published_or_final_version / Dental Surgery / Master / Master of Dental Surgery

published_or_final_version / Dentistry / Master / Master of Dental Surgery

Indiana University-Purdue University Indianapolis (IUPUI) / The Riley Children's Hospital Craniofacial Anomalies Team rigorously follows a treatment protocol developed by Dr. Sheldon Rosenstein for the treatment of cleft lip and palate patients. Rosenstein's protocol incorporates primary bone grafting and alveolar molding appliances for cleft lip and palate patients. While other cleft lip and palate treatment centers utilize alveolar molding appliances, there remains debate concerning the efficacy of primary bone grafting. The principal detraction of primary bone grafting is the concern that such early surgical treatment affects maxillary and craniofacial growth and development. The purpose of this retrospective study was to analyze post-treatment lateral head plates and dental casts of cleft lip and palate circumpubertal patients treated in infancy at Riley Hospital in Indianapolis by the Craniofacial Team following Rosenstein's protocol. The hypothesis was that primary alveolar bone grafting in conjunction with the use of alveolar molding appliances contributes to the early stabilization of the alveolar segments, and produces no statistically significant difference in craniofacial development among primary bone grafted patients and nongrafted patients. The dental arch dimensions of the nongrafted patients (control group) consisted of the same data utilized by Moorrees in his study of the dentition of the growing child. The dental arch dimensions of nongrafted cleft patients consisted of the same data utilized by Athanasiou in his study of the dentition of cleft patients treated surgically without bone grafting. Of the eight measurements made by the three examiners, six demonstrated excellent interexaminer agreement, one demonstrated moderate interexaminer agreement, and one demonstrated poor interexaminer agreement. The arch width and length for the grafted group was significantly smaller (p < .05, Student's t-test) than the normal group in all measures except for the mandibular canine width. The arch width and length for the grafted group was not significantly different (p < .05, Student's t-test) than the nongrafted group, except for the maxillary molar width where the grafted group was smaller than the nongrafted group. The cephalometric values of the Riley group were compared against a nongrafted group, an early primary grafted group, and the Bolton standard values cited in Rosenstein's study. The Bolton standard values were used as the control group. This study found the cephalometric values of the Riley experimental group (treated following Rosenstein's protocol) to be of no statistically significant difference (p < .05, Students t-test) when compared with cephalometric values of the nongrafted and primary alveolar grafted groups cited in Rosenstein's 1982 study. The cephalometric values of the Riley experimental group were less than the cephalometric values of the nonclefted patients (Bolton standard control group) cited in Rosenstein's 1982 study. Interexaminer agreement ranged from poor to good with the poorest agreement among the linear values of ANS/PNS and GO/ME. The intraclass correlation coefficient values for SNA,m ANB, and SNB ranged from fair to moderate. The Riley cephalometric values were equal or slightly better than Rosenstein's grafted and nongrafted groups. Though smaller than the control group, the Riley cephalometric values were of no statistical significance (p < .05, Students t-test) when compared with the same parameters cited in Rosenstein's study. Although these findings infer that the patients treated following Rosenstein's protocol demonstrate some degree of craniofacial growth attenuation when compared with nonclefted patients (Bolton standard control group), the Riley patients showed no worse growth attenuation than similar patients treated without Rosenstein's protocol for primary alveolar grafting. The hypothesis of this thesis was that Rosenstein's protocol was viable and non-detrimental when compared with other treatment regimens. The results of this study support the hypothesis that Rosenstein's surgical protocol is not a contributing factor in craniofacial growth attenuation among cleft lip and palate patients.