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Stability of Surgical and Orthodontic Techniques for the Treatment of Patients with Cleft Palate: A Systematic Review A Review and a Proposal
By Elisa Darqué, Iván Nieto Sánchez, Inés Díaz Renovales, and Patricia Martín-Palomino Sahagún.
Elisa Darqué is a doctor of dentistry (Alfonso X el Sabio University) and she’s a student in master’s degree in orthodontics (Alfonso X el Sabio University).
Iván Nieto Sánchez is a doctor of dentistry (Alfonso X el Sabio University); MS in Orthodontics (San Rafael Hospital); BS of Dentistry (Complutense University of Madrid); MS Biostatistics and Telemedicine for clinical practice and health management (UNED) Diploma in Lingual Orthodontics (University of Lyon I)
Patricia Martín-Palomino Sahagún PhD in Dentistry (University Alfonso X el Sabio), Master in Orthodontics (University Alfonso X El Sabio), DDS (University Alfonso X El Sabio)
Inés Díaz Renovales PhD in Dentistry University Alfonso X el Sabio, Master in Orthodontics (University Alfonso X el Sabio), DDS (University Complutense Madrid)
Abstract Introduction: Osteogenesis distraction is a medical technique in which surgery is performed to separate the bone, and a bone callus is created between the two segments that will ossify later. Unless stated otherwise, the process begins when incremental traction is applied to the repair callus joining the divided bone segments and continues for as long as this tissue is stretched. It is important to understand this concept to be able to compare it with orthognathic surgery in patients with cleft lip. Objective: The main objective of this study is to examine how the cleft palate could be treated as efficiently as possible. We aimed to compare the stability of distraction osteogenesis versus orthognathic surgery in the treatment of cleft palate through a systematic review. Materials and Methods: A systematic review was carried out on the PubMed and Medline, SciELO, ResearchGate, ScienceDirect, Dialnet, Web of Science, and Cochrane databases for articles published mainly in the last five years. We used the following keywords: “Distraction,” “cleft lip,” “orthognathic surgery,” “maxillary hypoplasia,” “Pierre Robin Syndrome,” “osteogenesis,” “cleft palate,” “cleft lip and palate treatment,” “distraction osteogenesis,” “maxillofacial surgery,” “callus distraction,” “callotasis,” “mandibula distraction,” “osteodistraction,” and “orthopedic surgery.” We added a filter to display articles from 2016 to May 2022. Results: From the 67 articles included in the review, the authors observed a greater recurrence of point A (or decrease of ANB) in patients who had been treated with orthognathic surgery than those who had been treated with distraction. Conclusion: According to the conclusions of several studies, it seems that distraction osteogenesis has better skeletal stability than orthognathic surgery in patients with cleft lip without growth. Moreover, orthognathic surgery has a much more important recurrence in the vertical plane than in the horizontal plane. In conclusion, with osteogenesis distraction, an overcorrection of 30 40% must be made.
*This article has been peer reviewed
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