Changes in sagittal morphometric parameters of the upper jaw in children with congenital unilateral cleft lip and palate during orthodontic treatment

Abstract

Introduction. In case of congenital cleft lip and palate (CLP), the formation of occlusal relationships is significantly affected by changes in the anatomical and topographical parameters of the palate, small and large fragments of the jaw. Goal. To provide a description of the changes in sagittal morphometric parameters of the upper jaw in children with unilateral CLP during orthodontic treatment of deformations of the dentognathic apparatus. Materials and methods. The subject of the analysis was the morphometric measurements of scanned models of the upper jaws of patients with unilateral CLP (n=97) at the stage of primary surgical interventions and orthodontic correction at the age of 5–14 years using the developed method of determining the size of the defect and fragments of the upper jaw. Research results and their discussion. The results of the morphometric analysis of changes in the sagittal dimensions S1, S2, S3 of the bone components of the small and large fragments of the upper jaw and the sagittal dimension S2-3 of the closure deficiency are presented. It has been proven that patients with unilateral VNHP are characterized by a decrease in the anterior-posterior length of the upper jaw. When conducting research to determine the sagittal length of the upper jaw in case of unilateral through non-unions, it was established that the front part lags behind in development by an average of 2.17±0.22 mm, and between the tooth rows there is a progenic ratio of the type “false progeny”. At the same time, the priority components of deformations in the transverse and sagittal planes were established, which were observed in 90.5% and 88.3% of children, respectively, and combined pathologies in the sagittal and transverse planes – in 79.6%. Therefore, taking into account the detected deformities, the task of the orthodontist when working with the specified contingent of children is to use removable and/or non-removable structures in order to restore the function of the maxillofacial apparatus and prevent the development of persistent forms of maxillofacial deformities. The results of our research on the issue of choosing orthodontic structures largely coincide with the point of view of most scientists. The choice depends on the period of development of the maxillofacial apparatus, age, type of nonunion, stages, timing and volume of surgical interventions, quality and technique of the operation, psycho-emotional state of the child, factors of communication between the parents and the patient with the doctor, socio-economic components, and most importantly, on topographic features of deformed structures of the jaw and the severity of deformation in the transverse and sagittal planes. At the same time, an important issue is the correlation of diagnostic criteria that reflect the results of treatment. Conclusions. The comparison of central tendencies for pairs of independent samples of morphometric data of bone components of the upper jaw of patients and the presence of opposite effects regarding the change in S2-3 dimensions affects the choice of appliance designs depending on the plan for the correction of deformities of the dentognathic apparatus.