Objective To study craniofacial growth and hypodontia in individuals born with Van der Woude syndrome (VWS) and compare with matched controls with and without a cleft. Design A multicenter retrospective case-control study. Setting Individuals from three craniofacial centers in Sweden and from a historical archive of Swedish healthy children were included. Patients Sixty individuals, with VWS (n = 20), non-syndromic cleft lip and/or palate (NSCL/P) (n = 20), and healthy controls (CTR) (n = 20), matched for age, gender and cleft type. Interventions Two lateral cephalograms per individual, taken at 10 and 16 years of age, were analyzed. Orthopantomograms were used to evaluate hypodontia. Main Outcome Measures Craniofacial growth followed longitudinally, with the primary variables SNA, SNB, ANB, NL/ML, and maxillary length. Prevalence of hypodontia was also recorded. Results Maxillary length increased 0.3 mm in the VWS group during puberty, compared to 4 mm in the NSCL/P group and 5.5 mm in the CTR group. Both cleft groups had a retruded maxilla at 16 years of age. The change in vertical jaw relation from 10 to 16 years showed a statistically significant difference between the VWS and the CTR group, with a slightly more posteriorly inclined mandible in the VWS group at 16 years. A statistically significant difference in hypodontia is seen between the cleft groups. In the VWS group, 90% had hypodontia compared to 60% in the NSCL/P group. Conclusion Individuals born with VWS have reduced maxillary growth during puberty and a higher prevalence of hypodontia compared to matched controls in the studied population.

BACKGROUND:Outcome studies conducted on patients treated for cleft lip and palate (CLP) typically focus on clinical measures, while significantly fewer investigate patients' subjective perceptions of the long-term outcomes. OBJECTIVE:To evaluate oral health related quality of life (OHRQoL) as reported by young adults born with unilateral cleft lip and palate (UCLP). MATERIAL:The study sample consisted of 32 consecutive patients (mean age 19.1 years) born with UCLP that had undergone interdisciplinary treatment. This group was compared with two noncleft control groups: one orthodontically treated group (Ortho) (n = 32, mean age 18.7 years) and one nonorthodontically treated group (Control) (n = 31, mean age 18.6 years). METHOD:In this cross-sectional, questionnaire-based study, three instruments, the oral health impact profile-14 (OHIP-14), the jaw functional limitation scale-20 (JFLS-20), and the orofacial esthetic scale (OES) were administered during the final routine follow-up visit at 19 years of age. RESULTS:No significant differences were found in JFLS-20 and OHIP-14 mean summary scores between the UCLP group and the noncleft groups. For OES, the UCLP group differed significantly from the Ortho group (P = 0.042) but not from the Control group. CONCLUSION:Young adults born with UCLP treated in an interdisciplinary team reported overall OHRQoL comparable to peers without a cleft and no history of orthodontic treatment. Their self-perceived orofacial appearance was similar to that of noncleft, nonorthodontically treated peers, but rated less favorable compared to noncleft peers who had received orthodontic treatment.

ABSTRACT Objective Few studies have analysed the outcome of bone grafts in bilateral alveolar clefts and the bone fill with a two‐step surgery method. The currently applied three‐dimensional method used in this study enables a comprehensive description of the bone fill of bilateral clefts after bone grafting. The study aimed to describe alveolar cleft volume and bone fill after alveolar bone grafting of bilateral alveolar clefts treated with two‐step bone grafting, with a comparison between the first and the second bone graft site. A secondary aim was to investigate whether the cleft volume on the non‐surgical side changed after contralateral surgery. Materials and Methods In this retrospective study, 60 CBCT scans from 20 patients were included (8 girls and 12 boys) with an age range of 6.5–11.5 years (mean age 8.7). The cleft volume was measured in pre‐ and post‐operative CBCT scans and assessed in ITK‐SNAP to calculate the bone fill of the cleft. Results After bone grafting, 47% of the first bone‐grafted cleft was filled with bone, and 33% of the second bone‐grafted cleft, without significant difference between them ( p = 0.03). The mean preoperative cleft volume was 0.42cm 3 and the mean residual cleft volume after bone graft was 0.23cm 3 . There was however a significant difference when comparing the bone fill between the nasal and the dental part ( p < 0.001). Conclusion Almost half of the cleft volume was filled with bone after bone grafting. The order of the bone graft side did not influence the bone fill of the cleft.

Objectives The fit between a bracket base and the tooth surface may affect the outcome of orthodontic treatment. The purpose of this study was to compare the fit of five commercially available brackets by evaluating the gap size between the bracket base and the buccal surface of the upper central incisor and first premolar. Methods Six maxillary digital models, comprising twelve teeth (including six upper first premolars and six central incisors), were imported into the 3Shape Indirect Bonding software. Five commercially available brackets (A-E) were digitally bonded to the upper first premolars and central incisors. Five virtual slices were made per bracket, and gap measurements were taken at fifteen locations. A mixed-effects model and multiple comparisons with the best (MCB) analysis (p<0.05) were used to evaluate differences between brackets. Results The gap was generally smaller for the central incisor than for the first premolar. Significant differences in mean and maximum gap sizes were found among the brackets. Central incisor brackets had larger gaps gingivally and distally, with brackets A and B having the largest gaps. First premolar brackets had the largest gaps occlusally and gingivally, with bracket E having the largest overall. The largest horizontal gap was observed mesially, regardless of bracket type. Conclusions The shape and fit of the bracket base are critical when selecting commercial brackets, as larger gaps in certain locations may affect the expression of tip and torque, potentially affecting treatment outcomes. The findings of this digital simulation study need further validation through a clinical trial with large sample size.

Mini implants have been widely used in orthodontics for the last two decades. These provide a reliable source of anchorage without relying on patient cooperation. However, disadvantages such as loss of mini-implants and damage to vital structures have been reported. Although breakage of mini-implants can occur, it is not frequently reported. The aim of this study is to evaluate the effect of pilot hole on insertion torque for orthodontic mini-implants and to examine the impact on fracture torque of bending of the mini-implants during insertion. Screws used for orthodontic treatments were installed in an artificial bone block with higher density than the bone in the human palate. The block was constructed in four layers of different densities. The first layer would simulate the compact bone in the midpalatal suture area with a density of 40 pounds per cubic foot (PCF). The second layer represented the spongious bone with a density of 20 PCF. The third and fourth layers, with densities of 45 and 50 PCF respectively, were designed to exceed the density of human bone to ensure the miniscrews would fracture during insertion. Insertion torque of twenty mini-implants was measured during insertion with and without predrilling a pilot hole. The fracture torque was measured in three different circumstances, only torque, torque combined with bending of the mini-implants at 20 and 30 degrees. A statistically significant difference (p<0.001) was found between insertion torque of mini-implants with and without predrilling (36.1 ± 8.1 and 53.2 ± 6 Ncm). The fracture torque was 89 ± 12.8 Ncm without bending and it decreased significantly (p<0.001) to 76.8± 10.2 and 55.3 ± 5.2 Ncm when the mini-implants bent at 20 and 30 degrees, respectively. Mini-implants are more likely to fracture when subjected to combined loads. Bending the screw during insertion decreases the fracture torque. Predrilling pilot holes reduces the required torque during insertion. That means the mini-implants are less likely to fracture when pilot holes are made prior to insertion.

Mini implants have been widely used in orthodontics for the last two decades. These provide a reliable source of anchorage without relying on patient cooperation. However, disadvantages such as loss of mini-implants and damage to vital structures have been reported. Although breakage of mini-implants can occur, it is not frequently reported. The aim of this study is to evaluate the effect of pilot hole on insertion torque for orthodontic mini-implants and to examine the impact on fracture torque of bending of the mini-implants during insertion. Screws used for orthodontic treatments were installed in an artificial bone block with higher density than the bone in the human palate. The block was constructed in four layers of different densities. The first layer would simulate the compact bone in the midpalatal suture area with a density of 40 pounds per cubic foot (PCF). The second layer represented the spongious bone with a density of 20 PCF. The third and fourth layers, with densities of 45 and 50 PCF respectively, were designed to exceed the density of human bone. Insertion torque of twenty mini-implants was measured during insertion with and without predrilling a pilot hole. The fracture torque was measured in three different circumstances, only torque, torque combined with bending of the mini-implants at 20 and 30 degrees. A statistically significant difference (p<0.001) was found between insertion torque of mini-implants with and without predrilling (36.1 ± 8.1 and 53.2 ± 6 Ncm). The fracture torque was 89 ± 12.8 Ncm without bending and it decreased significantly (p<0.001) to 76.8± 10.2 and 55.3 ± 5.2 Ncm when the mini-implants bent at 20 and 30 degrees, respectively. Mini-implants are more likely to fracture when subjected to combined loads. Bending the screw during insertion decreases the fracture torque. Predrilling pilot holes reduces the required torque during insertion and might decreases the risk of fracture.

OBJECTIVE:This study aimed to investigate how much the field of view (FOV) can be decreased while still depicting the necessary anatomical structures. A secondary aim was to assess how many incidental findings were missed with a reduced FOV. MATERIAL AND METHODS:In this retrospective study, 170 CBCT volumes from children with a mean age of 9.4 years were collected. All CBCT had a FOV of 80 × 50 mm covering the maxilla. The present study analysed whether a smaller FOV can be used while still including necessary anatomical structures. Measurements of the minimal height and width that include vital anatomical structures were performed with two FOV reduction protocols: one smaller (includes the cleft, adjacent central incisor and adjacent canine) and one larger (includes both canines, nasal floor and the cleft). RESULTS:The use of the larger protocol resulted in a FOV of 44.3 × 36.5 mm (95th percentile); for the smaller protocol, the FOV was 28.1 × 34.9 mm (95th percentile). In the larger protocol, incidental findings were missed in 22%. In the smaller protocol, 35% of the incidental findings were missed. However, most of these findings were irrelevant to the planning of the bone graft. CONCLUSION:A FOV of 50 × 40 mm (41% dose reduction compared with the original FOV) is suggested to fully depict the cleft area, central incisors, nasal floor and both canines. A FOV of 35 × 40 mm (56% dose reduction compared with the original FOV) is suggested to depict the cleft and the ipsilateral canine and central incisor adjacent to the cleft.

OBJECTIVES:To compare cephalometric long-term outcomes in patients with unilateral cleft lip and palate (UCLP) and treated with three different surgical protocols for palatal repair. Furthermore, to investigate growth longitudinally and evaluate the possibility to predict the outcome at age 19 from cephalometric values at 5 years. MATERIALS/METHODS:Lateral cephalograms of 68 patients, operated according to the Veau-Wardill-Kilner technique (n = 13), the minimal incision technique (n = 39), or MIT with muscle reconstruction (MITmr) (n = 16) were assessed. At a mean age of 19.0 (SD 0.7) years, 17 skeletal and 6 soft tissue variables were analysed using analysis of variance (ANOVA) with pairwise comparison. Lateral cephalograms at a mean age of 5.1 (SD 0.4) years, from 32 of the 68 patients were used to predict values at 19 years, using a multiple linear regression. RESULTS:There were statistically significant differences between the three surgical techniques for eight of the skeletal variables and for two of the soft-tissue variables at 19 years. The angle between the sella/nasion plane and the nasion/A plane (SNA) was 74.5 (SD 3.8) after Veau-Wardill-Kilner (VWK), 77.6 (SD 5.3) after minimal incision technique (MIT), and 76.7 (SD 2.6) after MITmr. Adjusted for baseline values, at 5 years, only face height had a significant effect dependent on surgical technique. LIMITATIONS:Due to the exclusion criteria or missing medical records, only 43% of 157 consecutive patients could be included in the study. CONCLUSION:MIT and MITmr resulted in better cephalometric results regarding facial growth sagittally and vertically compared to VWK. Most of the cephalometric variables measured showed a strong positive relation between the value at 5 and the value at 19 years of age.

With the help of educators from all over Europe, the European Guidelines for Postgraduate Education in Orthodontics were created, and its influence spread far and wide. These recommendations, which promote evidence-based treatment and integrate the most recent developments in orthodontic research and technology, have enabled orthodontic instructors and postgraduate students globally to stay up to date with the quickly changing field of orthodontics. The World Federation of Orthodontists (WFO) Guidelines for Postgraduate Orthodontic Education, which were released in 2009 and later revised in 2023, were also influenced by the European Guidelines. The use of these guidelines by postgraduate program directors around the world and by related educational, scientific, and administrative institutions will allow them to adapt their curricula to worldwide standard and to strive for excellence in themselves and our speciality.

BACKGROUND:Studies addressing the periodontal health of the teeth surrounding the bone-grafted cleft in patients born with unilateral cleft lip and palate disagree on whether periodontal health is compromised.OBJECTIVES:To determine periodontal health differences between the cleft and the non-cleft sides nearly a decade after secondary alveolar bone grafting.METHODS:This prospective, controlled (split-mouth design) study comprised an intraoral apical radiographic and a periodontal examination of 40 consecutive patients from one centre (n = 26 males) who had undergone bone grafting at mean age of 10.2 years (±1.6). Probing pocket depth, gingival index, gingival recession, and radiographic bone support were assessed.RESULTS:No significant difference occurred in probing pocket depth between teeth at cleft and non-cleft sites (OR 1.8, P = .488). Gingival recession was present at 6.6% of all examined sites on the cleft side and at 1.7% on the non-cleft side (OR 17.3, P < .001). Gingival recession occurred most often on the buccal and disto-buccal surfaces of the central incisor on the cleft side. The gingival index was significantly higher on the cleft side (OR 8.0, P < .001). The Bergland index was I or II in most patients (87%).LIMITATIONS:Recruitment of eligible patients was lengthy.CONCLUSION:The teeth on the cleft side had high levels of gingival inflammation. Few pathological gingival pockets, however, were found. Shallow gingival recessions frequently occurred around the central incisor on the cleft side. Teeth in the bone-grafted cleft region generally had good bone support.

BACKGROUND:Several methods have been proposed to assess outcome of bone-grafted alveolar clefts on cone beam computed tomography (CBCT), but so far these methods have not been compared and clinically validated.OBJECTIVES:To validate and compare methods for outcome assessment of bone-grafted clefts with CBCT and provide recommendations for follow-up.METHODS:In this observational follow-up study, two grading scales (Suomalainen; Liu) and the volumetric bone fill (BF) were used to assess the outcome of 23 autogenous bone-grafted unilateral alveolar clefts. The mean age at bone grafting was 9 years. The volumetric BF was assessed in five vertical sections. The bone-grafted cleft outcome was based on a binary coding (success or regraft) on a clinical multidisciplinary expert consensus meeting. Grading scales and volumetric assessment were compared in relation to the bone-grafted cleft outcome (success or regraft). Reliability for the different outcome variables was analyzed with intra-class correlation and by calculating kappa values.LIMITATIONS:The study had a limited sample size. Clinical CBCT acquisitions had a varying tube current and exposure time.RESULTS:Volumetric 3D measurements allowed for outcome assessment of bone-grafted alveolar clefts with high reliability and validity. The two grading scales showed highly reliable outcomes, yet the validity was high for the Suomalainen grading scale but low for the Liu grading scale.CONCLUSIONS:Volumetric 3D measurement as well as the Suomalainen grading can be recommended for outcome assessment of the bone-grafted cleft. Yet, one must always make a patient-specific assessment if there is a need to regraft.

To three-dimensionally assess and visualize the eruption path and development of the maxillary canine following alveolar bone grafting in patients born with cleft lip and palate. A further objective of this analysis was to assess how the presence of the lateral incisor impacts the eruption path of the canine. Observational follow-up study. Stockholm Craniofacial Team, Karolinska University Hospital, Sweden. Thirty children born with non-syndromic unilateral cleft lip with or without palate were consecutively included. CBCT scans of the maxilla were taken six months before and six months after the alveolar bone-grafting surgery for each patient. Canine eruption (angulation and vertical movement) and canine development (length and volume). There was a significant difference pre- and post-operatively of the canine angulation between the cleft and non-cleft sides. The mean angulation on the cleft side was 14.7° (SD = 11.1°) while on the non-cleft side, it was 4.9° (SD = 9.2°). No significant differences were noted between cleft-side and non-cleft side canines in terms of amount of vertical eruption and volumetric development. Absence of the lateral incisor did not significantly contribute to either canine angulation or its vertical eruption on the cleft-side. Higher angulation of the canine on the cleft side indicates a higher risk of future canine impaction. Presence or absence of the lateral incisor did not significantly affect canine angulation or its vertical eruption. Increased age and children born with total cleft lip and palate imply a higher risk of angulated canines on the cleft side.

BACKGROUND:Children born with an alveolar cleft receive bone grafts for improved function and aesthetics. The cleft area is examined radiologically before and after bone graft. Optimizing radiographic examination protocols is essential to protect these patients from possible delayed radiation injury later in life. This study investigates whether image quality of cone-beam computed tomography (CBCT) exposed with an ultra-low-dose (ULD) protocol is comparable to the clinical default protocol, the standard dose (SD) protocol, in visualizing details of importance in bone grafting of alveolar clefts. METHODS:In this randomized controlled study, 72 patients with unilateral or bilateral alveolar clefts between 9 and 19 years (mean age, 9.5 years) were randomized 1:1 with either a ULD or an SD CBCT examination protocol. The CBCT scans were conducted with a Planmeca ProMax Mid scanner with an 8 × 5-cm field of view. Two experienced radiologists blindly evaluated the images and visibility of cortical bone border, trabecular bone, tooth anatomy, root development, periodontal space, and cleft width. The visibility was categorized as unacceptable, acceptable, or excellent. RESULTS:Mann-Whitney U test showed no significant differences in structure visibility between ULD and SD protocols regarding anatomical structures of interest: cortical bone border ( P = 0.07), trabecular bone ( P = 0.64), tooth anatomy ( P = 0.09), root development ( P = 0.57), periodontal space ( P = 0.38), and cleft width ( P = 0.44). CONCLUSIONS:ULD and standard CBCT protocols provide comparable image quality in terms of structure visibility in the examination of alveolar clefts. The ULD protocol is preferred to the SD protocol because of the lower radiation dose without compromising diagnostic information of CBCT images. CLINICAL QUESTION/LEVEL OF EVIDENCE:Diagnostic, I.

Summary Background and trial design The Scandcleft intercentre study evaluates the outcomes of four surgical protocols (common method Arm A, and methods B, C, and D) for treatment of children with unilateral cleft lip and palate (UCLP) in a set of three randomized trials of primary surgery (Trials 1, 2, and 3). Objectives To evaluate and compare dental arch relationships of 5-, 8-, and 10-year-old children with UCLP after four different protocols of primary surgery and to compare three dental indices. The results are secondary outcomes of the overall trial. Methods Study models taken at the ages of 5 (n = 418), 8 (n = 411), and 10 years (n = 410) were analysed by a blinded panel of orthodontists using the Eurocran index, the 5-year-olds’ (5YO) index, and the GOSLON Yardstick. Student’s t-test, Pearson’s correlation, chi-square test, and kappa statistics were used in statistical analyses. Results The reliability of the dental indices varied between moderate and very good, and those of the Eurocran palatal index varied between fair and very good. Significant correlations existed between the dental indices at all ages. No differences were found in the mean 5-, 8-, and 10-year index scores or their distributions within surgical trials. Comparisons between trials detected significantly better mean index scores in Trial 2 Arm C (at all ages) and in Trial 1 Arm B (at 5 and 10 years of age) than in Trial 3 Arm D. The mean Eurocran dental index scores of the total material at 5, 8, and 10 years of age were 2.50, 2.60, and 2.26, and those of the 5YO index and GOSLON Yardstick were 2.77, 2.90, and 2.54, respectively. At age 10 years, 75.8% of the patients had had orthodontic treatment. Conclusions The results of these three trials do not provide evidence that one surgical method is superior to the others. The reliabilities of the dental indices were acceptable, and significant correlations existed between the indices at all ages. The reliability of the Eurocran palatal index was questionable. Trial registration ISRCTN29932826.

BACKGROUND:It is suggested that dental agenesis affects maxillary protrusion and dental arch relationship in children with unilateral cleft lip and palate (UCLP). In addition, an association between the need for orthognathic surgery and dental agenesis is reported.AIM:The aim was to study the impact of maxillary dental agenesis on craniofacial growth and dental arch relationship in 8-year-old children with UCLP.SUBJECTS AND METHODS:The sample consisted of individuals with UCLP from Scandcleft randomized trials. The participants had available data from diagnosis of maxillary dental agenesis as well as cephalometric measurements (n = 399) and GOSLON assessment (n = 408) at 8 years of age.RESULTS:A statistically significant difference was found for ANB between individuals with agenesis of two or more maxillary teeth (mean 1.52°) in comparison with those with no or only one missing maxillary tooth (mean 3.30° and 2.70°, respectively). Mean NSL/NL was lower among individuals with agenesis of two or more maxillary teeth (mean 9.90°), in comparison with individuals with no or one missing maxillary tooth (mean 11.46° and 11.45°, respectively). The number of individuals with GOSLON score 4-5 was 47.2% in the group with two or more missing maxillary teeth and 26.1% respectively 26.3% in the groups with no or one missing maxillary tooth. No statistically significant difference was found in the comparison between individuals with no agenesis or with agenesis solely of the cleft-side lateral.CONCLUSION:Maxillary dental agenesis impacts on craniofacial growth as well as dental arch relationship and should be considered in orthodontic treatment planning.

BACKGROUND:The Scandcleft trial is a randomized controlled trial that includes children with unilateral cleft lip and palate where registrations are standardized and therefore provides the opportunity to describe craniofacial characteristics in a very large sample of patients. OBJECTIVES:The aim of this study was to describe craniofacial growth and morphology in a large study sample of 8-year-old children with unilateral cleft lip and palate (UCLP); before orthodontic treatment and before secondary alveolar bone grafting; and to compare the cephalometric values with age-matched non-cleft children from previous growth studies to identify the differences between untreated cleft- and non-cleft children. MATERIALS:There are 429 eight-year-old UCLP patients in the Scandcleft study group. A total of 408 lateral cephalograms with a mean age of 8.1 years were analysed. Cephalometric analyses were performed digitally. The results from three previously published growth studies on non-cleft children were used for comparison. RESULTS:Cephalometric analyses showed a large variation in craniofacial morphology among the UCLP group. In general, they present with significant maxillary retrusion and reduced intermaxillary relationships compared to the age-matched non-cleft children. In addition, the vertical jaw relationship was decreased, mainly due to decreased maxillary inclination. The upper and lower incisors were retroclined. It can be expected that these differences will increase in significance as the children age. CONCLUSION:Results from this study provide proposed norms for the young UCLP before any orthodontic treatment and can be valuable for the clinician in future treatment planning. TRIAL REGISTRATION:ISRCTN29932826.

Objectives: To determine the developmental patterns of primary and secondary dentitions in infants with orofacial clefts. Design: Retrospective, longitudinal, population-based cohort study. Materials: Longitudinal records and radiographs of 192 nonsyndromic Northern European infants with isolated unilateral cleft lip (UCL, n = 111) and isolated cleft palate (CP, n = 81). Methods: Radiographic assessments of primary and secondary dentition anomalies and dental maturation, by gender and cleft severity for comparisons between the groups and with historical controls. Results: In infants with UCL, the frequencies of dental anomalies were high in both primary (38.7%) and secondary (18.0%) dentitions. Primary and secondary dentition anomalies were not observed in infants with CP and different in the UCL group (P = .003). Risk differences involved primary supernumerary teeth (P = .0001) and talon cusp formation (P = .0001), and secondary tooth agenesis (P = .001) of the maxillary lateral incisor on the side of the cleft lip. Delayed primary and secondary dental maturation occurred in the UCL and CP groups, greater in infants with UCL (P < .0001). Primary and secondary dental maturation featured sexual dimorphism with greater delay in males (UCL, P < .0001; CP, .0001 > P = .001). The effect of cleft severity on dental maturation was significant in infants with UCL (P = .0361) and CP (P = .0175) in the primary but not in the secondary dentition. Conclusions: There were different dental anomalies in the primary and secondary dentitions in operated infants with UCL and no dental anomalies in unoperated infants with CP. Dental maturation was delayed in infants with UCL and CP with greater delay in males compared to females.

Aims: To determine reliability and predictive validity of the 5-year-olds’(5YO) Index and GOSLON Yardstick in 119 patients born with unilateral cleft lip and palate at 5, 7/8, 10, 15/16, and 19 years. Methods: Five hundred thirty-four dental study models were appraised by 2 teams in 2 centers, twice in each center. Intrateam and interteam reliability in scoring the models was calculated using κ. Dental arch prediction rates were calculated as the proportion of models remaining in the same category (good–scores 1 and 2; fair–score 3; poor–scores 4 and 5) over time. Results: Intrateam and interteam κ statistics ranged from 0.74 to 0.89 and from 0.74 to 0.81, respectively. The 5YO Index and GOSLON Yardstick at 5 years produced almost identical results. The prediction rate of 19-year-old (n = 106) outcome was >80% for those in groups 1 and 2 at 5 years, while for those in groups 4 and 5 prediction was poor (<40%). Prediction of groups 4 and 5 remained poor until 10 years when it increased to 77%. At 15/16 years prediction rate was 93% for those in groups 4 and 5. Prediction of cases in group 3 was very poor at all ages. Conclusions: These results question the predictive value of “poor” dental arch relationships before 10 years of age. However, the predictive value of “good” dental arch relationship scores over time is good in all age groups. This has implications for audit policies to predict facial growth outcomes.

OBJECTIVES:The present study validated data that had been reported to the Swedish Quality Registry for Cleft Lip and Palate (CLP) under new requirements from 2016, when use of the 5-year-old (5YO) and the Modified Huddart and Bodenham (MHB) indices for rating occlusion in children born with unilateral CLP (UCLP) was introduced. MATERIALS AND METHODS:The sample included blinded study casts (n = 97) and photos (n = 4) of 5-year-old children who had been born with UCLP in 2009-2011 and were enrolled at one of six cleft centres in Sweden. Fourteen orthodontists from the centres assessed the patients (n = 101) using the 5YO and the MHB indices. Median 5YO and MHB scores of the 14 assessments were compared with original registry data (n = 61). Each centre devised code keys to protect the identities of their patients in the registry. RESULTS:Interrater agreement among the 14 orthodontists was good for the 5YO index (quadratic-weighted kappa: 0.72-0.92) and the MHB index (intraclass correlation coefficient: 0.991-0.994). Comparisons of median 5YOs for each identifiable child with their registry data (n = 61) found total agreement for 70.5 per cent. Comparisons between median MHBs and registry data showed very good or good agreement in 93.4 per cent of the cases. LIMITATIONS:Two teams lost their code keys, which reduced the sample to 61 patients. CONCLUSIONS:The dentoalveolar outcome data in the CLP registry was trustworthy. There was good agreement among the Swedish cleft teams assessing the 5YO and MHB indices in children born with UCLP at age 5 years.