KATASONOVA ELENA SERGEYEVNA Justification for application of new technologies at the early stages of congenital bilateral cleft lip and palate treatment in children 14.00.21 – Dentistry Summary Purpose of the study was to improve comprehensive treatment of children with congenital bilateral cleft lip and palate by innovative technologies.
We observed 80 children with congenital bilateral cleft lip and palate from the neonatal period up to the age of 3. According to the methods of treatment, they were divided as follows: 1) 30 patients with no preoperative orthodontic preparation; 2) 32 patients prepared for surgery using the method of T.V. Sharova; 3) 18 patients prepared for surgery using innovative methods.
Generally accepted clinical and laboratory examination and anthropometric studies were applied to all children with congenital bilateral cleft lip prior to surgery.
Evaluation of upper jaw bone development in children with congenital bilateral cleft lip and palate was performed in compliance to our study modification of control and diagnostic models according to G.V. Dolgopolova (2003). If upper jaw bone was sharply pronounced, computerized tomography was carried out on CT-scanner Somatom-CR (Siemens) using 3D bone reconstruction program with a purpose to plan the location of the fixing members of orthodontic appliance and mini implants (Absoanchor, Dentos corporation, Taegu, Korea).
Analysis of study results of children diagnostic models with congenital bilateral cleft lip and palate revealed various degrees of lateral fragments deformation in upper ridge and intermaxillary bone, its deviation angle from the midline (first, second and third degrees of severity of intermaxillary bone deformation). This allows differential approach to various methods of preoperative preparation of children with this pathology.
The use of non-removable intraosseous mini-implants in preoperative preparation of children with bilateral cleft lip and palate is the first experience in the Republic of Kazakhstan. Indication for use is considered to be the third degree of severity of intermaxillary bone and neighboring bone structure deformities (protrusion of intermaxillary bone up to 25 mm, deviation angle from the midline more than 11 degrees, distance between the lateral fragments of the upper ridge more than 25 mm). Taking foreign experience as a basis, we have applied this method of treatment to children from the age of 3 months and older taking into account the degree of intermaxillary bone deformation.
Surgical protocol of implant installation for supporting orthodontic non-removable appliances with intraosseous fixation in children with congenital bilateral cleft lip and palate did not differ from standard methods of dental implantation which was carried out carefully on the hard palate. Implants that are installed on the hard palate have shorter length (4-6 mm) which depends on the available bone volume.
Depth of implant penetration in the bone depended on the way of subsequent wiring. If the wire was to be directly fixed by loop and screw, the implant neck was located 1-2 mm above the bone surface for the sake of convenience. If for wire fixing a special suprastructure was used, the implant completely penetrated the formed bone bed. The operation was performed under general anesthesia. Non-removable device fixation was performed using microscrews applied in maxillofacial surgery.
The next step was adaptation to the device, adjustment of feeding and training to hygiene care for the device and oral cavity. Depending on the state of health, children were discharged from the hospital 6-7 days after the surgery under the care of orthodontist.
After adaptation to the device, screw activation of 0.5 mm was carried out once every two days with single-step activation of elastic rod one link every three days. The active period lasted from 20 to 30 days. One of significant steps was retention period which ranged from 15 to 30 days. After this period had been finished, the device was removed, and one-stage bilateral cheiloplasty was immediately performed.
When using microimplants without orthodontic appliance, reposition of jaw fragments and normalization of dentoalveolar arch was observed 1 month after initiation of orthodontic treatment.
Anthropometric data obtained from models of children jaws with congenital bilateral cleft lip and palate prepared for surgery by various methods showed absolute advantage of innovative technologies. Compared with findings obtained in patients without preoperative preparation or prepared by method of T.V. Sharova, the patients prepared for surgery using non-removable orthodontic appliances fixed by microimplants achieved full face contact between intermaxillary bone and upper jaw fragments which was confirmed by statistical data processing (R<0.05).
Thus, inclusion of innovative technologies in comprehensive treatment of children with congenital bilateral cleft lip and palate normalizes position of intermaxillary bone and upper jaw shape within 1-2 months and allows performance of primary single-step bilateral cheiloplasty in optimal time which generally completes rehabilitation time of patient with complex maxillofacial area pathology at preschool age which significantly reduces patient disability terms.