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Abstract this study was carried to evaluate the potential of CBCT for qualitative and quantitative assessment of defects and deformities of a sample of 20 patients with surgically repaired complete UCLP, ranging in age from 8 to 12 years divided into two groups (13 boys and 7 girls). These patients were selected from the outpatient clinic of the Orthodontic Department and Cleft-Care Clinic affiliated to the Oral and Maxillofacial Surgery Department- Faculty of Dentistry- Ain Shams University. All subjects were non-syndromic, medically free, with no previous orthodontic or maxillary orthopedic treatment and do not have any extracted permanent teeth. They were selected prior to performing alveolar cleft grafting. For every patient, CBCT scan was taken. Skeletal, dental and soft tissue characteristics and dental arch parameters were assessed for each subject using various views obtained from the CBCT scan. For lateral cephalometric analysis, the images obtained from the CBCT scan were analyzed using (Onyx Ceph®) orthodontic digitizing software program. Postero-anterior and axial views analyses for assessment of asymmetry were done directly using i-CATVisionTM V1.8 software of the CBCT machine. Moreover, incidence of congenitally missing permanent teeth in relation to the side and site of the bony defect was investigated using the panoramic views. Furthermore, Huddart/Bodenham scoring for assessment of the surgical outcomes as well as Angle’s classification of malocclusion were assessed using the implant screen. The collected data were tabulated and statistically analyzed using PASW Statistics 18.0® (Predictive Analytics SoftWare) for Windows. The obtained results of the current study led to the following conclusions: 1. CBCT is an excellent technology for quantifying and analyzing surface and deep defects and deformities in patients with CLP. 2. Patients with UCLP were found to have smaller cranial base angle, shorter anterior cranial base length, retruded and shorter maxilla, smaller mandible, impaired maxillary-mandibular jaw relation with prevalence of skeletal class III, retroclined upper and lower incisors with increased interincisal angle, retrusive upper lip and protrusive lower lip compared with noncleft children. 3. Three-dimensional assessment of asymmetry revealed: Nasal asymmetry on the bony level as well as the soft tissue level. There was a significant asymmetry of the nasal cavity in both the horizontal and vertical planes. The bony alar base showed significant sagittal and transverse depression on the cleft side. The lower half of the nasal septum was deviated towards the cleft side while both the ANS and the nasal tip were deviated towards the noncleft side. Three-dimensional collapse of the maxillary dentoalveolar complex on the cleft side. Reduction of molar point measurements on the cleft side in the vertical plane indicating canting of the occlusal plane. Direct correlation between nasal cavity, maxillary dentoalveolus and molar point asymmetry in the horizontal plane indicating horizontal collapse of the whole cleft side. Reduction in the transverse position of malare point on the cleft side indicating collapse of the malar prominence on the cleft side. Similar transverse dimension of both sides of the maxillary sinuses but the total anteroposterior length was smaller on the cleft side. Mandibular asymmetry was not statistically significant in both the horizontal and vertical planes. 4. There was a prevalence of left-sided cleft in the studied sample. The permanent maxillary lateral incisor was found to occur more often on the distal side of the cleft. The maxillary lateral incisor was the most prevalent missing permanent tooth, followed by maxillary second premolar. There was a significant association between the side of the cleft and the side of missing teeth. 5. The mean modified Huddart/Bodenham score for the studied group of UCLP patients indicates a constricted maxillary dental arch. 6. There was a predominance of class III malocclusion, followed by class I then class II. Only one case was not classified because the first molars were not erupted yet. 7. In the current study only small sex differences were found. Boys showed significantly lower mean values for the maxillary measurements than in girls, indicating that boys with UCLP had a more disturbed maxillary growth than do the girls. Skeletal class III malocclusion was more significant in boys than in girls. No significant difference in the degree of asymmetry between boys and girls was found except for the total antero-posterior length of the maxillary sinus which was smaller in the boys. 8. The study revealed a major defect in the documentation of the previously performed surgeries of lip and palate repair, which is important to study the effect of the variables of timing, number of surgeries and surgical technique on the dentocraniofacial morphology of patients with CLP. |