Oral Health Assessment in Cleft Lip & Palate Patients During Orthodontic Treatment for Maxillary Protraction: A Periodontal & Microbiological Study

Abstract

Objective

To assess the oral health status and microbiota of subgingival plaque in patients with surgically repaired cleft lip and palate (CLP) during orthodontic treatment for maxillary protraction with two different orthodontic appliances.

Design

Randomized controlled trial

Setting

Institutional.

Participants

A total of 90 patients with surgically repaired Unilateral Cleft Lip and Palate, out of initially enrolled 120 patients, were divided into 3 groups: experimental group I, experimental group II and control group, with 30 subjects each. Patients with a history of oral prophylaxis in last 6 months or antibiotic therapy within 3 months were excluded from the study.

Interventions

Bone Anchored Maxillary Protraction was done in experimental group I, while facemask with acrylic occlusal splint was used for maxillary protraction in experimental group II and no orthodontic intervention in control group.

Mean Outcome Measures

Plaque Index (PI), Gingival Index (GI), Gingival Bleeding Index (GBI), Probing Depth (PD), and microbiota of subgingival plaque (P. gingivalis, P. intermedia, Veillonella and Capnocytophaga) were compared at baseline (T₀) and after 8 months (T₁).

Results

The PI, GI, GBI and PD were observed to be significantly higher in experimental group II followed by experimental group I as compared to control group at 8 months interval (P < .001). The microbiota counts increased significantly in experimental group II and experimental group I (P < .001), as compared to control group.

Conclusion

Maxillary protraction with facemask and bone plates was found to be a better alternative than facemask with occlusal splint, considering the overall oral health of patients with CLP.

Keywords

cleft lip and palate maxillary protraction bone anchored maxillary protraction occlusal splint facemask periodontal health microbiological composition subgingival plaque

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References

Wehby

Cassel

. The impact of orofacial clefts on quality of life and health care use and costs. Oral Dis. 2010;16(1):3-10.

World Health Organization. Congenital anomalies; 2016. Available from: https://www.who.int/news-room/fact-sheets/detail/congenital anomalies.

McCarthy

May Junior

Littler

. Cleft lip & palate and craniofacial anomalies. In: Plastic Surgery. WB Saunders; 1990:2437-3174.

Wong

King

. The oral health of children with clefts-a review. Cleft Palate Craniofac J. 1998;35(3):248-254.

Shetye

. Orthodontic management of patients with cleft lip and palate. APOS Trends in Orthod. 2016;6(6):281-286.

Shkoukani

Chen

Vong

. Cleft lip - a comprehensive review. Front Pediatr. 2013;1(1):53.

Cornelis

Tepedino

Riis

Niu

Cattaneo

. Treatment effect of bone-anchored maxillary protraction in growing patients compared to controls: A systematic review with meta-analysis. Eur J Orthod. 2021;43(1):51-68.

Perdikogianni

Papaioannou

Nakou

Oulis

Papagiannoulis

. Periodontal and microbiological parameters in children and adolescents with cleft lip and palate. Int J Paediatr Dent. 2009;19(6):455-467.

Silness

Loe

. Periodontal diseases in pregnancy II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand. 1964;22(1):121-135.

10.

Loe

Silness

. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand. 1963;21(6):533-551.

11.

Ainamo

Bay

. Problems and proposals for recording gingivitis and plaque. Int Dent J. 1975;25(4):229-235.

12.

Quirynen

Dewinter

Avontroodt

Heidbuchel

Verdonck

Carels

. A split mouth study on periodontal and microbial parameters in children with complete unilateral cleft lip and palate. J Clin Periodontol. 2003;30(1):49-56.

13.

Świtała

Sycińska-Dziarnowska

Spagnuolo

, et al. Oral Microbiota in children with cleft lip and palate: A systematic review. J Clin Med. 2023;12(18):5867.

14.

Parapanisiou

Gizani

Makou

, et al. Oral health status and behaviour of Greek patients with cleft lip and palate. Eur Arch Paediatr Dent. 2009;10(2):85-89.

15.

Boloor

Thomas

. Comparison of periodontal status among patients with cleft lip, cleft palate, and cleft lip along with a cleft in palate and alveolus. J Indian Soc Periodontol. 2010;14(3):168-172.

16.

Schultes

Gaggl

Kärcher

. Comparison of periodontal disease in patients with clefts of palate and patients with unilateral clefts of lip, palate, and alveolus. Cleft Palate Craniofac J. 1999;36(4):322-327.

17.

Gupta

Sethi

Wadhwa

Batra

Shick

. Is caries prevalence site-specific in cleft lip and palate patients? A systematic review and meta-analysis. Dent Res J. 2023;20(1):111.

18.

Costa

Lima

Gomide

Rosa

. Clinical and microbiological evaluation of the periodontal status of children with unilateral complete cleft lip and palate. Cleft Palate Craniofac J. 2003;40(6):585-589.

19.

Lucas

Gupta

Ololade

Gelbier

Roberts

. Dental health indices and caries associated microflora in children with unilateral cleft lip and palate. Cleft Palate Craniofac J. 2000;37(5):447-452.

20.

Funahashi

Shiba

Watanabe

, et al. Functional dysbiosis within dental plaque microbiota in cleft lip and palate patients. Prog Orthod. 2019;20(1):1-10.

21.

Sahni

Grover

Sood

Jain

. The periodontal status of orofacial cleft patients: A systematic review and meta-analysis. Cleft Palate Craniofac J. 2022. doi:https://doi.org/10.1177/10556656221127549

22.

Bragger

Schurch

Jr Salvi

von Wyttenbach

Lang

. Periodontal conditions in adult patients with cleft lip, alveolus, and palate. Cleft Palate Craniofac J. 1992;29(2):179-185.

23.

Salvi

Bragger

Lang

. Periodontal attachment loss over 14 years in cleft lip, alveolus and palate (CLAP, CL, CP) subjects not enrolled in a supportive periodontal therapy program. J Clin Periodontol. 2003;30(9):840-845.

24.

Gaggl

Schultes

Kärcher

Mossböck

. Periodontal disease in patients with cleft palate and patients with unilateral and bilateral clefts of lip, palate, and alveolus. J Periodontol. 1999;70(2):171-178. doi:https://doi.org/10.1902/jop.1999.70.2.171

25.

Mossey

Modell

. Epidemiology of oral clefts 2012: An international perspective. Front Oral Biol. 2012;16(1):1-18.

26.

Passinato Gheller

Porto

Borba

, et al. Periodontal findings in children and adolescents with cleft lip and/or palate: A case-control study. Pediatr Dent. 2021;43(2):133-139.

27.

Mombelli

Bragger

Lang

. Microbiota associated with residual clefts and neighbouring teeth in patients with cleft lip, alveolus, and plalate. Cleft Palate Craniofac J. 1992;29(5):463-469.

28.

Eslami

Majidi

Aliakbarian

Hasanzadeh

. Oral health-related quality of life in children with cleft lip and palate. J Craniofac Surg. 2013;24(4):e340-e343.

29.

Ng'ang'a

Valderhaug

. Oral hygiene practices and periodontal health in primary school children in Nairobi, Kenya. Acta Odontol Scand. 1991;49(5):303-309.

30.

Das

Beena

Azher

. Oral health status of 6- and 12-year-old school going children in Bangalore city: An epidemiological study. J Indian Soc Pedod Prev Dent. 2009;27(1):6-8.

31.

Goel

Sequeira

Peter

. Prevalence of dental disease amongst 5-6 and 12-13 year old school children of Puttur municipality, Karnataka state-India. J Indian Soc Pedod Prev Dent. 2000;18(1):11-17.

32.

Marzouk

Youssef

Tsigarida

, et al. Association between oral clefts and periodontal clinical measures: A meta-analysis. Int J Paediatr Dent. 2022;32(4):558-575.

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