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Study on the shape of the alveolar ridge and tooth position after cleft lip and palate surgery in children with unilateral cleft lip alveolus and palate 1. longitudinal study from before operation on cleft lip to the time of completion of permanent dentition



Study on the shape of the alveolar ridge and tooth position after cleft lip and palate surgery in children with unilateral cleft lip alveolus and palate 1. longitudinal study from before operation on cleft lip to the time of completion of permanent dentition



Shikoku Acta Medica 41(3): 193-204



Studies were made on chronological changed of the alveolar arch, tooth position and dental arch, using longitudinal plaster casts from 20 children with unilateral cleft lip, alveolus and palate. The casts were taken at four stages, before and after operation on cleft lip, before operation on cleft palate and at the time of completion permanent dentition. The results at each stage were compared with values in 20 normal children. The results and conclusions were as follows: 1. Before operation on cleft lip, the alveolar arch width in the posterior region was significantly less than that of controls at points F (the point of intersection of the alveolar ridge line and superior labial frenulum), being about 90% of that in controls. 2. After operation on cleft lip, the end-to-end length of the alveolar cleft was less than that before operation. The alveolar arch length of children with cleft lip at point F was significantly less (about 85% shorter) than that of control children. 3. Before operation on children with cleft palate, the width of the alveolar and dental arch in the posterior region was significantly more than that of controls on the normal side, whereas the length was significantly shorter. The alveolar arch was nearly parabolical in shape. The length of the alveolar and dental arch was about 85% of that of controls and was significantly shorter at point F. Comparison of the ratio of the alveolar arch lengths in affected and normal children showed no differences between before operation for cleft palate and after operation for cleft lip. 4. At the time of the completion of permanent dentition, the alveolar and dental arch wideth from the canine to the first molar, and more particularly from the first molar to the second molar, was significantly smaller than that of controls and so the difference between the alveolar and dental arch lengths of children with cleft palate and normal children was greater than before the operation for cleft palate. The alveolar and dental arch lengths at point F were significantly about 80% shorter in affected children than in controls. Because the teeth of children with cleft palate tended to deviate from the alveolar ridge line, their dentition at this time was complicated and was classified into three shapts: Type-I, parabolical; type-II, V-shaped, and type-III, saddleback shaped. Type-II was the commonest. A degree of transformation of the dental arch at this time was not related to the end-to-end length of the alveolar cleft at the time of operation for cleft lip. These findings indicate that operations on cleft lip and palate have effects on the alveolar arch, tooth position and entition. Cleft lip surgery induced mainly improvement in the position of the alveolar ridge, whereas cleft palate surgery caused marked transformation until the time of completion of permanent dentition.

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