Date of Award
9-26-2025
Department
Department of Orthodontics
First Advisor
Marie M. Tolarová
First Committee Member
Olivia Yue
Second Committee Member
Mirek Tolar
Abstract
Objectives: To evaluate and compare orthodontic treatment protocols for non-syndromic orofacial clefts (OFCs) across six craniofacial centers in North America and one in Jordan, with emphasis on timing, sequencing, and clinical techniques surrounding alveolar bone grafting (ABG), expansion, and retention. Methods: A cross-sectional survey was completed by lead orthodontic providers at six North American centers and the Farah Rehabilitation Institute at King Hussein Medical City, Amman. The survey assessed pre-ABG evaluations, appliance selection, expansion intervals, treatment records, retention methods, ABG success evaluation, and postsurgical recall. Descriptive statistics were used to summarize and compare trends. Results: All centers performed orthodontic evaluations before ABG. Provider continuity was reported at four North American centers (66.7%) but was inconsistent in Jordan. North American centers used broader records, including digital models and CBCT, whereas Jordan relied on photographs, study models, and panoramic radiographs. Presurgical orthopedics such as nasoalveolar molding (NAM) were reported at one North American center (16.7%) and at the Jordanian center. Expansion was universal: Hyrax appliances were most common (83.3% in North America; also used in Jordan), with additional fan-type (50%) and quad helix (16.7%) expanders in North America. Jordan used Hyrax and quad helix only, with standardized activation intervals (4–5 weeks) compared with variable schedules (1–6 weeks) in North America. Post-expansion radiographs were obtained in half of North American centers but routinely in Jordan. Retention appliances included Hawley and TPAs in North America, and Essix, Hawley, and fixed lingual retainers in Jordan. ABG success was evaluated variably in North America but uniformly in Jordan. Five of six North American centers (83.3%) reported failure rates of 0–25%, one reported 25–50%, while Jordan reported 25–50%. Post-ABG recall intervals varied (3–12 months in North America; standardized 6 months in Jordan). Conclusions: Despite universal expansion and pre-ABG evaluations, variation exists in records, appliances, imaging, and ABG 3 assessment. Jordan’s centralized model promoted standardization but reported higher failure rates. These findings underscore the need for consistent, evidence-based protocols in cleft orthodontic care.
Recommended Citation
Sayed, Ila, "A Cross National Analysis of Orofacial Cleft Care: Comparison of Parental Experience and Course of Orthodontic Treatment between Six Craniofacial Centers in the United States, and One in Jordan" (2025). Orthodontics and Endodontics Theses. 57.
https://scholarlycommons.pacific.edu/dugoni_etd/57
