Preliminary study of Korean orthodontic residents' current concepts and knowledge of cleft lip and palate management

Abstract

Objective: A national survey was conducted to assess orthodontic residents' current concepts and knowledge of cleft lip and palate (CLP) management in Korea.

Methods: A questionnaire consisting of 7 categories and 36 question items was distributed to 16 senior chief residents of orthodontic department at 11 dental university hospitals and 5 medical university hospitals in Korea. All respondents completed the questionnaires and returned them.

Results: All of the respondents reported that they belonged to an interdisciplinary team. Nineteen percent indicated that they use presurgical infant orthopedic (PSIO) appliances. The percentage of respondents who reported they were 'unsure' about the methods about for cleft repair operation method was relatively high. Eighty-six percent reported that the orthodontic treatment was started at the deciduous or mixed dentition. Various answers were given regarding the amount of maxillary expansion for alveolar bone graft and the estimates of spontaneous or forced eruption of the upper canine. Sixty-seven percent reported use of a rapid maxillary expansion appliance as an anchorage device for maxillary protraction with a facemask. There was consensus among respondents regarding daily wearing time, duration of treatment, and amount of orthopedic force. Various estimates were given for the relapse percentage after maxillary advancement distraction osteogenesis (MADO). Most respondents did not have sufficient experience with MADO.

Conclusions: These findings suggest that education about the concepts and methods of PSIO and surgical repair, consensus regarding orthodontic management protocols, and additional MADO experience are needed in order to improve the quality of CLP management in Korean orthodontic residents.

Keywords: Cleft lip and palate management; Korea; Orthodontic training programs.

Figure 1

Types of presurgical infant orthopedic appliance.

Figure 2

Cleft lip (CL) repair. A, Operation timing; B and C, operation method for unilateral and bilateral CL.

Figure 3

Cleft palate repair. A, Operation timing; B, concept of stage; C, operation method.

Figure 4

Early orthodontic treatment for cleft patients. A, Timing; B, primary goals.

Figure 5

Criteria for the determination of alveolar bone graft timing.

Figure 6

Estimates of the percentage of eruption of the upper permanent canine after alveolar bone grafting. A, Percentage of spontaneous eruption; B, percentage of window opening and forced eruption.

Figure 7

Maxillary protraction with facemask (MP-FM). A, Preferred anchorage device; B, preferred method of the maxillary expansion when using MP-FM with a rapid maxillary expansion appliance; C, preferred site for installation of the skeletal anchorage system; D, average treatment duration. REM, Rapid maxillary expansion.

Figure 8

Surgical correction for cleft patients. A, Timing of maxillary advancement distraction osteogenesis (MADO); B, criteria for differential diagnosis of maxillary advancement with LeFort I osteotomy between conventional orthognathic surgery (COS) and MADO; C, estimates of relapse percentage after COS (gray) and MADO (black); D, estimates of the percentage of cleft patients who require COS and MADO in spite of growth modification.