Clinical Paper Cleft Lip and Palate Examination of dental casts in newborns with bilateral complete cleft lip and palate § A. Wutzl, K. Sinko, N. Shengelia, W. Brozek, F. Watzinger, K. Schicho, R. Ewers: Examination of dental casts in newborns with bilateral complete cleft lip and palate. Int. J. Oral Maxillofac. Surg. 2009; 38: 1025–1029. # 2009 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved. A. Wutzl 1 , K. Sinko 1 , N. Shengelia 1 , W. Brozek 2 , F. Watzinger 1 , K. Schicho 1 , R. Ewers 1 1 University Hospital of Cranio-Maxillofacial and Oral Surgery, Medical University of Vienna, Austria; 2 Department of Pathophysiology, Medical University of Vienna, Austria Abstract. This study reports measurements of dental casts in patients up to 6 months of age with bilateral complete cleft lip and palate (BCLP). 25 mouth casts of newborns with BCLP were selected from the hospital archive. They were measured independently by two examiners who assigned numbers to each measurement, referring to the expected reproducibility. The investigators also classified each dental cast according to an established score. The absolute values of all measured distances (P-P 0 , L-C1-C2-T, L 0 -C1 0 -C2 0 -T 0 , P-L, P 0 -L 0 , L-L 0 , C1-C1 0 , C2-C2 0 , Q1- Q1 0 , Q2-Q2 0 , T-T 0 , I-Q1Q1 0 , I-Q2Q2 0 , I-TT 0 ) are reported. Inter-observer reproducibility was acceptable with total measurement errors ranging from 0.5 to 1.4 mm. Most reliability scores, ranging from 1 (very high) to 5 (very low), showed a mean between 2 and 3 (min 2.17; max 3.16). The two examiners rated only one patient differently, according to the applied classification scheme. The absolute measurement values of the two classification systems accorded with the literature. This is the first study to measure the distances according to an established protocol in BCLP patients. The measurements between certain landmarks are more precise than others; it may be possible to use the more precise points for a longitudinal study from birth to 18 years. Keywords: BCLP; cast model; measurements; reliability score. Accepted for publication 27 April 2009 Available online 28 May 2009 Postnatal development and growth in patients with cleft lip and palate depends on intrinsic 5,11,20 and extrinsic factors 21,22 that have not been fully elucidated. Treat- ment of cleft lip and palate is a difficult process, to which different medical and dental specialities contribute 10 . The authors think that prospective studies starting at birth are necessary to evaluate treatment regimes and that dental casts are an important tool for documenting the original maxillo-dental status. Landmarks are clearly identifiable points that have a biological meaning as representatives of anatomical struc- tures 1,15 . Landmark analysis is a useful method for comparing the outcome of patients undergoing different treatment regimes. Many studies describe the use of dental casts for treatment evalua- tion 1,4,9 . Landmarks on the dental casts of patients with cleft lip are more difficult to find than those on the casts of healthy orthodontic patients 19 . This might be the reason for the great number of studies contributing to the accuracy of document- ing and measuring the original status of cleft patients 3,13,19 . Most of these studies used maxillary arch dimensions and occlusal relation- ships for analysis. These measurements depend on statistical bias through the changes of growth 8 . Other studies have tried to categorize patients using initial dysmorphology to predict dentoskeletal outcome 6,16 . Int. J. Oral Maxillofac. Surg. 2009; 38: 1025–1029 doi:10.1016/j.ijom.2009.04.023, available online at http://www.sciencedirect.com § No benefit of any kind has been received either directly or indirectly by the authors. 0901-5027/1001025 + 05 $36.00/0 # 2009 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.