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      Norwegian Orthodontists’ Experience and Challenges With Treatment of Patients With Cleft Lip and Palate

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          Abstract

          Background:

          Patients born with cleft lip and/or palate (CL/P) have orthodontic treatment challenges due to maxilla deficiency, malocclusions, and dental abnormalities. In Norway, orthodontic treatment is done by centralized CL/P teams. Due to traveling restrictions, this treatment might be done locally in the future. The experience of Norwegian community orthodontists in managing such patients has not been investigated previously.

          Objective:

          To assess Norwegian orthodontists’ management of patients with CL/P and need for further education.

          Material and Methods:

          All orthodontists in Norway were sent a questionnaire about their experience, challenges, and knowledge and asked about their need of further theoretical education and clinical training in the management of patients with CL/P.

          Results:

          Norwegian orthodontists’ standard of knowledge of CL/P treatment is adequate. However, few respondents have treated a high number of cleft patients. Eighty-six percent of the participants believed that treating CL/P patients involves challenges, such as time-consuming treatment and technical difficulties. Increased perceived need for more education was revealed among participants stated unpreparedness during education (4 folds), encountered challenges, and lack of knowledge (almost 3 folds).

          Conclusions:

          The study revealed that community orthodontists in Norway lack experience and acknowledged the challenges in treating patients with CL/P. Most of the respondents perceived a need for additional education and clinical training to treat CL/P patients competently. The findings suggested more focus on patients with CL/P management in the curricula and more collaboration between centralized CL/P teams and community orthodontists.

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          Most cited references34

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          Incidence of cleft lip, cleft palate, and cleft lip and palate among races: a review.

          A review of the literature pertaining to the incidence of cleft lip, cleft palate, and cleft lip and palate in different races is presented. The studies have been evaluated according to the method used to record the incidence rate. Half of the studies include in their base population livebirths, stillbirths, and abortions, or livebirths and stillbirths to record the incidence rate. In addition, in most of the studies, clefts with associated malformations and possible syndromes are included in the reported incidence. There is evidence, however, to suggest that the risk of developing clefts in stillbirths and abortions is three times as frequent as in livebirths and that clefts with associated malformations behave differently epidemiologically from clefts without associated malformations. It is suggested, therefore, that the incidence of cleft lip, cleft palate, and cleft lip and palate should be studied separately for each group, namely for livebirths, stillbirths, and abortions and should be reported separately for clefts without associated malformations, clefts with associated malformations, and syndromes. More research is needed to study the risk of developing clefts among the various groups that exhibit different epidemiologic behavior for each race.
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            Elimination of the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment.

            A combined surgical/orthodontic procedure to eliminate the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment is described. The operations have been carried out on 378 patients: 240 males and 138 females. Seventy-two patients had bilateral clefts, making a total of 450 grafted clefts. The optimal age for this secondary bone grafting has been found to be 9 to 11 years. In 292 of the cases, the canine had reached its final position in the arch, which allowed a four-group semiquantitative assessment of the newly obtained interdental septum on dental radiographs. The best results have been achieved in cases where the bone graft was carried out prior to the eruption of the canine. In this group, a normal (category I) interdental septal height was achieved in 64 percent and a slightly lower (category II) interdental septum in 32 percent. Interdental septa classified as type I and II are considered to be acceptable. The cleft space was closed in 90 percent of the cases. No significant difference between unilateral and bilateral cases was found. When the same procedure was carried out after eruption of the canine, the results were less favorable.
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              • Abstract: found
              • Article: not found

              The Eurocleft project 1996-2000: overview.

              The original Eurocleft project, a European intercentre comparison study, revealed dramatic differences in outcome, which were a powerful stimulus for improvement in the services of respective teams. The study developed a preliminary methodology to compare practices and the potential for wider European collaboration including opportunities for the promotion of clinical trials and intercentre comparison was recognized by the European Commission. Therefore, the project: 'Standards of Care for Cleft Lip and Palate in Europe: Eurocleft' ran between 1996 and 2000 and aimed to promote a broad uplift in the quality of care and research in the area of cleft lip and palate.
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                Author and article information

                Journal
                Cleft Palate Craniofac J
                Cleft Palate Craniofac J
                CPC
                spcpc
                The Cleft Palate-Craniofacial Journal
                SAGE Publications (Sage CA: Los Angeles, CA )
                1055-6656
                1545-1569
                20 July 2021
                July 2022
                : 59
                : 7
                : 859-866
                Affiliations
                [1 ]Oral Health Centre of Expertise/Western Norway, Department of Clinical Dentistry, University of Bergen, Norway
                [2 ]Department of Clinical Dentistry, University of Bergen, Norway
                [3 ]Department of Clinical Dentistry, University of Bergen, Norway
                [4 ]King Faisal University SA, University of Science and Technology, Omdurman, Sudan
                [5 ]Oral Health Centre of Expertise/Western Norway, Bergen, Norway
                Author notes
                [*]Paul K. Saele, Department of Clinical Dentistry, University of Bergen, Center for Cleft Lip and Palate, Bergen, Oral Health Centre of Expertise in Western Norway, Post Box 2354, Møllendal, 5867 Bergen, Norway. Email: paul.kare.sele@ 123456vlfk.no
                Author information
                https://orcid.org/0000-0001-5216-7724
                Article
                10.1177_10556656211028509
                10.1177/10556656211028509
                9260468
                34282635
                567bdad0-48af-4013-add7-0ad28e034963
                © 2021, American Cleft Palate-Craniofacial Association

                This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

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                cl/p,orthodontist,experience,education,norway
                cl/p, orthodontist, experience, education, norway

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