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COMMENTARY
Year : 2017  |  Volume : 4  |  Issue : 3  |  Page : 187-188

Three methods comparison using two-dimensional software (a novel technique), three-dimensional-cone-beam computed tomography, and manual method to measure maxillary casts: Unilateral and bilateral cleft lip and palate infants up to 6 months


Department of Orthodontics, Manipal College of Dental Science, Manipal University, Manipal, Karnataka, India

Date of Web Publication21-Nov-2017

Correspondence Address:
N Madhumitha
Room 7, 2nd Floor, Dental OPD, Department of Orthodontics, Manipal College of Dental Science, Manipal University, Manipal - 576 104, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jclpca.jclpca_96_17

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How to cite this article:
Madhumitha N. Three methods comparison using two-dimensional software (a novel technique), three-dimensional-cone-beam computed tomography, and manual method to measure maxillary casts: Unilateral and bilateral cleft lip and palate infants up to 6 months. J Cleft Lip Palate Craniofac Anomal 2017;4, Suppl S1:187-8

How to cite this URL:
Madhumitha N. Three methods comparison using two-dimensional software (a novel technique), three-dimensional-cone-beam computed tomography, and manual method to measure maxillary casts: Unilateral and bilateral cleft lip and palate infants up to 6 months. J Cleft Lip Palate Craniofac Anomal [serial online] 2017 [cited 2022 Jul 6];4, Suppl S1:187-8. Available from: https://www.jclpca.org/text.asp?2017/4/3/187/218905

Sir,

Transverse maxillary dimensions of cleft palates have been researched by several authors using three-dimensional (3D) digital models showing maxilla of unilateral cleft palate changed after primary surgery[1] and an increased anterior maxillary dimension in complete cleft lip and palate group.[2] However, the use of maxillary casts for linear measurements using two-dimensional (2D) method was novel.

The authors had not mentioned the type of impression material (silicon impression material, impression compound, or alginate) used. The other option is a direct scanning of impression to generate digital models which is valid for measurements.[3] The linear measurements made using cone-beam computed tomography (CBCT) generated models and Anatomodels were not as accurate as Digimodels (Digimodels of impressions).[4] Hence, the reason for choosing CBCT generated models was not discussed by authors.

The authors have also failed to mention whether any obturator appliance or nasoalveolar molding performed (for the cleft palate group) before start of the study, which could affect the transverse dimension of maxilla. The inclusion criteria, exclusion criteria, or the type of cleft of the sample group was not elaborated too. If complete clefts were included, the width of posterior cleft could have been evaluated and compared to an age-matched control group without cleft palate. Therefore, the measurements of cleft width are key to the rehabilitation process. A wider Inter-canine and anterior cleft width were observed in digital models of unilateral cleft palate but a wider intertuberosity and posterior cleft in digital models of bilateral cleft palate of 3–9 month olds.[5]

The maxillary landmarks used for measurements on digital models and protocol for identification were not defined. The location of landmarks on neonatal cleft palate is difficult, and errors in landmark identification may affect linear and angular measurement,[6] and positioning landmarks in maxilla lead to errors of up to 1.5 mm on 2D model or up to 1.01 mm in 3D models.[7]

The authors also failed to elaborate the standardization process for the digital photographs of the study models used. The sample group of cleft palate had a wide mean age (10 weeks to 6 months), and the procedure followed to avoid the intraexaminer bias was not explained.

In conclusion, measurements such as alveolar crest height, sagittal asymmetry, rotation of minor and major segments, cleft width, and bone loss within each cleft type also should be considered. Comparison of findings with unrepaired cleft palate group would have added value to research.

Acknowledgment

Manipal University, Karnataka, India, for providing library and scientific journals for the preparation of commentary.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Sakoda KL, Jorge PK, Carrara CF, Machado MA, Valarelli FP, Pinzan A, et al. 3D analysis of effects of primary surgeries in cleft lip/palate children during the first two years of life. Braz Oral Res 2017;31:e46.  Back to cited text no. 1
    
2.
Mello BZ, Fernandes VM, Carrara CF, Machado MA, Garib DG, Oliveira TM, et al. Evaluation of the intercanine distance in newborns with cleft lip and palate using 3D digital casts. J Appl Oral Sci 2013;21:437-42.  Back to cited text no. 2
    
3.
Wiranto MG, Engelbrecht WP, Tutein Nolthenius HE, van der Meer WJ, Ren Y. Validity, reliability, and reproducibility of linear measurements on digital models obtained from intraoral and cone-beam computed tomography scans of alginate impressions. Am J Orthod Dentofacial Orthop 2013;143:140-7.  Back to cited text no. 3
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4.
de Waard O, Rangel FA, Fudalej PS, Bronkhorst EM, Kuijpers-Jagtman AM, Breuning KH, et al. Reproducibility and accuracy of linear measurements on dental models derived from cone-beam computed tomography compared with digital dental casts. Am J Orthod Dentofacial Orthop 2014;146:328-36.  Back to cited text no. 4
    
5.
Fernandes VM, Jorge PK, Carrara CF, Gomide MR, Machado MA, Oliveira TM, et al. Three-dimensional digital evaluation of dental arches in infants with cleft lip and/or palate. Braz Dent J 2015;26:297-302.  Back to cited text no. 5
    
6.
Spauwen PH, Hardjowasito W, Boersma J, Latief BS. Dental cast study of adult patients with untreated unilateral cleft lip or cleft lip and palate in Indonesia compared with surgically treated patients in the Netherlands. Cleft Palate Craniofac J 1993;30:313-9.  Back to cited text no. 6
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7.
Boldt F, Weinzierl C, Hertrich K, Hirschfelder U. Comparison of the spatial landmark scatter of various 3D digitalization methods. J Orofac Orthop 2009;70:247-63.  Back to cited text no. 7
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