Assessment of the Dental Arch Relationship Using the 5-Year-Old Index after Early Two-stage Palatoplasty for Complete Unilateral Cleft Lip and Palate
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1 Assessment of the Dental Arch Relationship Using the 5-Year-Old Index after Early Two-stage Palatoplasty for Complete Unilateral Cleft Lip and Palate Department of Oral and Maxillofacial Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health (Chief: Director of Department Juntaro NISHIO) * Oral and Maxillofacial Surgery I, Division of Pathogenosis and Control of Oral Diseases, Integrated Oral Sciences and Stomatology, Osaka University Graduate School of Dentistry (Chief: Prof. Mikihiko KOGO) ** Department of Oral -Maxillofacial Surgery, Dentistry and Orthodontics, University of Tokyo Hospital (Chief: Prof. Tsuyoshi TAKATO)
2 Yoshiko HIRANO, Hiroshi KOHARA, Yusuke YOKOTA*, Chie KOBAYASHI, Juntaro NISHIO, and Takashi SUSAMI** Abstract: Objective: To compare deciduous dental arch relationships of patients with complete unilateral cleft lip and palate (UCLP) divided into two groups with differing primary protocols. Design: Retrospective study of treatment outcomes using blinded evaluation of dental <BR> study casts. Patients: 64 (two-stage group: 35, PB group: 29) consecutively treated 4-year-old patients <BR> with complete, nonsyndromic UCLP. Interventions: In bolth <BR> groups, passive presurgical orthopedics were used until 12 months and primary lip repair was completed at 3 months of age. In the two-stage group regimen, velar closure was completed with the modified Furlow procedure at 12 months of age and hard palate closure at 18 months of age with the Veau technique. In the PB group regimen, one-stage push back palatoplasty was completed at 12 months of age. Every operation was completed by one surgeon. Main outcome measure: Averaged ratings and score distributions of dental casts using <BR> the 5-Year- Old Index by three assessors were calculated. The 5-Year-Old Index is a clinical tool that allows categorization of the dental arch relationships of deciduous dentition in patients with UCLP into five groups (group 1: exellent, group 2: good, group 3: fair, group 4: poor, group 5: very poor). The weighted Kappa analysis was used to compare intra- and interexaminer reliability. Results: Intra- and interexaminer reliability tests showed good or excellent <BR> reliability. The mean score of the two-stage group was significantly better than that of the PB group. Most of the half numbers in the two-stage group were distributed in group 1 or group 2. Conclusions: The early two-stage palatoplasty regimen is less harmful <BR> to the maxillo-facial growth than the one-stage push back procedure at 12 months of age. Key words: japanese patients with complete unilateral cleft lip and palate, the early two-stage palatoplasty, dental arch relationship, push back procedure, 5-Year-Old Index
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4 後 方 移 動 す る こ とで軟 口蓋 を延 長 す る.ま た,鼻 側 粘 膜 はZ形 成 に よ っ て延 長 す る.口 蓋 腔帆 挙 を受 け た5-Year-OldIndexを 合 し,咬 合 状 態 を5段 筋 は 硬 口蓋 後 端 の 付 着 部 か ら十 分 に 剥 離 し て は,5つ muscleslingの 個 ず つ10個 形 成 を行 う.両 群 の 口 蓋裂 手 術 示 す 参 照 模 型 と照 階 に評 価 した.参 照模 型 の グ ル ー プ に 区 分 さ れ た裂 側 の異 な る2 か らな る.前 後 的,垂 直 的,側 方的 は,口唇裂 手 術 を施 行 した1人 の 口腔 外 科 専 門医 歯 列 弓 関係 か ら各 症 例 の 咬合 状 態 を5グ ル ー プ に が 行 った. 区 分 す る.そ の 指 標 と してoverjet,crossbite, 4.方 法 openbite,歯 列 弓 形 態,切 (1)資 料 の採 取 チ ェ ッ クす る(表3).例 両 群 と も,概 ね4歳 児 に,十 分 な観 察 に よ り中 準 また は後 方 傾 斜 を伴 っ た正 常 被 蓋 で,反 対 咬 合 心 咬合 位 を確 認 した 後 で,通 法 に従 い,印 象 採 得 も開咬 もな く,良 好 な歯 列 形 態 と深 い 口蓋 を呈 し 歯 の 傾 斜 状 態 の順 に え ば,上 顎 乳 切 歯 の標 お よび咬 合 採 得 を行 った.印 象 採 得 後,白 色 硬石 て い る もの を グ ル ー プ1と 評 価 す る.ま た,顎裂 膏 に て歯 列 石 膏模 型 を作 成 し,ソ ー ピ ン グ処 理 を 周 囲 の 開咬 は 問 わず,上 顎 乳 切 歯 の標 準 ま た は後 施 し資料 と した. 方 傾 斜 を伴 っ た切 端 咬 合,ま (2)咬 合 状 態 の 評価 方 法 対 象65人 の上 下 顎 石 膏 模 型 に無 作 為 に番 号 を 打 ち,そ れ を共 同 執 筆 者 の 一 人(TS)か た は上 顎 乳 切 歯 の後 方 傾 斜 を伴 った 反 対 咬 合 で,患 側 に反 対 咬 合 が み ら提 供 られ る もの を グ ルー プ3と 評 価 す る.一 方,上 顎 乳 切 歯 の 前 方 傾 斜 を伴 う もの の 全 顎 にわ た る反 対
5 咬合 が み られ,歯 列 形 態 は不 良 で 口蓋 は平 坦 で あ 人 の 評 価 者 の2回,計6個 る もの を グ ルー プ5と 評 価 す る.い ず れ の 指標 に 3人 の 評 価 者 の う ち2人(YH,TS)が2回 とも も口蓋裂 児 の 矯 正 歯 科 臨 床 上 の問 題 点 が 反 映 され ス コ ア1と 目に て い る. ス コ ア1,2回 今 回 の評 価 者 は2人 TS)と1人 の矯 正 歯 科 専 門 医(YH, の 口腔 外 科 医(YY)で た,2人 の矯 正 歯 科 専 門医 の うち1人 は 外 部 評 価 者(TS)で あっ た. 評 価 は 同 一 模 型 に 対 して3人 行 うこ とと し,2回 の 評 価 者 が2回 目の評 価 は 記 憶 に よ るバ イ ア ス を防 ぐた め 日 を 替 え た.グ 価 が 下 さ れ,こ の 数 値1 5を ル ー プ1 5に 評 評 価模 型 のス コ ァ と し て,一 模 型 に3人2回,計6個 の1人(YY)は1回 目 に ス コ ア2と 評 価 し て い る. 評 価 者 内 お よ び 評 価 者 間 の 一 致 に つ い て は, あ っ た.手 術 執 刀 者 は評 価 に は加 わ らず,ま 評 価 し,他 の ス コ ア を 示 す(図2). のス コア WeightedKappastatisticsを ま た,両 用 い て 検 定 し た. 群 の ス コ ア の 平 均 値 はstudentt-testを 用 い て 有 意 差 を 検 定 し た. 結 果 1.評 価 者 内 お よび 評価 者 間 の 一 致 度 3人 の 評 価 者 が 日 を改 め て 行 っ た2回 の 評価 の なか で,同 一 評 価 者 が 同 じ症 例 を評価 して も,必 ず し も一 致 した わ け で はな い.し か し,評 価値 の を付 した.二 期 群 に お い て は35例 の計210個 の 差 異 が1を 超 え る もの は なか っ た.ま た,3人 ス コア が,PB群 の 計174個 の 評価 者 の 同 一症 例 に 対 す る 評価 値 の差 異 が1を 超 に お い て は29例 ス コア が付 与 され た.二 期 群 の1例 に下 され た3 の え る もの もな か っ た.評 価 者 内 お よび 評価 者 間 に
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