Department of Orthodontics

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https://hdl.handle.net/10566/406

The discipline of Orthodontics focuses on the growth and development of the craniofacial complex and dental occlusion, and the treatment of abnormalities related to these structures.

The Department of Paediatric Dentistry conducts an undergraduate and a postgraduate programme to enable students to manage the child dental patient. The postgraduate programmes consist of a postgraduate diploma in dentistry part-time and a masters programme full time.

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Assessment of Dental Arch Relationships in a sample of patients with Unilateral Cleft Lip and Palate in the Western Cape, South Africa
(University of the Western Cape, 2024) Galane, Mpatikana Leslie; Bellardie, Haydn
Unilateral cleft lip and palate (UCLP) is a specific form of orofacial cleft (OFC) that accounts for 23% of those born with clefts. In the Eastern Cape, Free State and Northern Cape provinces of South Africa (SA), the prevalence of OFCs is 0.1, 0.1, and 1.2 per 1000, respectively. UCLP is more common in males compared to females, with 2:1 gender distribution. In addition, UCLP has a strong predilection for the left side of the maxilla as compared to the right side. Individuals born with UCLP typically require several surgeries and/or other intricate procedures to rectify this anomaly. Individuals diagnosed with UCLP frequently exhibit a range of functional and aesthetic defects, in addition to the particular deformities associated with the condition. Complications related to UCLP include hypoplastic maxilla and a high incidence of Class III malocclusion. Children who are born with UCLP requires a complex management that starts with specialist nursing care, surgical repair on both the lip (which is generally done at three months of age) and the palate (at any time between six to 14 months of age). Several studies have verified that if the initial surgery is performed unskillfully, it can have a detrimental impact on the growth of the face, development of the dentition, and speech. Establishing a dependable approach for evaluating dental arch relationships is crucial in order to evaluate and contrast the outcomes of early management of UCLP in children.
A cephalometric and dental analysis of treatment outcomes of unilateral cleft lip and palate children treated at the Red Cross children's hospital
(University of the Western Cape, 2000) Kaskar, Salim; Bellardie, Haydn
This study was a cephalometric and dental investigation of the treatment outcomes of UCLP children treated at the Red Cross Children's Hospital (RCCH) with respect to craniofacial morphology and dental arch relationship. The quality of the outcome for the RCCH group was compared with the outcomes reported for the Six-Centre International Study (Melsted et al., 1992; Mars et al., 1992). The sample consisted of 20 (11 females, 9 males) consecutively treated UCLP children who had cephalometric and dental records taken between the ages of8 to 11years (mean 10.13 ± 1.2 years). The cephalometric analysis described by Melsted et al. (1992) was used to evaluate the skeletal and soft tissue morphology. The quality of the dental arch relationship was measured according to the Gosion Yardstick (Mars et al., 1987). The treatment outcome of children treated at the RCCH was evaluated with respect to craniofacial form and dental arch relationship. When comparing the mean cephalometric skeletal parameters of the RCCH to the six centres in the Eurocleft study, a significant difference was found between the RCCH group and centre D for most of the variables. A significant increase in the upper incisor inclination and maxillary inclination was found in the RCCH patients compared to the European centres. The difference in the soft tissue parameters was limited to the relative protrusion of the nose and the sagittal soft tissue variable sss-ns-pgs. The analysis of the Goslon scores showed a significant difference between the RCCH group and centres C, D, and F. According to the Goslon score, 85% of the RCCH patients had good to satisfactory dental arch relationship, which was comparable to that recorded for centres A(92%), B(89%) and C(94). In conclusion, the results of the cephalometric analysis and the Goslon Yardstick showed a significant difference between the RCCH group and centre D. The GosIon score indicated good quality of the dental arch relationship, which faired favourably with the better centres in the Six Centre Study.
Radiographic outcome of secondary alveolar bone grafting in patients with alveolar clefts
(John Wiley & Sons, 2021) Bellardie, Haydn
Objective: To determine the outcome of secondary alveolar bone grafting (SABG) in a series of consecutive patients with clefts involving the alveolus.Design and Setting: Retrospective cohort study of consecutive operations per-formed between June 2011 and September 2016 by a single surgeon at a single United Kingdom cleft center.Participants: A total of 160 patients with a cleft/s involving the alveolus, inclusive of syndromic patients and those with atypical facial clefts.Interventions: A standard protocol involved an oral hygiene program, pre-surgical orthodontics where necessary and autologous bone grafting from the iliac crest.Main Outcome Measure(s): The Kindelan bone-fill index was used to evaluate suc-cess using occlusal radiographs. Weighted Cohen's kappa coefficient was used as a measure of intra- and inter- rater agreement. Fisher's exact test was used to examine the effects of type of cleft, pre-surgical orthodontics or age at time of SABG on ra-diographic outcome.Results: There were 200 SABGs assessed. Mean age at time of SABG was 9.1 years old (SD 1.1) with 99% (n =198) of grafts deemed successful. There were two fail-ures where re- graft was performed successfully during the study period. A grade 1 outcome was achieved for 92.5% (n = 185) of grafts and this did not appear to be af-fected by type of cleft (P= .290), pre-surgical orthodontics (P= .380) or age at time of SABG (P= .081).Conclusions: The high success rate reported in this study supports the favorable out-comes of a high-volume cleft surgeon. These findings can be used for comparative audit with similar units providing cleft care.
Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: Comparison of dental arch relationships and dental indices at 5, 8, and 10 years
(Oxford University Press, 2021) Bellardie, Haydn; Heliövaara, Arja; Küseler, Annelise
Background and trial design: The Scandcleft intercentre study evaluates the outcomes of four surgical protocols (common method Arm A, and methods B, C, and D) for treatment of children with unilateral cleft lip and palate (UCLP) in a set of three randomized trials of primary surgery (Trials 1, 2, and 3). Objectives: To evaluate and compare dental arch relationships of 5-, 8-, and 10-year-old children with UCLP after four different protocols of primary surgery and to compare three dental indices. The results are secondary outcomes of the overall trial. Methods: Study models taken at the ages of 5 (n = 418), 8 (n = 411), and 10 years (n = 410) were analysed by a blinded panel of orthodontists using the Eurocran index, the 5-year-olds' (5YO) index, and the GOSLON Yardstick. Student's t-test, Pearson's correlation, chi-square test, and kappa statistics were used in statistical analyses. Results: The reliability of the dental indices varied between moderate and very good, and those of the Eurocran palatal index varied between fair and very good. Significant correlations existed between the dental indices at all ages. No differences were found in the mean 5-, 8-, and 10-year index scores or their distributions within surgical trials. Comparisons between trials detected significantly better mean index scores in Trial 2 Arm C (at all ages) and in Trial 1 Arm B (at 5 and 10 years of age) than in Trial 3 Arm D. The mean Eurocran dental index scores of the total material at 5, 8, and 10 years of age were 2.50, 2.60, and 2.26, and those of the 5YO index and GOSLON Yardstick were 2.77, 2.90, and 2.54, respectively. At age 10 years, 75.8% of the patients had had orthodontic treatment. Conclusions: The results of these three trials do not provide evidence that one surgical method is superior to the others. The reliabilities of the dental indices were acceptable, and significant correlations existed between the indices at all ages. The reliability of the Eurocran palatal index was questionable. Trial registration: ISRCTN29932826.
Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: dental anomalies in 8-year olds
(European Journal of Orthodontics, 2020) Bellardie, Haydn
Background: Children born with unilateral cleft lip and palate (UCLP) are reported to display several dental anomalies including agenesis, supernumeraries, as well as variations in dental size, shape, and path of eruption. The extensive sample of individuals with UCLP included in the Scandcleft randomized control trials offers the opportunity to study more rare conditions, which is seldom possible with limited samples. Objectives: The aim was to study dental anomalies at 8 years of age in children born with UCLP included in the Scandcleft randomized control trials. Methods: Panoramic and intraoral radiographs from 425 individuals (279 males and 146 females) with a mean age of 8.1 years were assessed by four orthodontists regarding dental anomalies. Results: Agenesis was found in 52.5 per cent and supernumerary teeth in 16.9 per cent of the participants. The cleft lateral was missing in 43.8 per cent and was found peg shaped in 44.7 per cent. The distribution of ectopic eruption was 14.6 per cent, mainly affecting maxillary first molars, while transposition was found in 3.4 per cent of the individuals. In addition, infraocclusion of one or several primary molars was registered in 7.2 per cent of the participants. Conclusion: We conclude that 8-year-old children born with UCLP display multiple dental anomalies. The Scandcleft sample allowed rarely studied conditions such as infraocclusion of primary molars and transposition to be studied in children born with UCLP
Scandcleft randomized trials of primary surgery for unilateral cleft lip and palate: maxillary growth at eight years of age
(European Journal of Orthodontics, 2022) Bellardie, Haydn
Objectives: To assess differences in craniofacial growth at 8 years of age according to the different protocols for primary cleft surgery in the Scandcleft project. Design and setting: Prospective, randomized, controlled clinical trial (RCT) involving 10 centres, including non-syndromic Caucasians with unilateral cleft lip and palate (UCLP). In Trial 1, a common surgical method (1a) with soft palate closure at 3–4 months of age and hard palate closure at 12 months of age was tested against similar surgery but with hard palate repair at 36 months (delayed hard palate closure) (1b). In Trial 2, the common method (2a) was tested against simultaneous closure of both hard and soft palate at 1 year (2c). In Trial 3, the common method (3a) was tested against hard palate closure together with lip closure at 3 months of age and soft palate closure at 1 year of age (3d). Participants were randomly allocated by use of a dice. Operator blinding was not possible but all raters of all outcomes were blinded. Subjects and methods: The total number of participating patients at 8 years of age was 429. Lateral cephalograms (n = 408) were analysed. The cephalometric angles SNA and ANB were chosen for assessing maxillary growth for this part of the presentation. Results: Within each trial (Trial 1a/1b, Trial 2a/2c, and Trial 3a/3d), there was no difference in cephalometric values between the common and the local arm. There were no statistically significant differences in the SNA and ANB angles between the common arm in Trial 1a (mean SNA 77.8, mean ANB 2.6) and Trial 2a (mean SNA 79.8, mean ANB 3.6) and no difference between Trial 1a and Trial 3a, but a statistical difference could be seen between Trial 2a and Trial 3a (mean SNA 76.9, mean ANB 1.7). However, the confidence interval was rather large. Intra- and inter-rater reliability were within acceptable range.

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