Dental and orthodontic disorders and treatment in VCFS
Dental and orthodontic disorders and treatment in VCFS
Dental and orthodontic disorders and treatment in VCFS
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<strong>Dental</strong> & <strong>orthodontic</strong> <strong>disorders</strong><br />
<strong>and</strong> <strong>treatment</strong> <strong>in</strong> <strong>VCFS</strong><br />
George J Cisneros, DMD, MMSc<br />
Professor & Chair<br />
Department of Orthodontics<br />
New York University College of Dentistry<br />
New York, NY, USA
Overview<br />
• <strong>Dental</strong> – Oral Health<br />
• Orthodontic<br />
• Related Studies
<strong>Dental</strong> - Oral Health Concerns<br />
• Hypodontia<br />
• Small Teeth<br />
• Hypoplasia<br />
• Poorly Developed Teeth<br />
• Saliva<br />
• Quality & Quantity<br />
• Metabolic Factors<br />
• Caries<br />
•
Orthodontic Issues<br />
• Hypodontia<br />
• Small Teeth<br />
• Delayed Tooth Eruption<br />
• Anodontia<br />
• Miss<strong>in</strong>g Teeth<br />
• Malocclusion<br />
•
Related Studies<br />
• Craniofacial Morphology <strong>in</strong> the Velo-cardio-facial<br />
Syndrome<br />
• Arvystas <strong>and</strong> Shpr<strong>in</strong>tzen,1984<br />
• A Comparison of Two Syndromes with the Rob<strong>in</strong> Sequence<br />
• Gl<strong>and</strong>er <strong>and</strong> Cisneros,'91<br />
• Craniofacial Morphology <strong>and</strong> Velopharyngeal Physiology<br />
<strong>in</strong> Four Syndromes of Cleft<strong>in</strong>g<br />
• Gold<strong>in</strong>g-Kushner,'91<br />
• <strong>Dental</strong> Characteristics Associated with <strong>VCFS</strong><br />
• Lisa A. Lehky,’96
Craniofacial Morphology <strong>in</strong> the<br />
Velo-cardio-facial Syndrome<br />
Arvystas <strong>and</strong> Shpr<strong>in</strong>tzen,1984<br />
• Lateral cephalographs<br />
• 13 patients<br />
• Cranial base angle<br />
• normal literature - 129°<br />
• VCF - 137°
A Comparison of Two Syndromes with<br />
the Rob<strong>in</strong> Sequence<br />
Gl<strong>and</strong>er <strong>and</strong> Cisneros,'91<br />
• Velo-cardio-facial<br />
• non-Rob<strong>in</strong> (N=18) & Rob<strong>in</strong> (N=11)<br />
• Stickler<br />
• non-Rob<strong>in</strong> (N=11) & Rob<strong>in</strong> (N=9)<br />
• Cephalometric Analysis<br />
• 50 variables<br />
• Hard & soft tissue
Cephalometric Analysis<br />
Skeletal<br />
Soft Tissue
A Comparison of Two Syndromes with<br />
the Rob<strong>in</strong> Sequence<br />
Results<br />
• No difference between VCF (non-Rob<strong>in</strong>) <strong>and</strong> VCF<br />
(Rob<strong>in</strong>)<br />
• Rob<strong>in</strong> symptoms – neuromuscular<br />
• not due skeletal / soft tissue morphology<br />
• Morphological differences were noted<br />
• Stickler (non-Rob<strong>in</strong>) v. Stickler (Rob<strong>in</strong>)
Craniofacial Morphology <strong>and</strong> Velopharyngeal<br />
Physiology <strong>in</strong> Four Syndromes of Cleft<strong>in</strong>g<br />
Gold<strong>in</strong>g-Kushner,'91<br />
• Cephalometrics<br />
• Speech<br />
• Videofluoroscopy<br />
• Nasopharyngoscopy<br />
• Syndromes-<br />
• Velo-cardio-facial<br />
• Stickler<br />
• Treacher-Coll<strong>in</strong>s<br />
• Van der Woude
Craniofacial Morphology <strong>and</strong> Velopharyngeal<br />
Physiology <strong>in</strong> Four Syndromes of Cleft<strong>in</strong>g<br />
• In VCF<br />
• Flat cranial base<br />
• <strong>in</strong>creased pharyngeal depth<br />
• Th<strong>in</strong> pharyngeal soft tissue, th<strong>in</strong>/short soft<br />
palate<br />
• suggest<strong>in</strong>g muscle deficiency<br />
• Prevalence <strong>and</strong> severity of VPI <strong>in</strong>creased
Velo-cardio-facial Syndrome<br />
• Platybasia (cranial base)<br />
• Low sella<br />
• Short posterior cranial base<br />
• Normal anterior cranial base<br />
• Convex facial profile<br />
• Hyperdivergent jaw pattern<br />
• Short m<strong>and</strong>ibular body<br />
• Normal maxilla<br />
• Large/wide pharyngeal space
Velo-cardio-facial Syndrome
<strong>Dental</strong> Characteristics Associated with <strong>VCFS</strong><br />
Lehky,’96<br />
<strong>Dental</strong> characteristics associated<br />
with <strong>VCFS</strong> patients compared to<br />
controls <strong>and</strong> normative data
Distribution of congenitally<br />
miss<strong>in</strong>g m<strong>and</strong>ibular teeth
Distribution of congenitally<br />
miss<strong>in</strong>g maxillary teeth
Distribution of congenitally<br />
miss<strong>in</strong>g teeth by arch
Distribution of congenitally<br />
miss<strong>in</strong>g teeth
<strong>VCFS</strong><br />
Control group<br />
Previous data - general population<br />
• Higher prevalence of miss<strong>in</strong>g m<strong>and</strong>ibular teeth<br />
• Pattern of miss<strong>in</strong>g teeth differed<br />
• Delayed calcification - m<strong>and</strong>ibular posterior teeth<br />
• All permanent teeth - smaller mesial-distal width
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