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Biomedical subjects

R S Tindlund

Publications and source records attributed to R S Tindlund.

9 recordsLinked to original sources
PubMed1997

Functional results with the team care of cleft lip and palate patients in Bergen, Norway. The Bergen Cleft Palate-Craniofacial Team, Norway.

There is international consensus about some fundamental elements concerning treatment of cleft lip and palate (CLP): (1) multidisciplinary teamwork, (2) centralization, (3) team continuity, (4) long-term treatment planning (from birth to adulthood), (5) documentation, (6) evaluation, (7) follow-up studies, (8) research and (9) quality assurance. Every year 120-140 children are born with CLP in Norway (2 per 1,000 live births). For more than four decades the treatment of CLP has been centralized to the University Clinics in Oslo and Bergen. The cost of treatment as well as the travel expenditures for patients born with facial clefts are paid by the Norwegian government (social security). In a speech study of 180 6-year-old children with CLP/CP first operated in Bergen during 1973-1981, normal resonance was found in 76.7% of the children, moderate hypernasality in 11.7%, while 11.6% had marked hypernasality.

Adolescent↗
PubMed1994

Skeletal response to maxillary protraction in patients with cleft lip and palate before age 10 years.

Over the last 15 years, cleft lip and palate (CLP) patients with maxillary deficiency in the care of the Bergen CLP Team have received interceptive orthopedic treatment to correct anterior and posterior crossbites during the deciduous and mixed dentition periods. The present study comprises 72 subjects of various cleft types with anterior crossbite, treated to an acceptable positive overjet by maxillary protraction using a facial mask (Delaire). Lateral cephalograms were taken immediately before and after the active treatment periods. Individuals exhibiting a favorable (fair) skeletal response to the protraction were compared with those who revealed little, (poor) skeletal response. Two cephalometric variables were chosen for the evaluation of the sagittal skeletal treatment changes: (1) the sagittal maxillomandibular change (change of angle ss-n-sm [ANB]); and (2) the forward movement of the maxilla (change of distance NSP-maxp), where maxp (maxillary point) represents the anterior contour of maxilla and NSP is the perpendicular to the nasion-sella-line (NSL) through sella. A numerical change greater than or equal to the value 1.5 (degrees or mm, respectively) was classified as fair versus poor response revealing a change less than 1.5. Fair-response (favorable response) of sagittal maxillomandibular change was found in 63% of the cases (mean increase of angle ANB was 3.3 degrees), more often when protraction started early. The length of maxilla was increased, the skeletal maxilla was moved forward 1.8 mm, the upper dentition advanced 3.6 mm, the occlusal line was clockwise rotated, and the anterior face height was increased. Similarly, fair-response of forward movement of maxilla was found in 44% of the cases (mean increase of distance NSP-maxp was 2.4 mm), more often when protraction was started early and after long treatment duration. The maxillary prognathism increased 1.8 degrees, the angle ANB increased 3 degrees, the length of maxilla increased 1.5 mm, and the upper dentition was advanced 3.7 mm. The anterior face height increased with counterclockwise rotation of the nasal line, whereas the occlusal line was clockwise rotated. A paired fair-response of both skeletal maxillomandibular change and skeletal forward movement of maxilla was found in 35% of the cases. During protraction the mean increase of maxillary prognathism was 2.1 degrees, the maxilla moved forward 3.1 mm, the maxillary dentition advanced 4.3 mm, the maxillary length increased 1.9 mm, the ANB angle increased 3.7 degrees, and the lower anterior facial height increased 3.4 mm.

Cephalometry↗
PubMed1993

Orthopedic protraction of the upper jaw in cleft lip and palate patients during the deciduous and mixed dentition periods in comparison with normal growth and development.

Cleft lip and palate (CLP) patients often develop maxillary retrusion after cleft repair. Since 1977, a group of 98 cases with negative overjet (anterior crossbite) during the period of deciduous dentition has been treated by the Bergen CLP team. The purpose of treatment has been to achieve favorable occlusion with positive overjet and overbite by means of anterior orthopedic traction (protraction). The average age at start of treatment was 6 years 11 months, and mean treatment duration was 13 months. The protraction force was 700 g. The serial lateral cephalograms of the treated CLP group were compared with those of a noncleft group with normal growth. Normalization of the sagittal maxillomandibular relationship (ANB angle) was achieved. Significant changes were a more anterior position of the upper jaw, and a more posterior position of the lower jaw, due to mandibular clockwise rotation. The variation was considerable. This paper reports the overall changes in the whole CLP group (ALL-C group).

Cephalometry↗
PubMed1993

Intercanine widening and sagittal effect of maxillary transverse expansion in patients with cleft lip and palate during the deciduous and mixed dentitions.

Since 1977 cleft lip and palate (CLP) patients with maxillary deficiency have received an interceptive orthopedic treatment consisting of (a) transverse expansion, (b) protraction, and (c) fixed retention. Ideally the treatment should be completed early enough to permit spontaneous eruption of the maxillary permanent incisors into normal occlusion without orthodontic intervention. The early transverse expansion considerably increases space so that unerupted malpositioned incisors spread out spontaneously, creating optimal conditions for eruption and root formation. Dental diagnosis in the cleft areas is made easier. Posterior crossbites in 112 CLP patients were expanded with a modified quad-helix appliance cemented with four bands in the deciduous or mixed dentition. Intercanine widening was about 3 mm per month regardless of cleft type. Several authors have claimed that transverse expansion of the upper jaw will increase sagittal overjet. Other authors have not found such an effect. The sagittal effect on the maxilla was studied in 68 CLP patients who had received transverse expansion. Analysis of the lateral cephalograms revealed no significant sagittal dentofacial maxillary treatment effects involving forward movement of maxilla, but a downward clockwise rotation of the mandible was found.

Adolescent↗
PubMed1993

Maxillary protraction: different effects on facial morphology in unilateral and bilateral cleft lip and palate patients.

Since 1977 patients with anterior/posterior crossbites in the care of the Bergen CLP team have undergone an interceptive orthopedic protraction phase during the deciduous and mixed dentition period. Eighty-seven cases with complete clefts (63 unilateral and 24 bilateral) displaying anterior crossbite (negative overjet) were treated to normal occlusion. A fixed quad-helix appliance was used in combination with a facial mask. In the unilateral complete cleft lip and palate (UCLP) group, mean age at start of treatment was 6 years 10 months and mean duration was 12 months. In the bilateral complete cleft lip and palate (BCLP) group, mean age at start of treatment was 7 years and mean duration 15 months. The protraction force was 700 g. The sagittal changes during protraction in the UCLP and BCLP groups were compared, and related to the growth changes in a group of noncleft children at the same age. Dentofacial treatment effect was different in the UCLP and BCLP groups. Significant increase of maxillary prognathism (angle s-n-ss) was found only in the UCLP group, whereas the treatment effect in the BCLP group was mainly dentoalveolar. However, after protraction there was no longer a significant difference in maxillary prognathism between the two CLP groups, and the sagittal position of the upper molars was normalized in both groups. The upper incisors remained retroclined in both groups, significantly more in the BCLP group. Increase of the upper facial height (n-sp") and clockwise rotation of the occlusal line were significantly greater in the BCLP group. The computerized occlusal line was unsuitable as a reference standard for the evaluation of sagittal dentofacial treatment changes when the occlusal line was rotated during treatment.

Cephalometry↗
PubMed1993

Soft-tissue profile changes during widening and protraction of the maxilla in patients with cleft lip and palate compared with normal growth and development.

During the last 15 years, cleft lip and palate (CLP) patients with maxillary deficiency in the care of the Bergen CLP team have undergone an interceptive orthopedic treatment phase during the deciduous and mixed dentition period. The present study includes 68 patients who received maxillary transverse expansion by use of a modified quad-helix appliance and 98 cases given maxillary protraction by a facial mask. All cases were treated until an acceptable normal occlusion was attained. Lateral cephalograms were taken immediately before and after the active treatment periods. Sagittal changes of the soft-tissue profile during transverse expansion and protraction were analyzed separately for unilateral complete cleft lip and palate (UCLP) patients and bilateral complete cleft lip and palate (BCLP) patients. The soft-tissue profiles of the groups were compared to growth changes of noncleft age-matched children (NORM group). During the short period of maxillary transverse expansion (mean period, 3.5 months) no significant change of the soft-tissue profile was found, except in the protrusion of the lower lip in the BCLP group. During the period of maxillary protraction (mean periods, 12 months in the UCLP group and 15 months in the BCLP group) the soft-tissue profile improved significantly by reducing the characteristic tendency towards a concave profile in CLP patients with maxillary deficiency. Significant increases of the sagittal maxillomandibular lip relation (angle SS-N-SM: mean increase, 2.5 degrees) and the Holdaway-angle (H-angle: mean increase, 3.0 degrees) were found to be similar in the UCLP and BCLP groups. However, the use of different reference lines for evaluation of treatment effects upon the soft-tissue profile resulted in conflicting findings suggesting that anteriorly situated reference lines are more suitable for the evaluation of CLP patients. Thus, the esthetic line (E.line) indicated a favorable position of the lips after treatment; the subspinale-pogonion line (ss.pg) revealed an improved soft-tissue profile; the soft-tissue-facial line (N.PG) showed a retruded nose and upper lip; whereas basal references such as the nasionsella line (NSL) and the occlusal-line perpendicular (OLP) mainly showed major differences between the CLP groups and the NORM groups.

Cephalometry↗
PubMed1989

Orthopaedic protraction of the midface in the deciduous dentition. Results covering 3 years out of treatment.

If there is underdevelopment of the upper jaw, the current Bergen concept indicates a period of orthopaedic/orthodontic treatment of cleft lip and palate patients at 6-7 years of age. A fixed quad-helix-appliance is used in combination with a facial mask. The result is retained with a fixed palatal arch. A preliminary follow-up study on sagittal growth and development in 30 patients is reported. By treating early, a more basal response is obtained, and several years of more correct function is gained.

Cephalometry↗