Journal of Dental Medicine

Background and Aims: Cleft lip and palate patients require orthodontic treatments during their childhood and adolescence. Tweed diagnostic triangle as well as cephalometric assessments provides important data regarding the skeletal patterns for the treatment and diagnostic purposes. The present study determined the cephalometric changes of Tweed triangle in the cleft lip and palate patients compared to normal patients.

Materials and Methods: In total, 101 cleft and palate patients as well as 95 normal individuals with the balanced age, gender and race were evaluated. All the cleft and palate patients had similar treatment histories. Radiographic clichés were obtained from both groups and the images were traced after identifying the anatomic landmarks. The studied landmarks included points, lines, and plans as well as dental and skeletal angles and distance ratios measured in radiographic images. The landmarks were statistically analyzed using Student t test.

Results: Significant differences were found between the cleft lip and palate patients and normal individuals regarding craniofacial complex morphology (P<0.001). Gender did not show significant effect on the cephalometic indices changes (except to IMPA and FMIA angles). Tweed angle changes were more in the males than that of females between normal and cleft lip and palate patients. Mandibular retrusion (decreased SNB), gonial angle opening, increased mandibular plan inclination and facial anterior height were similar in the normal and cleft lip and palate individuals while no significant differences were found between two groups regarding cranium indices (P>0.05).

Conclusion: In total, significant differences were observed between normal and cleft lip and palate individuals regarding Tweed diagnostic triangle area. These differences were decreased IMPA and increased FMA and FMIA angles. No significant differences were found in terms of other indices.

Background and Aims: Cleft lip and palate is among challenging dentistry problems that calls for a multidisciplinary treatment approach. The treatment protocols in adults aims to improve function, appearance, and psychological conditions. The present article aimed in introducing the procedure of conventional prosthesis application for treatment of an adult patient focusing on complicated intra-operatory challenges.
Materials and Methods: A 52-year-old male patient was referred for correcting his functional deficiency resulted from bilateral cleft lip and palate. After surgical stent fabrication and vestibuloplasty, transitional prosthesis was fabricated using “Melted-sugar method”. Six month later, Richmond copings and fixed prostheses were made and the treatment was completed by delivery of mandibular removable partial prosthesis and maxillary obturator. Finding the correct position of hard palate, not interfering with normal phonetic, and hollowing his obturator, along with stablishing correct vertical dimension were among several challenges call for special considerations.
Conclusion: Following sound procedure, the conventional prosthetic treatment could be considered as an acceptable and applicable treatment option for adults suffering from untreated cleft palate, who are not good candidates for more complicated treatment procedures.

Background and Aims: The incisive canal cyst also known as nasopalatine duct cyst (NPDC) is the most common developmental non odontogenic cyst and it is usually asymptomatic with a well corticated round, ovoid or in some cases unique heart shaped radiolucent radiographic finding. Its accurate diagnosis from odontogenic cysts, odontogenic tumor, and benign non-odontogenic tumors using clinical and radiographic findings leads to eradication of pathologic condition with minimum residual defects and patient discomfort. In this case report, the clinical and radiographic findings of a 60-year-old female with the chief complaint of swelling was reviewed. There were typical histologic and radiographic findings related to nasopalatine duct cyst. The surgical management is explained. Follow up visit showed satisfactory healing and no dehiscence. It could be suggested that heart shaped radiographic finding in 3-D reconstructed image in the maxillary midline would be a good predictor for NPDC.

Background and Aims: Recently, the use of the palatal process as a source of autogenous bone graft has been considered. Given the anatomical limitations of this space, the assessment of available bone in this area can play an important role in the correct treatment plan. The aim of this study was to assess the amount and density of available bone for the preparation of autogenous graft from the maxillary palatal process using CBCT (Cone Beam Computed Tomography).
Materials and Methods: This cross-sectional analytical study was conducted by collecting CBCT images from 78 patients referred to one of the maxillofacial radiology clinics in Kermanshah in 2022 and 2023. All the patients had no signs of trauma, impacted teeth, pathological lesions, cleft palate, severe periodontitis, or extensive surgery, and also had all the teeth in the area of interest (right first premolar to left first premolar) and their bone growth was completed (age over 20 years). The CBCT images were collected and analyzed using the ondemand program. Different indices such as the area of each cross-sectional slice, bone volume (main variable) were measured with the help of mathematical formula, bone density, and incisive canal diameter. In order to test the hypotheses, the Smirnov-Kolmogorov test was used to check the normality of data, and since none of our variables were normal, we used Spearman and Mann-Whitney correlation tests.
Results: This study was conducted on 78 subjects with a mean age of 43 years, 39 of whom were female and 39 of whom were male. The mean bone volume obtained was 1.84 cm3. The highest bone density was observed in the lateral incisor region and the mean incisal canal diameter was reported to be 2.68 mm. According to the results of the Spearman test, none of the variables had a significant relationship with the age variable. According to the results of the Mann-Whitney test, there was no significant difference in bone density in the lateral, canine, and premolar tooth areas between men and women. However, available bone volume was associated with gender, and this amount was calculated to be greater in men than in women.
Conclusion: According to the findings of this study, the average bone volume in the anterior region of maxilla was 1.51 cm3 and the highest bone density was in the lateral tooth region. The average incisal canal diameter was 2.68 cm3 and the available bone volume was related to gender and this value was higher in men than that of women. However, there was no difference in the bone density between men and women.