Bonded maxillary expander in growing patients with or without unilateral cleft lip and palate: How does it influence transversal and vertical dentoskeletal changes?

Abstract

Objectives Growing patients with unilateral cleft lip and palate (UCLP) usually show maxillary retrusion with constricted upper arch. Thus, orthodontic treatment with maxillary expansion is often needed. This study aimed to evaluate transversal and vertical changes in patients with or without UCLP after maxillary expansion. Material and Methods This observational retrospective study included patients aged between 7 and 14 years, with UCLP (test group) or without cleft lip and palate (controls), constricted upper arch and normodivergent growth pattern treated with a bonded maxillary expander. Patients with craniofacial syndromes, previous orthodontic treatment, or incomplete records were excluded. The digital dental casts and lateral radiographs of the head before (T0) and after treatment (T1) were collected and digitized by scanning with the 3ShapeTRIOS®. Statistical analysis was performed with STATA software. The Chi-square test was used for sex data in the two groups, and evaluation of the differences between the two groups was performed with the independent samples. P < 0.05 was considered statistically significant. Results The study sample included 51 patients (10.0 ± 2.5 years), 21 patients with UCLP, and 30 patients as the control group. Before treatment, all the transversal values measured on the maxillary arch at the occlusal and gingival level, as well as the length of the arch, presented statistically significant differences between the two groups with P < 0.05. The comparison at T1 did not show significant differences between the two groups for the transversal values, except for the value measured between the second premolars at the gingival level ( P < 0.05). The cephalometric values measured in the analysis in the two groups did not show a statistically significant difference, except for the I-SN who showed significant differences both at T0 and T1 due to the presence of previous scars in UCLP patients. Conclusion The UCLP group showed an improvement in all transverse diameters after treatment with the bonded maxillary expander without affecting the mandibular divergence and incisor inclination.