Size of palatal shelves on the outcome of dental arch

Objective: This retrospective study evaluated the correlation between the size of palatal shelves and the occlusal index in patients with complete unilateral cleft lip and palate. 

Method: The study evaluated dental casts of 339 patients whose impressions were obtained at three different stages: before cheiloplasty (stage 1), before palatoplasty (stage 2) and in the complete deciduous or early mixed dentition (stage 3). The palatal shelves were measured on scanned images of dental casts of stages 1 and 2, using the software Adobe Photoshop CS2. The occlusal index was evaluated on the dental casts of stage 3 using the index proposed by Atack et al. 1997, known as 5-year-old index. 

Result: The dimension of palatal shelves compared between stages 1 and 2 evidenced a mean growth of 0.5 cm. The cleft width at the central portion presented a mean value of 1.13 in stage 1 and 0.69 in stage 2. The correlation between the size of palatal shelves and the occlusal index was analyzed by the Spearman correlation test. The results demonstrated significant negative correlation between the size of palatal shelves and the occlusal index only for patients operated by one of the surgeons and only for one surgical technique (Millard with Furlow). It is believed that other factors involved in the rehabilitation process may have greater influence on the occlusal index outcome than the size of palatal shelves

Conclusion:

The surgeon’s skill in performing a certain technique and achieve his or her best outcomes seems to be a determining factor for the facial growth outcome of these patients.