Long-term health of the stomatognathic system as well as esthetic aspects are the therapeutic goals in patients with orofacial clefts. The aim of this study was to analyze the periodontal condition of patients with cleft palate (CP) and cleft lip, palate, and alveolus (CLP) and to determine the differing degrees and localization of periodontal disease.
Design
In 30 patients with unilateral cleft lip, palate, and alveolus and 30 patients with cleft palate (CP), periodontal lesions were identified and classified according to the Community Periodontal Index of Treatment Needs (CPITN) and pathological mobility of teeth was noted. The state of oral hygiene was recorded by the Approximal Plaque Index.
Results
In general, poor oral hygiene was found in all patients. Patients with CLP were classified as CPITN code 0 in 0%, codes 1 and 2 in 7%, code 3 in 43%, and code 4 in 50% of cases. Patients with cleft palate showed code 0 in 0%, codes 1 and 2 in 30%, code 3 in 45%, and code 4 in 25% of cases. In this study, periodontal disease was found in patients with cleft palate to a similar extent to that in the general population, whereas patients with cleft lip, palate, and alveolus had a predisposition to deep peridontal destruction of teeth adjacent to the cleft. The registration of pathological mobility of teeth and resulting loss of attachment corresponded to the periodontal disease classification according to the CPITN.
Conclusion
A critical periodontal situation was found in patients with unilateral cleft lip, palate, and alveolus. In contrast, patients with cleft palate exhibited a similar periodontal situation to that found in the general population, with additional damage that may be attributed to orthodontic treatment.
AhrensP.BublitzK.A.Parodontalerkrankungen und Behandlungsbedarf der Hamburger Bevölkerung.Dtsch Zahnärztl Z1987; 42: 433–437.
2.
AinamoJ.BayI.Problems and proposals for recording gingivitis and plaque.Int Dent J1975; 25: 229–235.
3.
AinamoJ.Barnes D, Beagrie G. Cutress T, Martin J, Sardo-Imtirri J. Development of the World Health Organisation (WHO) Community Periodontal Index of Treatment Needs (CPITN).Int Dent J1982; 32: 281–291.
4.
AxelssonP.LindheJ.Effect of controlled oral hygene procedures on caries and periodontal deseases in adults.J Clin Periodontal1978; 5: 133–155.
5.
BenningtonI.C.WatsonI.B.JenkinsW.M.M.AllanG.R.J.Restorative treatment of the cleft palate patient.Br Dent J1979; 146: 14–17, 47–50, 79–82. 115–118, 144–148, 183–186.
6.
BerndorferA.Basic principles of the Veau operation method. In memory of Victor Veau.Acta Chir Plast1969; 11: 175–177.
7.
BräggerU.SchürchE.Gusberti FA, Lang NP. Periodontal conditions in adolescents with cleft lip, alveolus and palate following treatment in a co-ordinated team approach.J Clin Periodontal1985; 12: 494–502.
8.
BräggerU.Schürch E, Salvi G, von Wyttenbach T, Lang NP. Periodontal conditions in adult patients with cleft lip, alveolus and palate.Cleft Palate Craniofac J1992; 29: 179–185.
9.
EricssonI.ThilanderB.Orthdontic forces and recurrence of periodontal desease.Am J Orthd1978; 74: 41–44.
10.
GözG.Die kieferorthopädische Zalmbewegung.München and Wien: Untersuchung zur Biologie und Mechanik Hansa Verlag;1987.
11.
HampS.E.LundströmF.NymanS.Periodontol conditions in adulescents subjected to multiband orthodontic treatment with controlled oral hygiene.Eur J Orthod1982; 4: 77–80.
12.
HirschfelderU.Nachuntersuchung zur Reaktion des marginalen und apikalen Parodontiums unter kontinuierlicher Kraftapplikation, Fortschr Kieferorthop1990; 51: 82–85.
13.
HohlfeldM.Bernimoulin JP. Teilergennisse einer epidemiologischen Untersuchung des Parodontalzustandes bei 45-54 jährigen Berliner Probanden.Dtsch Zahnärztl Z1986; 41: 616–619.
14.
HotzM.M.GnoinskiW.M.NussbaumerM.KistlerE.Early maxillary orthopedics in CLP cases. Guideline of surgery, Cleft Palate J1978; 15: 405–411.
15.
JohansonB.OhlsonA.FriedeH.AhlgrenJ.A follow-up study of cleft lip and palate patients treated with orthodontics, secondary bone grafting and prosthetic rehabilitation.Scand J Plast Reconstr Surg1974; 8: 121–135.
16.
JonasJ.Histomorphologische Untersuchungen über das destruktive und resolutive Verhalten des Ligamentum parodontal unter kieferorthopädischen Zahnbewegungen.Fortschr Kieferorthop1978; 39: 398–401.
17.
JonasJ.Die Reaktionsweise des Parodonts auf Kraftapplikation.Fortschr Kiefemrthop1980; 41: 228–232.
18.
KloehnJ.S.PfeifferJ.S.The effect of orthodontic treatment on the periodontium.Angle Orthod1974; 44: 127–131.
19.
LangN.P.Considerations in treatment planning and preventive aspects of dental reconstructions in cleft lip and palate. In: KehrerB.SlongoT.GrafB.BettexM., eds. Longterm Treatment in Cleft Lip and Palate.Bern, Switzerland: Huber;1981: 332–338.
20.
LangeD.E.Die gezielte Vorbehandlung vor der systematischen Parodontalbe-handlung.Zahnärztl Well Reform1975; 8: 366–374.
21.
LindheJ.NymanS.The effect of plaque control and surgical pocket elimination on the establishment and maintenance of periodontal health. A longitudinal study of periodontal therapy in cases of advanced disease.J Clin Periodontal1975; 2: 67–79.
22.
LindheJ.HaffajeeA.E.SokranskyS.S.Progression of periodontal disease in adult subjects in the absence of periodontal therapy.J Clin Periodontal1983; 10: 433–442.
23.
LöeH.AnerudA.BoysenH.SmithM.The natural history of periodontal disease in man. The rate of periodontal destruction before 40 years of ageJ Periodontal1978; 49: 607–620.
24.
MicheelisW.BauchJ.Mundgesundheitszustand und -verhalten in der Bundesrepublik Deutschland Institut der Deutschen Zahnärzte (IDZ).Deutscher Ärzteverlag Köln, 1991; a.b,c,d,e: 207,216,220.
25.
O'LearyT.J.DrakeR.B.NaylorJ.E.The plaque control record.J Clin Periodontal1972; 43: 38–42.
26.
PistoriusA.Epidemiologische Untersuchungen über den Mundbefund bei Patienten der Poliklinik für Zahnerhaltung und Parodontologie. München: Med. Dissertation; 1992.
27.
RamfjordS.P.Indices of prevalence and incidence of periodontal disease.J Periodontal1959; 30: 51–59.
28.
RamstadT.Effects of improved surgery on the prosthodontic treatment of unilateral complete cleft patients. In: KehrerB.SlongoT.GrafB.BettexM., eds. Longterm Treatment in Cleft Lip and Palate.Bern. Switzerland: Huber1981: 322–332.
29.
RateitschakK.H.Herzog-SpechtF.A.Reaktion und Regeneration des Parodonts auf orthodontische behandlung mit festsitzenden Apparaten.Schweiz Mschr Zahnheilk1965; 75: 741–746.
30.
ReitanK.Continous bodily tooth movement and its histological significance.Acta Odantol Scand1947; 6: 115–118.
31.
ReitanK.Some factors determining the evaluation of forces in orthodontics.Am J Orthod1957; 43: 32–36.
32.
ReitanK.Biomechanical principles and reaction. In: GraberT.M.SwainB.E. eds. Orthodontics, Current Principles and Techniques. Vol 13. St. Louis And Toronto: V. Mosby; 1988.
33.
Sanvenero-RoselliG.Verschluß von Gaumenspalten unter Verwendung von Pharynxlappen.Fortschr Kiefer Gesichtschir1955; 1: 65–69.
34.
SilnessJ.Periodontal conditions in patients treated with dental bridges.J Periodontal Res1979; 5: 60–68.
35.
SilnessJ.GustavsenF.Alveolar bone loss in bridge recipients after six and twelve years.Int Dent J1985; 35: 297–300.
36.
SuomiD.J.GreeneJ.C.VermillionJ.R.DoyleJ.ChangJ.I.LearherwoodE.C.The effect of controlled oral hygene procedures on the progression of periodontal disease in adult: results after third and final year.J Periodontal]1971; 42: 152–160.
37.
TennisonC.W.The repair of the unilateral cleft lip by the stencil methode, Plast Reconstr Surg1952; 8: 115–120.
38.
ValderhaugJ.Periodontal conditions and caries lesions following the insertion of fixed prostheses: a 10 year follow-up study.Int Dent J1980; 30: 296–304.
39.
WainwrightW.M.Faciolingual tooth movement: influence on the root and cortical plate.Am J Orthod1973; 65: 278–283.
40.
WehrbeinH.DietrichP.Parodontale Veränderungen nach orthopädischer Zahnbewegungeine retrospektive histologische Studie am Menschen.Fortschr Kieferorthop1992; 53: 167–171.
41.
WHO.Epidemiology, etiology, and prevention of periodontal diseases.WHO Tech Rep1978; 62l.
42.
WidmairW.Ein neues Verfahren zum Verschluβ von Gaumenspalten.Chirurg1959; 30: 274–278.
43.
ZachrissonB.U.AlnaesL.Periodontal condition in orthodontically treated and untreated individuals. I. Loss of attachment, gingival pocket depth and clinical crown hight.Angle Orthod1973; 43: 43–46.
44.
ZachrissonB.U.AlnaesL.Periodontal condition in orthodontically treated and untreated individuals II. Alveolar bone loss: radiographic findings, Angle Orthod1974; 44: 48–51.
