ClinicalCases - American Association of Orthodontists...Values" M±SD" Values" % ARCH"WIDTH" (mm) Intercanine"cusp"" 24 33.0 ± 2.3 9 27.2% Intercanine"ging" 18 25.5 ±1.8" " 7.5 29.4%

#4 Clinical Cases

CLP MAXILLARY MORPHOLOGY: A 3D EVALUATION outline

#1 Literature Review

#2 3D EvaluaDon Approach

#3 Maxillary Morphology Comparison: CleK vs Non-‐CleK Subjects

www.ortodonzia.unina2.it

Mossey PA, Little J, Munger RG, Dixon MJ, Shaw WC. Cleft lip and palate.

The Lancet 2009;374(9703):1773-85.

CLP is a craniofacial malformaDon due to the failure of fusion

of the maxillary processes and/or palatal shelves 4th -‐ 12th week of embryogenesis

CLP : 3D MAXILLARY MORPHOLOGY CHANGES definiDon and Dming

First-‐trimester diagnosis of cleK lip and palate using three-‐dimensional ultrasound. MarDnez-‐Ten P, Adiego B, Illescas T, Bermejo C, Wong AE, Sepulveda W. Ultrasound Obstet Gynecol. 2012 Jul;40(1):40-‐6. doi: 10.1002/uog.10139

Mossey et al, 2009 MarDnez-‐Ten et al, 2012 www.ortodonzia.unina2.it

CLP reflects the complexity and diversity of the mechanisms involved at molecular level during embryogenesis

Johnson MC, Bronsky PT. Prenatal craniofacial development: new insights on normal

and abnormal mechanisms. Critical Reviews in Oral Biology and Medicine 1995;6:25-79.

Schutte BC, Murray JC. The many faces and factors of oro-facial clefts.

Human Molecular Genetics 1999;8:1853-9.

Prescott NJ, Winter RM, Malcom S. Non-syndromic cleft lip and palate: complex

genetics and environmental effects. Annals of Human Genetics 2001;65:505-15.

Spritz RA. The genetics and epigenetics of oro-facial clefts.

Current Opinion in Pediatrics 2001;13:556-60.

Wilkie AO, Morriss Kay GM. Genetics of craniofacial development and

malformation. Nature Reviews Genetics 2001;2:458-68.

Murray J. Gene/environment causes of cleft lip and/or palate.

Clinical Genetics 2002;61:248-26.

Hayes, 2002 Murray, 2002

Czeizel and Bànhidy, 2010

CLP : 3D MAXILLARY MORPHOLOGY CHANGES eDology

Czeizel AE and Nagy E; 1986 Johnson MC and Bronsky PT; 1995 SchuEe BC and Murray JC; 1999

PrecooE NJ et al; 2001 Spritz RA; 2001

Wilkie AO and Morriss Kay GM; 2001


geneDc and environmental factors oKen act in associaDon

CLP : 3D MAXILLARY MORPHOLOGY CHANGES eDology

Hayes, 2002 Murray, 2002

Czeizel and Bànhidy, 2010 Bezerra et al, 2014

MTHFR 677T allele Kim et al, 2009; Platek et al, 2009; Ho et al, 2013

Jianyan et al, 2010; Dixon et al, 2011; Ho et al, 2013; Kim et al, 2013

(Blanton et al, 2011) Platek et al, 2009; Bhaskar et al, 2011; Liang et al, 2014

Folic acid deficiency

MTHFR 677T allele < folic acid Alcohol consumpDon > MTHFR 1298C allele Alcohol consumpDon < folic acid

Alcohol consumpDon MTHFR 1298C allele


1. CLEFT OF PRIMARY PALATE (lip -‐ alveolus)

2. CLEFT OF PRIMARY AND SECONDARY PALATE (lip -‐ alveolus -‐ hard -‐ soK palate)

CLP : 3D MAXILLARY MORPHOLOGY CHANGES classificaDon

ICPR, 2006

3. CLEFT OF THE SECONDARY PALATE (hard -‐ soK)


CLP : 3D MAXILLARY MORPHOLOGY CHANGES epidemiology

CleK is the most common craniofacial malformaDon that an orthodonDst will encounter

Kawakami et al, 2002

incidence

Mossey and CasDllia, 2003 Bernheim et al, 2006

Thornton J.B, Nimer S, Howard P, 1996.

The Incidence, Classi>ication, Etiology and Embriology of Oral Cleft.

Seminar in Orthodontics; Sept; 2(3): 162-‐168.

Rodrigeuz C, Mosquera C, Garcia E, Fernandez J, Rodriguez A, Riano I, Ariza F. 2009.

The epidemiology of cleft lip and palate over the period 1990-‐2004 in Asturias.

An Pediatr (Barc) Aug 31.


1/1000 1/700

Thornton J.B, Nimer S, Howard P, 1996.

The Incidence, Classi>ication, Etiology and Embriology of Oral Cleft.

Seminar in Orthodontics; Sept; 2(3): 162-‐168.

Rodrigeuz C, Mosquera C, Garcia E, Fernandez J, Rodriguez A, Riano I, Ariza F. 2009.

The epidemiology of cleft lip and palate over the period 1990-‐2004 in Asturias.

An Pediatr (Barc) Aug 31.

CleK palate 45.5%

CleK lip & palate 33%

CleK lip 21.5%

Rodriguez et al, 2009 Thornton et al, 1996 www.ortodonzia.unina2.it

prevalence

CLP : 3D MAXILLARY MORPHOLOGY CHANGES epidemiology

c

from birth unDl adulthood

Christensen et al, 2004 Okada et al, 2014

necessary to achieve a proper occlusion and beoer estheDcs

CLP : 3D MAXILLARY MORPHOLOGY CHANGES mulDdisciplinary approach

12.  PlasDc Surgeon 13.  Max-‐fac. Surgeon

14.  AnestheDst 15.  Radiologist

16.  PedodonDst 17.  OrthodonDst

12.  PeriodonDst 18.   Implantologist 19.  ProsthodonDst

1.   General PracDDoner

2.   Gynecologist 3.   Sonographer

4.   Neonatologist 5.   Pediatrician 6.   GeneDcist 7.   Psychologist 8.   Social Worker 9.   NutriDonist 10.  Speech Therapist 11.   Otorhinolaryngologist

Susumu TAKAYANAGI

piet haers

Maxillofacial Surgeon Gynecologist Sonographer Neonatologist Pediatrician GeneDcist Psychologist Social Worker NutriDonist Otorhinolaryngologist

Speech Therapist PlasDc Surgeon

General PracDDoner AnestheDst Radiologist PedodonDst OrthodonDst PeriodonDst

Implantologist ProsthodonDst


…children without smiles are like a garden without flowers!

MARCO

CLP : 3D MAXILLARY MORPHOLOGY CHANGES orthodonDc treatment

CLP : 3D MAXILLARY MORPHOLOGY CHANGES problem list

DENTAL Ø  Class II or III relaDonship Ø  AgeneDc, rotated, anomalous

incisors

SKELETAL Ø  Class II or III relaDonship Ø  Hypo-‐hyperdivergent paoern

ESTHETIC Ø  Convex or concave profile

FUNCTIONAL Ø  Speech and/or oral breathing


Anomalous upper arch and

palate morphology

COMMON DENOMINATOR

CLEFT LIP AND PALATE aim

CLP : 3D MAXILLARY MORPHOLOGY CHANGES aim

using 3D analysis to compare upper dental arch and palate morphology in untreated unilateral cleK vs untreated non-‐cleK

in mixed denDDon phase to examine arch width, palatal area and volume


UCLP NCLP

Anna, 9 yrs and 11 mos

www.ortodonzia.unina2.it [email protected]

1.2 1.3

ANNA CONTROL DIFFERENCE Values M ± SD Values %

ARCH WIDTH (mm)

Intercanine cusp 25 33.0 ± 2.3 -‐8 24.2%

Intercanine ging 20 25.5 ± 1.8 -‐5.5 21.5%

Intermolar cusp 46 48.0 ± 11.8 -‐2 4.1%

Intermolar ging 30 32.8 ± 8.2 -‐2.8 8.5%

PALATAL AREA (mm2)

753 776.9 ± 163.7 -‐23.9 3%

PALATAL VOLUME (mm3)

2694 2871.4 ± 898.7 -‐177.4 6.1%


CLP : 3D MAXILLARY MORPHOLOGY CHANGES

Anna,

9 yrs and 11 mos

before…

Anna,

14 yrs and 1 mo

…aKer

[email protected] www.ortodonzia.unina2.it

DIFFERENCE

Values %

ARCH WIDTH (mm)

Intercanine cusp 25 35 +10 39.3%

Intercanine ging 20 26 +6 30.2%

Intermolar cusp 46 54 +8 17.4%

Intermolar ging 30 36 +6 20.0%

PALATAL AREA (mm2) 753 992 +239 31.7%

PALATAL VOLUME (mm3) 2694 4563 +1869 69.3%


before and aKer treatment


Anna, 16 yrs and 1 mo


2 yrs aKer treatment


Anna, today

Heoy, 11 yrs and 6 mos

1.2 2.2 2.3

3.7

Inter-‐disciplinary approach of a pa8ent with an unilateral cle; lip and palate Perillo L, Vitale M, d’Apuzzo F, Isola G, Nucera R, Matarese G

AJODO-‐D-‐16-‐0066R1

HETTY CONTROL DIFFERENCE

Values M ± SD Values %

ARCH WIDTH (mm)

Intercanine cusp 24 33.0 ± 2.3 -‐9 27.2%

Intercanine ging 18 25.5 ± 1.8 -‐7.5 29.4%

Intermolar cusp 46 48.0 ± 11.8 -‐2 4.1%

Intermolar ging 30 32.8 ± 8.2 -‐2.8 8.5%

PALATAL AREA (mm2) 700 776.9 ± 163.7 -‐76.9 9.8%

PALATAL VOLUME (mm3)

2586 2871.4 ± 898.7 -‐285.4 9.9%



Heoy,

11 yrs and 6 mos

before...

Heoy,

14 yrs and 6 mos

…aKer


DIFFERENCE

Values %

ARCH WIDTH (mm)

Intercanine cusp 24 24 0 0%

Intercanine ging 18 18 0 0%

Intermolar cusp 46.5 49.5 +3 6.5%

Intermolar ging 30 33.5 +3.5 11.7%

PALATAL AREA (mm2)

700 700 0 0%

PALATAL VOLUME (mm3) 2586 3160 574 22.2%


before and aKer treatment


Heoy, 16 yrs and 6 mos


2 yrs aKer treatment


Heoy, today

Documents

ClinicalCases - American Association of Orthodontists...Values" M±SD" Values" % ARCH"WIDTH" (mm) Intercanine"cusp"" 24 33.0 ± 2.3 9 27.2% Intercanine"ging" 18 25.5 ±1.8" " 7.5 29.4%