Fan Type + TPA Figueiredo et al, 2014
Modified Haas Trindade-Suedam et al, 2015
Modified Haas + Delaire da Luz Vieira et al, 2009; Façanha et al, 2014
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CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION orthodontic treatment… How?
Phase I: Maxillary Expansion & Maxillary protraction or Mandibular growth control
Phase II: Fixed appliances Class II or III elastics Extractions when needed
Phase III: Retention Upper lingual arch retainer
Lower fixed retainer www.ortodonzia.unina2.it
Bonded expander/Hyrax
Delaire or chin cup
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION Diagnosis
DENTAL Anomalous arch form Anterior or posterior crossbite Delayed upper incisor eruption Agenetic, rotated, anomalous incisors Class II or III relationship
SKELETAL Maxillary deficiency Crossbite Class II or III relationship Hypo-hyperdivergent pattern
ESTHETIC Concave, straight or convex profile Upper/lower lip retrusion
FUNCTIONAL Speech Oral breathing www.ortodonzia.unina2.it
LIMITED TIME-CONSUMING
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION 2D methodology
Athanasiou et al, 1987, 1988 Lewis et al, 2008
Heidbuchel et al, 1998 Garrahy et al, 2005 www.ortodonzia.unina2.it
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Author Width Height Length Depth Area Volume Shape
Okazaki et al, 1991
Kilpelainen et al, 1996 a
Smahel et al, 2003
Smahel et al, 2004
Smahel et al, 2009
Braumann et al, 2003
Lo et al, 2003
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION 3D studies
Mello at al, 2013
Lehner et al, 2003
Schliephake, 2006
Nishikubo et al, 2009
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Lo et al, 2003
Braumann et al, 2003
Kilpelainen et al, 1996 b
Ruskova et al, 2012
Bejedova et al, 2011
Nishikubo et al, 2009
Schliephake, 2006
Mello et al, 2013
Lehner et al, 2003
Kilpelainen et al, 1996 b
Bejedova et al, 2011
Ruskova et al, 2012
Author
Untreated CLP
Untreated NCLP
Age (yrs)
Dent. 3D Width
(mm)
Palatal (%)
Area Vol.
Okazaki et al 1991
30 Uni 30 4.6 dec. MFT
Treated CLP
Kilpelainen et al 1996
95 CP 68 13.1 perm. MFT
Smahel et al 2003
29 CP 28 15.3
perm. FTP
Smahel et al 2004
30 Uni 28 14.7 perm. FTP
Smahel et al 2009
30 Bi 28 14.7 LS
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION comparison with other 3D studies
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CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION aim
To compare maxillary morphology in untreated unilateral cleft vs untreated non-cleft
in mixed dentition phase using 3D analysis
to examine width, palatal area and volume
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UCLP NCLP
Department of Orthodontics
Second University of Naples
Italia
Department of Pedodontics
Dental Polyclinic Kranj
Slovenia
sex 9 girls 10 boys
age 9.08 ± 1.63
mixed dentition
same surgeon and procedures
high quality dental casts
normal occlusion
high quality dental casts
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION selection criteria
other cranio-facial syndromes
previous/concomitant orthodontic treatment
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Untreated CLP unilateral-cleft
19
Untreated NCLP non-cleft
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dental study cast
3D digital image
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION method
Accuracy 15µm
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intercanine width
intermolar width
cusp level
gingival level
Primozic et al, 2013
Hayashii et al, 2015
software
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION cast analysis: maxillary arch
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area volume
Gingival plane - Palate boundaries - Distal plane
Primozic et al, 2013
2006 software
CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION cast analysis: palate
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Anna, 9 yrs and 11 mos
www.ortodonzia.unina2.it [email protected]
Hetty, 11 yrs and 6 mos
1.2
[email protected] www.ortodonzia.unina2.it
2.2 2.3
3.7
Davide, 8 yrs and 6 mos
[email protected] www.ortodonzia.unina2.it
Chiara, 19 yrs and 1 mo
[email protected] www.ortodonzia.unina2.it
شكرا
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Danke
Thanks
Obrigado
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Tack
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感謝
ขอบคุณ
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תודה
GRAZIE
Head and chairman: Prof. Letizia Perillo
Postgraduate Program in Orthodontics
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