Long-term follow-up study of patients with a unilateral complete cleft of lip, alveolus, and palate following the Utrecht treatment protocol: dental arch relationships

Publication date: Available online 6 February 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Isabelle Francisca Petronella Maria Kappen, Gerhard Koendert Peter Bittermann, Dirk Bitterman, Aebele Barber Mink van der Molen, William Shaw, Corstiaan Cornelis Breugem
ObjectiveThis study sought to evaluate long-term dental arch relationships in adults with a unilateral complete cleft lip and palate (UCLP) treated by the Utrecht protocol and to compare results with the centers from the Eurocleft study.Materials and methodsRetrospective analysis of UCLP patients age 17 or older, treated by two-stage palate closure at the Wilhelmina Children's Hospital, a tertiary center for cleft surgery in Utrecht, the Netherlands. Patients were invited to the clinic for a long-term evaluation. Casts were obtained on the day of follow-up and assessed by the modified Goslon Yardstick for permanent dentition. Dental casts were scored twice by 3 different examiners.ResultsIntra-rater agreement varied from 0.743 to 0.844, the inter-rater agreement from 0.552 to 0.718. The mean Goslon Yardstick score was 3.3. Thirty-three percent of the patients had a Goslon score of 1 or 2, 45% had a score of 4 or 5.ConclusionsThe present study found unfavorable results regarding dental arch relationships after delayed hard palate closure at 3 years old. The mean Goslon Yardstick score was 3.3 (SD 1.4) and 45% of the casts were allocated to group 4 or 5 despite extensive orthodontic treatment. We observed a high number of secondary surgical interventions but no evident benefit regarding dental occlusion following the Utrecht treatment protocol, which includes a two-stage palatoplasty. Other factors than the timing of palate closure are likely of influence.



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