CBCT provides accurate 3D imaging of the craniofacial region and has many applications for evaluating patients with cleft lip and palate, including: 1) Assessment of alveolar bone morphology, volumetric analysis of cleft defects, and evaluation of secondary alveolar bone grafting outcomes. 2) Evaluation of dental anomalies such as tooth lengths and eruption paths. 3) Detection of incidental findings and assessment of facial soft tissue thickness.

1. Advancesincbctdiagnosticsinpatientswith
cleftlipandpalate
1

2. INTRODUCTION
2

3. Introduced in 1998
CRANIOFACIAL IMAGING IN 21st CENTUARY
Evolutionary process of conventional CT’s
CBCT
3

4. Godfrey Hounsfield
Nobel prize in Medicine, 1979
Allan Cormack
COMPUTED TOMOGRAPHY
4

5. 5

6. NewTom 9000 / NewTom 3G
i-CAT
6

7. CBCT in orthodontics: assessment of treatment outcomes and indications for its use
Kapila et al ,Dentomaxillofacial Radiology (2015) 44, 20140282 7

8. Dose
AS LOW AS RESONABLY
ACHEIVABLE
8

9. 9

10. C B C T vs PANORAMIC radiograph
Panoramic
Provides a distorted and
magnified image
Shows image layer view only
Structures are superimposed
CBCT
Provides an undistorted image
Cross-sectional (bucco-lingual), axial,
coronal, sagittal, and panoramic views
Structures can be separated
10

11. CBCT IN
ORTHODONTICS
11

12. CBCT in orthodontics: assessment of treatment outcomes and indications for its use
Kapila et al ,Dentomaxillofacial Radiology (2015) 44, 20140282
ITERATIVE CLOSEST POINT
12

13. CBCT in orthodontics: assessment of treatment outcomes and indications for its use
Kapila et al ,Dentomaxillofacial Radiology (2015) 44, 20140282
SHAPE CORRESPONDENCE
13

14. CBCT in orthodontics: assessment of treatment outcomes and indications for its use
Kapila et al ,Dentomaxillofacial Radiology (2015) 44, 20140282
IMPACTION
14

15. CBCT in orthodontics: assessment of treatment outcomes and indications for its use
Kapila et al ,Dentomaxillofacial Radiology (2015) 44, 20140282
IMPACTION
15

16. CBCT in orthodontics: assessment of treatment outcomes and indications for its use
Kapila et al ,Dentomaxillofacial Radiology (2015) 44, 20140282
SUPERNUMERARY
TEETH
16

17. CBCT in orthodontics: assessment of treatment outcomes and indications for its use
Kapila et al ,Dentomaxillofacial Radiology (2015) 44, 20140282
ALVEOLAR
BOUNDARY
CONDITION
17

18. CBCT in orthodontics: assessment of treatment outcomes and indications for its use
Kapila et al ,Dentomaxillofacial Radiology (2015) 44, 20140282
ALVEOLAR BOUNDARY
CONDITION-
transposition
18

19. TMJ
19

20. CBCT in orthodontics: assessment of treatment outcomes and indications for its use
Kapila et al ,Dentomaxillofacial Radiology (2015) 44, 20140282
AIRWAY
MORPHOLOGY
20

21. CLEFT LIP AND
PALATE
CBCT in orthodontics: assessment of treatment outcomes and indications for its use
Kapila et al ,Dentomaxillofacial Radiology (2015) 44, 20140282 21

22. CLEFT LIP AND PALATE
22

23. 23

24. 24

25. Internationally Approved classification:-
Classification of Cleft of the Lip, Alveolus and Palate: MILLARD 1976
(Based on embryological principles)
Group 1: Cleft of anterior (primary) palate.
Lip
Alveolus
Group 2: Cleft of anterior and posterior
(primary and secondary) palate:
Lip
Alveolus
Hard Palate
Group 3: Cleft of posterior (secondary) palate:
Hard palate
Soft palate
25

26. VEAU’S CLASSIFICATION (1931)
Group I - Cleft of soft palate only
Group II - Cleft of hard and soft palate,
extending no further than the incisive
foramen thus involving the secondary
palate alone.
26

27. Group III - Complete unilateral cleft of soft
and hard palate, lip and alveolar ridge
Group IV - Complete bilateral cleft of soft
and hard palate, lip and alveolar ridge on
both sides.
27

28. Kernahans striped Y logo classification.
28

29. Milliards modification
29

30. LAHSHAL Classification
L -
A -
H -
S -
H -
A -
L -
Lip
Alveolus
Hard palate
Soft palate
Hard palate
Alveolus
Lip
30

31. Overview of orthodontic care for children with cleft lip and palate, 1915-2015
Katherine et al,Am J Orthod Dentofacial Orthop 2015;148:543-56
31

32. Pre surgical
Orthopedics
1-4 weeks Repositioning palatal segment
facilitates lip repair
Lip closure 8 to 12
weeks
May be preceded by
preliminary lip adhesion as an
alternative to presurgical
orthopedics
Palate closure 18 to 24
months
Closing only the soft palate
initially an alternative, but one
stage closure of the hard and
soft palate is the usual
procedure
32

33. Speech therapy 6 to 11 years Articulation errors often
develop as child tries to
compensate for cleft
Early orthodontics 7 to 8 years Usually incisor alignment and
maxillary transverse expansion
Alveolar grafting 6 to 10 years Needed before permanent
canines erupt; timing
determined by stage and
sequence of dental
development
33

34. Comprehensive
orthodontics
11 to 14 years Class III elastics often very
helpful
Orthognathic
surgery
17 to 19 years
Maxillary advancement,
perhaps combined with
mandibular set-back; not done
until growth completed except
in rare instances of severe
psychosocial impact; needed
infrequently
Fixed
prosthodontics
17 to 19 years
Replacement of missing
lateral incisors:
comprehensive treatment only
after growth completed
34

35. CBCT IN CLEFT LIP AND PALATE
35

36. Assessment of Alveolar
Bone Morphology
36

37. Alveolar Bone Morphology in Patients With Bilateral Complete Cleft Lip and Palate in the Mixed Dentition: CBCT Evaluation
Garib et al, Cleft Palate–Craniofacial Journal, March 2012, Vol. 49 No. 2
Alveolar Bone Morphology in Patients With
Bilateral Complete Cleft Lip and Palate
37

38. Alveolar Bone Morphology in Patients With Bilateral Complete Cleft Lip and Palate in the Mixed Dentition: CBCT Evaluation
Garib et al, Cleft Palate–Craniofacial Journal, March 2012, Vol. 49 No. 2 38

39. Alveolar Bone Morphology in Patients With Bilateral Complete Cleft Lip and Palate in the Mixed Dentition: CBCT Evaluation
Garib et al, Cleft Palate–Craniofacial Journal, March 2012, Vol. 49 No. 2 39

40. Alveolar Bone Morphology in Patients With Bilateral Complete Cleft Lip and Palate in the Mixed Dentition: CBCT Evaluation
Garib et al, Cleft Palate–Craniofacial Journal, March 2012, Vol. 49 No. 2 40

41. Alveolar Bone Morphology in Patients With Bilateral Complete Cleft Lip and Palate in the Mixed Dentition: CBCT Evaluation
Garib et al, Cleft Palate–Craniofacial Journal, March 2012, Vol. 49 No. 2 41

42. Assessment of the alveolar bone support of patients with unilateral cleft lip and palate: A cone-beam computed tomography study
Esra et al, Angle Orthod. 2015;85:1003–1008
Assessment of the alveolar bone support of
patients with unilateral cleft lip and palate
42

43. Assessment of the alveolar bone support of patients with unilateral cleft lip and palate: A cone-beam computed tomography study
Esra et al, Angle Orthod. 2015;85:1003–1008 43

44. Assessment of the alveolar bone support of patients with unilateral cleft lip and palate: A cone-beam computed tomography study
Esra et al, Angle Orthod. 2015;85:1003–1008 44

45. Use of Cone Beam Computed Tomography to Volumetrically Assess Alveolar Cleft Defects—
Preliminary Results
Fasial et al, J Oral Maxillofac Surg 70:188-191, 2012
Volumetric Assessment of Alveolar Cleft Defects
Cleft height
45

46. Cleft width
Use of Cone Beam Computed Tomography to Volumetrically Assess Alveolar Cleft Defects—Preliminary Results
Fasial et al, J Oral Maxillofac Surg 70:188-191, 2012
46

47. Cleft length
Use of Cone Beam Computed Tomography to Volumetrically Assess Alveolar Cleft Defects—Preliminary Results
Fasial et al, J Oral Maxillofac Surg 70:188-191, 2012
47

48. Assessment of secondary
alveolar bone grafting
48

49. Volumetric Assessment of Secondary Alveolar Bone Grafting Using Cone Beam Computed Tomography
Oberoi et al, Cleft Palate–Craniofacial Journal, September 2009, Vol. 46 No. 5
Volumetric Assessment of Secondary
Alveolar Bone Grafting
49

50. Pre and one year after grafting
Volumetric Assessment of Secondary Alveolar Bone Grafting Using Cone Beam Computed Tomography
Oberoi et al, Cleft Palate–Craniofacial Journal, September 2009, Vol. 46 No. 5 50

51. Application of Limited CBCT to Clinical Assessment of Alveolar Bone Grafting: A Preliminary Report
HAMADA et al, Cleft Palate–Craniofacial Journal, March 2005, Vol. 42 No. 2
Assessment of Alveolar Bone Grafting
51

52. Application of Limited CBCT to Clinical Assessment of Alveolar Bone Grafting: A Preliminary Report
HAMADA et al, Cleft Palate–Craniofacial Journal, March 2005, Vol. 42 No. 2 52

53. Application of Limited CBCT to Clinical Assessment of Alveolar Bone Grafting: A Preliminary Report
HAMADA et al, Cleft Palate–Craniofacial Journal, March 2005, Vol. 42 No. 2 53

54. Assessment of bone
resorption
54

55. Assessment of Bone Resorption After Secondary Alveolar Bone Grafting Using Three-Dimensional Computed Tomography: A Three-Year Study
Matthias et al, Cleft Palate–Craniofacial Journal, March 2007, Vol. 44 No. 2
Assessment of Bone Resorption After
Secondary Alveolar Bone Grafting
55

56. Assessment of alveolar bone grafting
CBCT in the assessment of alveolar bone grafting in children with unilateral cleft lip and palate
Anni et al, European Journal of Orthodontics 36 (2014) 603–611 56

57. CBCT in the assessment of alveolar bone grafting in children with unilateral cleft lip and palate
Anni et al, European Journal of Orthodontics 36 (2014) 603–611 57

58. fair labiopalatal bone support
CBCT in the assessment of alveolar bone grafting in children with unilateral cleft lip and palate
Anni et al, European Journal of Orthodontics 36 (2014) 603–611 58

59. Good labiopalatal bone support
CBCT in the assessment of alveolar bone grafting in children with unilateral cleft lip and palate
Anni et al, European Journal of Orthodontics 36 (2014) 603–611 59

60. Nasal floor
CBCT in the assessment of alveolar bone grafting in children with unilateral cleft lip and palate
Anni et al, European Journal of Orthodontics 36 (2014) 603–611 60

61. Comparison between multislice and cone-beam computerized tomography in the volumetric assessment of cleft palate
Marco et al, Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:249-257
Comparison between multislice CT and CBCT in the
volumetric assessment of cleft palate
61

62. Comparison between multislice and cone-beam computerized tomography in the volumetric assessment of cleft palate
Marco et al, Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:249-257 62

63. Comparison between multislice and cone-beam computerized tomography in the volumetric assessment of cleft palate
Marco et al, Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:249-257 63

64. Comparison between multislice and cone-beam computerized tomography in the volumetric assessment of cleft palate
Marco et al, Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:249-257 64

65. Comparison between multislice and cone-beam computerized tomography in the volumetric assessment of cleft palate
Marco et al, Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:249-257 65

66. Evaluation of donor site
66

67. Evaluation of the anterior mandibular donor site one year after secondary reconstruction of an alveolar cleft:3-dimensional analysis using CBCT
Bilsen et at, British Journal of Oral and Maxillofacial Surgery 53 (2015) 719–724
Evaluation of the anterior mandibular
donor site
67

68. Evaluation of the anterior mandibular donor site one year after secondary reconstruction of an alveolar cleft:3-dimensional analysis using CBCT
Bilsen et at, British Journal of Oral and Maxillofacial Surgery 53 (2015) 719–724 68

69. Regeneration of bone
Evaluation of the anterior mandibular donor site one year after secondary reconstruction of an alveolar cleft:3-dimensional analysis using CBCT
Bilsen et at, British Journal of Oral and Maxillofacial Surgery 53 (2015) 719–724 69

70. Evaluation of dental
anomalies
70

71. Maxillary Dental Anomalies in Patients with Cleft Lip and Palate: A Cone Beam Computed Tomography Study
Buyuk et al, The Journal of Clinical Pediatric Dentistry Volume 39, Number 2/2015
Maxillary Dental Anomalies
71

72. Tooth Lengths of the Permanent Upper Incisors in Patients With Cleft Lip and Palate Determined With CBCT
Zhou et al, The Cleft Palate-Craniofacial Journal 50(1) pp. 88–95 January 2013
Tooth Lengths of the Permanent Upper
Incisors
72

73. Tooth Lengths of the Permanent Upper Incisors in Patients With Cleft Lip and Palate Determined With CBCT
Zhou et al, The Cleft Palate-Craniofacial Journal 50(1) pp. 88–95 January 2013 73

74. Three-Dimensional Assessment of the Eruption Path of the Canine in Individuals With Bone-Grafted Alveolar Clefts Using CBCT
Oberoi et al, Cleft Palate–Craniofacial Journal, September 2010, Vol. 47 No. 5
Eruption Path of the Canine
74

75. Incidental findings on cone beam computed tomography scans in cleft lip and palate patients
Mette et al, Clin Oral Invest (2014) 18:1237–1244
Incidental findings on cone beam
computed tomography scans
75

76. Incidental findings on cone beam computed tomography scans in cleft lip and palate patients
Mette et al, Clin Oral Invest (2014) 18:1237–1244
76

77. Incidental findings on cone beam computed tomography scans in cleft lip and palate patients
Mette et al, Clin Oral Invest (2014) 18:1237–1244
77

78. Evaluation of facial soft
tissue
78

79. Facial soft-tissue thickness in patients affected by bilateral cleft lip and palate: A retrospective CBCT study
Mevlut et al, Am J Orthod Dentofacial Orthop 2014;146:573-8
SNA , SNB , ANB , SN-MP , Co-
A (mm), CoGn (mm), U1-SN,
and IMPA
Facial soft-tissue thickness
79

80. Glabella (G-G0),
Nasion (N-N0),
Rhinion (rhi-rhi0),
Subnasale (a-sn),
Labrale superior (pr-ls),
Stomion (u1-sto),
Labrale inferior (id-li),
Labiomental (b-labm),
Pogonion (pog-pog0),
Gnathion (gn-gn0).
Facial soft-tissue thickness in patients affected by bilateral cleft lip and palate: A retrospective CBCT study
Mevlut et al, Am J Orthod Dentofacial Orthop 2014;146:573-8 80

81. Facial soft-tissue thickness in patients affected by bilateral cleft lip and palate: A retrospective CBCT study
Mevlut et al, Am J Orthod Dentofacial Orthop 2014;146:573-8 81

82. Evaluation of facial
asymmetry
82

83. Three-dimensional evaluation of midfacial asymmetry in patients with nonsyndromic unilateral cleft lip and palate by CBCT
Park et al, Korean J Orthod 2013;43(3):113-119
Evaluation of midfacial asymmetry
83

84. 84

85. CBCT Assessment of Lower Facial Asymmetry in Unilateral Cleft Lip and Palate and Non-Cleft Patients with Class III Skeletal Relationship
Lin et al, PLOS ONE | DOI:10.1371/journal.pone.0130235 August 3, 2015
Lower Facial Asymmetry
85

86. 86

87. 87

88. Airway analysis
88

89. Three Dimensional Assessment of the Pharyngeal Airway in Individuals with Non-Syndromic Cleft Lip and Palate
Oberoi et al, PLoS ONE August 2012 | Volume 7 | Issue 8 89

90. MAXILLARY EXPANSION
90

91. Dentoskeletal effects of 3 maxillary expanders in patients with clefts: A cone-beam computed tomography study
Daniel e al, Am J Orthod Dentofacial Orthop 2014;146:73-81
Hyrax
91

92. Fan-type
92

93. Inverted mini-hyrax
93

94. 94

95. CONCLUSION
95

96. REFERENCES
• CBCT in orthodontics: assessment of treatment outcomes and indications for its use
Kapila et al ,Dentomaxillofacial Radiology (2015) 44, 20140282
• Overview of orthodontic care for children with cleft lip and palate, 1915-2015
Katherine et al,Am J Orthod Dentofacial Orthop 2015;148:543-56
• Alveolar Bone Morphology in Patients With Bilateral Complete Cleft Lip and Palate in the Mixed Dentition: CBCT Evaluation
Garib et al, Cleft Palate–Craniofacial Journal, March 2012, Vol. 49 No. 2
• Assessment of the alveolar bone support of patients with unilateral cleft lip and palate: A cone-beam computed
tomography study
Esra et al, Angle Orthod. 2015;85:1003–1008
• Use of Cone Beam Computed Tomography to Volumetrically Assess Alveolar Cleft Defects—Preliminary Results
Fasial et al, J Oral Maxillofac Surg 70:188-191, 2012
• Comparison between multislice and cone-beam computerized tomography in the volumetric assessment of cleft palate
Marco et al, Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:249-257
96

97. • Volumetric Assessment of Secondary Alveolar Bone Grafting Using Cone Beam Computed Tomography
Oberoi et al, Cleft Palate–Craniofacial Journal, September 2009, Vol. 46 No. 5
• Evaluation of the anterior mandibular donor site one year after secondary reconstruction of an alveolar cleft:3-dimensional
analysis using cone-beam computed tomography
Bilsen et at, British Journal of Oral and Maxillofacial Surgery 53 (2015) 719–724
• Application of Limited CBCT to Clinical Assessment of Alveolar Bone Grafting: A Preliminary Report
HAMADA et al, Cleft Palate–Craniofacial Journal, March 2005, Vol. 42 No. 2
• Assessment of Bone Resorption After Secondary Alveolar Bone Grafting Using Three-Dimensional Computed Tomography: A
Three-Year Study
Matthias et al, Cleft Palate–Craniofacial Journal, March 2007, Vol. 44 No. 2
• Tooth Lengths of the Permanent Upper Incisors in Patients With Cleft Lip and Palate Determined With Cone Beam Computed
Tomography
Zhou et al, The Cleft Palate-Craniofacial Journal 50(1) pp. 88–95 January 2013
• Incidental findings on cone beam computed tomography scans in cleft lip and palate patients
Mette et al, Clin Oral Invest (2014) 18:1237–1244
• Three Dimensional Assessment of the Pharyngeal Airway in Individuals with Non-Syndromic Cleft Lip and Palate
Oberoi et al, PLoS ONE August 2012 | Volume 7 | Issue 8
97

98. • CBCT in the assessment of alveolar bone grafting in children with unilateral cleft lip and palate
Anni et al, European Journal of Orthodontics 36 (2014) 603–611
• Maxillary Dental Anomalies in Patients with Cleft Lip and Palate: A Cone Beam Computed Tomography Study
Buyuk et al, The Journal of Clinical Pediatric Dentistry Volume 39, Number 2/2015
• Three-Dimensional Assessment of the Eruption Path of the Canine in Individuals With Bone-Grafted Alveolar Clefts
Using CBCT
Oberoi et al, Cleft Palate–Craniofacial Journal, September 2010, Vol. 47 No. 5
• Facial soft-tissue thickness in patients affected by bilateral cleft lip and palate: A retrospective cone-beam computed
tomography study
Mevlut et al, Am J Orthod Dentofacial Orthop 2014;146:573-8
• Three-dimensional evaluation of midfacial asymmetry in patients with nonsyndromic unilateral cleft lip and palate
by cone-beam computed Tomography
Park et al, Korean J Orthod 2013;43(3):113-119
• Cone-Beam Computed Tomography Assessment of Lower Facial Asymmetry in Unilateral Cleft Lip and Palate and
Non-Cleft Patients with Class III Skeletal Relationship
Lin et al, PLOS ONE | DOI:10.1371/journal.pone.0130235 August 3, 2015
98

99. • CLEFT LIP AND PALATE :DIEGO.F.WYSZYNSKI
• Cone Beam Computed Tomography in orthodontics:Sunil S Kapila
• Dentoskeletal effects of 3 maxillary expanders in patients with clefts: A cone-beam computed
tomography study
Daniel e al, Am J Orthod Dentofacial Orthop 2014;146:73-81
99

100. 100