Effects of Lip Thickness on Alveolar Bone Grafting Outcomes in Patients with Complete Unilateral Cleft Lip and Palate: Finite Element Analysis
Objective of this pilot study was to define a relationship of upper lip thickness and alveolar bone grafting outcomes in patients with complete unilateral cleft lip and palate. Occlusal topographic radiographs and lateral cephalograms, at 1 month and 1 year after alveolar bone grafting of 10 patients were assessed to evaluate changes of grafted bone height percentages. Three-dimensional finite element models were created to reveal a relationship of lip thickness and force loaded on the maxilla. The results showed a statistically significant correlation between lip thickness and postsurgical graft alveolar bone height ratio: the less lip thickness, the less alveolar bone graft height remaining. Moreover, a finite element study result also indicated that the less lip thickness, the more loaded force on maxilla. These concluded that lip thickness might be a factor affecting alveolar bone grafting outcomes.
1. Gabka J. : Aetiology and statistics of harelips and cleft palate. Wallace AB, ed. Transactions of the International Society of Plastic Surgeons and Congress : 1960, at Livingstone Edinburgh.
2. Bianchi DW, Crombleholme TM, DíAlton ME. Fetology : Diagnosis and management of the fetal patient. New York: Mc Graw-Hill; 2000: 198-207.
3. Tan KI. Incidence and epidemiology of cleft lip / palate in Singapore. Ann Acad Med Singapore 1988; 17: 311-4.
4. Chuangsuwanich A, Aojanepong C. Epidemiology of cleft lip and palate in Thailand. Ann Plast Surg 1998; 41: 7-10.
5. Waitzman AA, Posnick JC, Armstrong DC, Pron GE. Craniofacial skeletal measurements based on computed tomography: Part II. Normal values and growth trends. Cleft Palate Craniofac J 1992; 29(3): 118-28.
6. Harris EF, Hullings JG. Delayed dental development in children with isolated cleft lip and palate. Arch Oral Biol 1990; 35: 469ñ73.
7. Ranta R. A review of tooth formation in children with cleft lip/palate. Am J Orthod Dentofacial Orthop 1986; 90: 11-8.
8. Filho OGS, Neto JV, Filho LC, Freitas JAS. Influence of lip repair on craniofacial morphology of patients with complete bilateral cleft lip and palate. Cleft Palate Craniofac J 2003; 40(2): 144-53.
9. Barry LE. Alveolar cleft bone grafting (Part I): Primary bone grafting. J Oral Maxillofac Surg 1996; 54(1): 74-82.
10. Dewinter G. Dental abnormalities, bone graft quality, and periodontal conditions in patients with unilateral cleft lip and palate at different phases of orthodontic treatment. Cleft Palate Craniofac J 2003; 40(4): 343-50.
11. Brattström V, McWilliams J. The influence of bone grafting age on dental abnormalities and alveolar bone height in patients with unilateral cleft lip and palate. Eur J Orthod 1989; 11: 351ñ8.
12. Silva Filho OG, Lauris RCMC, Capelozza Filho L, Semb G. Craniofacial morphology in adult patients with unoperated complete bilateral cleft lip and palate. Cleft Palate Craniofac J 1998; 35: 111-9.
13. Batra PA, Sharma JB, Duggal RC, Hariparka SH. Secondary bone grafting in cleft lip and palate with eruption of tooth into the graft: A case report. J Indian Soc Pedod Prev Dent 2004; 22(1): 8-12.
14. Bergland O, Semb G, Abyholm FE. Elimination of the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment. Cleft Palate J. 1986; 23: 175-205.
15. Helms JA, Speidel TM, Denis KL. Effect of timing on long-term clinical success of alveolar cleft bone grafts. Am J Orthod Dentofacial Orthop 1987; 92: 232-40.
16. Long RE, Sprangler BE, Yow M. Cleft width and secondary alveolar bone graft success. Cleft Palate J 1995; 35: 420-6.
17. Witherow H, Cox S, Jones E, Carr R, Waterhouse N. A new scale to assess radiographic success of secondary alveolar bone grafts. Cleft Palate Craniofac J 2002: 39(3): 255-60.
18. Broadbent BH. A new X-ray technique and its application in orthodontics. Angle Orthod 1931: 45-60.
19. Athanasiou AE. Orthodontic cephalometry. 1st ed. London: Mosby; 1997.
20. Papadopoulos MA, Jannowitz C, Boettcher P, Henke J, Stolla R, Zeilhofer HF, Kovacs L, Erhardt W, Biemer E, Papadopulos NA. Three-dimensional fetal cephalometry: An evaluation of the reliability of cephalometric measurements based on three-dimensional CT reconstructions and on dry skulls of sheep fetuses. J Cranio Maxill Surg 2005; 33(4): 229-37.
21. Waitzman AA, Posnick JC, Armstrong DC and Pron GE. Craniofacial skeletal measurements based on computed tomography: Part III. Normal values and growth trends. Cleft Palate Craniofac J 1992; 29: 118-28.
22. ธงชัย ฟองสมุทร. วิธีไฟไนต์เอลิเมนต์เบื้องต้น. เชียงใหม่ : หจก. ดาราวรรณการพิมพ์, 2549: 3-6
23. Zienkiewicz OC. The finite element method in engineering science. 1st ed. London: McGrawHill; 1977.
24. Jones ML, Hickman J, Middleton J, Knox J and Volp C. A validated finite element method study of orthodontic tooth movement in the human subject. J Orthod 2001; 28(1), 29-38.
25. Williams KR, Edmondson JT, Morgan G, Jones ML, Richmond S. Orthodontic movement of a canine into an adjoining extraction site. J Biomed Eng 1986; 8: 115-20.
26. Nyashin MY, Pechenov VS and Rammerstorfer FG. Determination of optimal orthodo-ntic forces. Russ J Biomechanics 1997; 1(1-2): 84-96.
27. Katada H, Katada H, Isshiki Y. Changes in orthodontic cephalometric reference points on application of orthopedic force to jaw: threedimensional finite element analysis. Bull Tokyo Dent Coll 2005; 46(3): 59-65.
28. Chang YI, Shin SJ, Baek SH. Threedimensional finite element analysis in distal en masse movement of the maxillary dentition with the multiloop edgewise archwire. Eur J Orthod 2004; 26(3): 339-45.
29. Rudolph DJ. Willes PMG, Sameshima GT. A finite element model of apical force distribution from orthodontic tooth movement. Angle Orthod 2001; 71(2): 127-31.
30. Zhao L, Patel PK. : Three dimensional finite element analysis of axillary palate with a unilateral cleft. ISB 20th Congress - ASB 29th Annual Meeting 31 July-5 August 2005, at Cleveland, Ohio.
31. Pegoretti A. Finite element analysis of glass fibre reinforced composite endodontic post. Biomaterials 2002; 23(13): 2667-82.
32. Basu S. A three-dimensional model of human lip motion. Master of Engineering in Electrical Engineering and Computer Science. Massachusetts Institute of Technology, 1997.
33. Van der Meij AJ, Baart J, Prahl-Andersen B, Valk J, KostensePJ, Tuinzing DB. Computed tomography in evaluation of early secondary bone grafting. Int J Oral Maxillofac Surg 1994; 23: 132-6.
34. Van der Meij AJ, Baart JA, Prahl-Andersen B, Kostense PJ, van der Sijp JR, and Tuinzing DB. Outcome of bone grafting in relation to cleft width in unilateral cleft lip and palate patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003; 96(1): 19-25.
35. Lilja J, Kalaaji A, Friede H, Elander A. Combined bone grafting and delayed closure of the hard palate in patients with unilateral cleft lip and palate: Facilitation of lateral incisor eruption and evaluation of indicators for timing of the procedure. Cleft Palate Craniofac J 2000; 37(1): 98-105.
36. Gundlach KK, Behlfelt K, Pfeifer G. The maxillary arch in 8-and 16-year old patients with complete unilateral clefts treated according to the Hamburg regimen. In: Pfeifer G, ed: Craniofacial abnormalities and clefts of lip, alveolus and palate; Vol I. George Thieme Verlag, Stuttgart: 1991: 256-257.
37. Enemark H, Sindet-Pedersen S, Bundgaard M. Long-term results after secondary bone grafting of alveolar clefts. J Oral Maxillofac Surg 1987; 45(11): 913-8.
38. Brock RA 2nd, Taylor RW, Buschang PH, Behrentsd RG. Ethnic differences in upper lip response to incisor retraction. Am J Orthod Dentofacial Orthop 2005; 127(6): 683-91.
39. Normando ADC, Silva Filho OG and Capelozza Filho L. Influence of surgery on maxillary growth in cleft lip and/or palate patients. J Cranio Maxill Surg 1992; 20(3): 111-8.