the clefts occur 
 between the 4 and 12 weeks of intrauterine life , period during 
 which the embryonic development of the face and palate are taking place . maxillary hypoplasia and mid face 
 retrusion are frequent findings in patients with cleft lip and palate . a widely accepted 
 etiology for the occurrence of maxillary retrusion has been the iatrogenic effects of 
 surgical interventions , creating lip tension and scar tissue surrounding the palate and 
 maxilla , resulting in the growth disturbance . the treatment of cleft lip and palate is a difficult process , which should be initiated 
 soon after birth and continue up to adulthood , requiring the participation of an 
 interdisciplinary team . the 
 morphological rehabilitation of clefts involves lip plastic surgery at 3 months of age 
 and palate plastic surgery around 1 year of age , as well as secondary alveolar bone 
 graft performed between 9 and 12 years of age . additionally to the primary plastic surgeries , the rehabilitation 
 requires an interdisciplinary protocol involving different specialties as speech and 
 language therapy , maxillofacial surgery and oral rehabilitation so that the therapeutic 
 procedures should be standardized . the fact that the clinician is aware of the dimensional alterations of the dental arches 
 occurring in cleft lip and palate subjects is of extreme therapeutic interest , because 
 it can influence on the stability of the results obtained in the rehabilitation of the 
 individual . the clinician should not only aim the rehabilitation of the patients but 
 also their social inclusion . the rehabilitation process involves the action of an 
 interdisciplinary team within a relationship of reciprocity , mutuality and dialogue . in 
 this relationship the ideal rehabilitative 
 treatment is still a problem , and in many areas there are several protocols . thus , the systematic and early documentation of cleft lip and palate individual should 
 be emphasized considering that their rehabilitative treatment is a constant challenge 
 and should be started at birth . it is 
 important to emphasize that the dental documentation provides an adequate and 
 prospective planning , by individualizing the procedures required by each specific case , 
 and allows evaluating longitudinally the progress reached in the proposed treatment . ( 2009 ) observed that 
 prospective studies starting at birth are necessary to evaluate the treatment protocol 
 and that dental casts are an important tool for documenting the original maxilla - tooth 
 status . many studies used maxillary arch dimensions and landmarks for analysis of the 
 development and growth in patients with cleft lip and palate . landmarks analysis is a useful method for comparing the outcome of 
 patients undergoing different treatment protocols . landmarks on the dental casts of 
 patients with cleft lip and palate are more difficult to find than those on the casts of 
 non - cleft patients . recently , the three - dimensional ( 3d ) scanner was presented in literature as a tool for 
 analysis of arch dimensions and landmarks on cleft lip and palate casts . it produces 3d 
 data from the surface structures of the cast using scanning techniques . the potential 
 benefit of this tool for landmark positioning and analysis is a matter of 
 discussion . ( 2006 ) quantified the accuracy of landmark positioning on 
 digitized casts using laser scanning of children with unilateral cleft lip and 
 palate . the study of the 
 dental arches of cleft lip and palate patients contributes for a better understanding of 
 the morphological alterations of the dental arches , which can be useful in the 
 preventive and corrective treatment of cleft lip and palate patients . the purpose of this present study was to compare , by means of 3d digital casts , the 
 anterior transverse dimension of the dental arch in newborns with and without cleft lip 
 and palate . the ethical committee in research of the hospital for the rehabilitation of craniofacial 
 anomalies of the university of so paulo approved the protocol of this study 
 ( # 080/2012 ) . the parents or guardians of the children received detailed information 
 concerning the nature and the procedures involved in the study and signed informed 
 consent forms . the sample was composed of ninety - four children aged from 3 to 9 months , of both 
 genders . inclusion criteria included cleft lip and palate with or without simonart band , 
 without any associated syndrome or malformation and without previous surgery . the 
 participants of the study were divided into three groups : group i - children without 
 craniofacial deformities ( n=19 ) ( control group ) ; group ii - children with unilateral 
 cleft lip and palate ( uclp ) ( n=50 ) ; group iii - children with bilateral cleft lip and 
 palate ( bclp ) ( n=25 ) . the selection of the children for the samples was performed according to each group . in 
 group i ( control ) , the participants were selected in the discipline of pediatric 
 dentistry of the bauru school of dentistry ( fob / usp ) , and in groups ii and iii , at the 
 hospital for rehabilitation of craniofacial anomalies ( hrac / usp ) . the assessment was performed through dental casts of each patient by one investigator 
 previously trained and calibrated . the measurements of the maxillary arches were 
 obtained from the casts and used for correlation among groups . next , data were recorded 
 on specific charts for each patient . for that purpose , dental study casts were obtained 
 after a reliable copy of the condensation silicon impression ( perfil , vigodent , rio de 
 janeiro , brazil ) , aiming at reaching a perfect reproducibility of dental arches . the 
 impression was executed through customized dental trays , properly selected , made 
 directly in the mouth of the patient , prior to the primary surgeries . the dental trays were customized and constructed in acrylic resin , with size compatible 
 with the dental arch of the patients ( figure 1 ) . 
 to reach the best adaptation of the tray , dental periphery wax was used to seal the area 
 of the bottom of the gingival sulcus . the next step was the manipulation of the 
 impression material according to the instructions of the manufacturer . the mixing ratio 
 was one scoop of base paste for two scoops of catalyst paste . customized trays constructed in acrylic resin for impressions of children at first 
 ages the impression was taken with the child seated on the lap of the mother to avoid that 
 the hands of the newborns would touch the mouth . after the setting of the 
 impression material , the tray was removed and the impression quality was verified . this 
 should be perfect , comprising the anterior border of the cleft and the tuberosity 
 region , requiring deepness of the gingival sulcus , in all its extension ( figure 3 ) . child seated on the lap of the mother to perform the impression ( parents signed 
 informed consent authorizing the publication of this picture ) impression of the maxillary dental arch comprising from the anterior border of the 
 cleft to the retromolar region dental casts were constructed in white plaster ( figure 
 4 ) . following , the casts were cut aiming to obtain standardized bases 
 proportional to the dental - alveolar areas . the casting of group i ( control group ) was 
 matched for age and the casts were as standardly obtained as those for the cleft lip and 
 palate groups . dental casts were digitized using a 3d scanner ( 3shape 's 
 r700 scanner , copenhagen k , denmark ) linked to a computer . next , the 
 casts were reliably digitized and the obtained measurements were assessed through 
 software ( 3d software orthoanalyzer , copenhagen k , denmark ) ( figure 5 ) . study casts with standardized cuts proportional to the dental - alveolar areas screen of the computer showing the digitzed cast and the respective 
 measurements the software reads the landmarks images ( measuring points and lines ) according to their 
 cartesian planes . then , it unites these planes to generate measurements , which were 
 executed directly on the scanner images . on the digital casts , the landmarks of the 
 maxillary dental arches , required for the execution of the intercanine distance 
 measurements ( c and c ' points ) , were defined according to those described by seckel , et 
 al . canine landmarks in unilateral cleft lip and palate patients canine landmarks in bilateral cleft lip and palate patients the data were submitted to statistical analysis for comparison among groups after all 
 impressions and measurements . the results showed a mean of 36.5 mm for unilateral cleft lip and palate group , 34.8 mm 
 for bilateral cleft lip and palate group and 27.52 mm for the control group ( table 1 ) . measurements found in the studied groups uclp = unilateral cleft lip and palate bclp = bilateral cleft lip and palate one examiner previously calibrated visually evaluated each image , after a 30-day 
 interval between the assessments ( p=0.126 ) . there was a statistically significant 
 difference between the control group and both groups of patients with cleft lip and 
 palate . there was no statistically significant difference between groups with complete 
 unilateral and bilateral cleft lip and palate ( table 
 2 ) . results of t test for the studied variables = statistically significant differences ( p<0.05 ) uclp = unilateral cleft lip and palate bclp = bilateral cleft lip and palate the requirements of patients with cleft lip and palate extend beyond surgical repair . a 
 multidisciplinary approach to the care of patients with cleft lip and palate is the 
 widely accepted standard protocol in most regions of the developed world . however , the 
 existing shortages of healthcare resources have precluded provision of the most basic 
 care to patients with cleft lip and palate . innovative technology applications may 
 facilitate the performance of the evaluation of dental arch dimensions in these 
 patients . three - dimensional imaging of digital casts are increasingly gaining acceptance as an 
 alternative to traditional plaster casts . the potential advantages of digital casts are 
 reduced storage requirements , rapid access to digital information and easy transfer of 
 data , versatility and financial savings . compared with the physical plaster casts , the digital data are 
 easier to store and they do not degrade . in addition , scanners with a higher resolution will be able to 
 produce digitized casts that give a more detailed resemblance of the original physical 
 cast . it has also become 
 readily available to reproduce the physical casts from the archived 3d digital data 
 using modern rapid prototyping technology . in this investigation , we used digital models for evaluation of the 
 dental arches measurements in newborns with cleft lip and palate . this study measured the intercanine distance following the protocol by seckel , et 
 al . the intercanine distance measurement is very important to evaluate the 
 treatment protocol for cleft lip and palate patients longitudinally . for this reason , we investigated the reliability and 
 repeatability for both the observer and the measurements . the intra - observer 
 measurements were calculated , the correction of the estimated difficulty of accuracy of 
 the measurement determined and compared by method error . ( 1995 ) affirmed that the reproducible 
 landmark positioning can only be a reality if the quality of the cast is optimal and the 
 investigator is experienced and , even then , only for some of the landmarks investigated . reproducibility might be enhanced by additional information from serial casts of the 
 same individual . in the hrac / usp ( 1999 ) determined the reliability of the 
 surface laser scanning technique and assessed the reliability of interactive 3d landmark 
 localization . the clinical application of this technology in cleft lip and palate 
 documentation requires validation of the technique . original and duplicate plaster casts 
 of an infant with a complete unilateral cleft lip and palate were digitized with a laser 
 scanner . the authors concluded that landmarks well defined by a clearly visible visual 
 cue on the 3d image were more reliable . the methodology used in the present study evaluated a three - dimensional imaging method 
 to measure 3 to 9 month - old unoperated patients with different types of cleft . our data 
 showed that bilateral cleft lip and palate and unilateral cleft lip and palate had 
 significantly larger intercanine distance than control group . ( 2003 ) , observed that bilateral and 
 unilateral complete cleft lip and palate subjects had significantly smaller palatal 
 surface area than both unilateral incomplete cleft lip and palate and cleft palate 
 groups , which indicated a tissue deficiency . this intrinsic deficiency of the palatal 
 surface is likely to become maxillary hypoplasia with the ongoing facial growth and 
 development . the growth potential may further be impacted by surgical interventions with 
 adverse iatrogenic consequence . the 
 great variability in cleft width , maxillary segment position and tissue deficiency 
 within each cleft type also should be considered . the rehabilitative treatment following - up at early age has been little studied due to 
 the difficulty in establishing a methodology enabling to access and analyze early - age 
 patients without the involvement of ethical aspects which could justify the execution of 
 the therapeutic procedures , mainly regarding children less than 5-years - old not 
 presenting anatomical alterations in either the skull or face . notwithstanding , the 
 recording of these data is of extreme relevance to allow the establishment of normality 
 patterns inside the brazilian infant and adolescent population . also , they can be 
 compared with those of infant and adolescent population showing craniofacial anomalies . 
 to enable methods of assessment and comparison of the diagnosis and treatment , it is 
 necessary the assessment of normality conditions . the impression procedure of children at early childhood has unique characteristics and 
 it is rarely executed for growth documentation . in cleft lip and palate children , the 
 impression is vital for the obtainment of the dental mold which will enable the 
 conduction of important studies , assessments and explorations of the documentation for 
 the adequate rehabilitation . the use of landmarks and tridimensional images for the 
 study of dental arches has been a method largely employed for several aims : study of the 
 maxillary growth and development ; effects of the repair surgeries ; and maxillary 
 morphology alterations in cleft lip and palate patients . in the analysis of the results 
 obtained , the intercanine distance of unilateral cleft lip and palate children was 
 greater than that of groups i and iii . the intercanine means of group ii and iii were 
 very closer : 36.5 mm and 34.83 mm , respectively , without statistically significant 
 differences . there were statistically significant differences between the means of group 
 i ( 27.52 mm ) and those of the other two groups . this finding probably occurred because 
 the palate of either bilateral or unilateral cleft lip and palate children , rather than 
 that of the control groups , is compromised in both types of cleft , proving that the 
 intercanine distance depends directly on the situation of the palate . this study was 
 important to determine a treatment protocol for patients with cleft lip and palate . patients with complete cleft lip and palate were born with an increased anterior 
 dimension of the maxillary dental arch compared with non - cleft patients .
objectivethe purpose of this present study was to compare , by means of 3d digital casts , 
 the anterior transverse dimension of the dental arch of newborns with and without 
 cleft lip and palate.material and methodsthe sample was composed of ninety - four children aged from 3 to 9 months divided 
 into three study groups : group i - children without craniofacial deformities 
 ( control group ) ; group ii - children with unilateral cleft lip and palate ; group 
 iii - children with bilateral cleft lip and palate . 
 impressions were executed 
 before lip and palate repair in patients with clefts . 
 dental casts were digitized 
 using a 3d scanner linked to a computer . 
 measurements of the intercanine distance 
 were measured on the digital casts . 
 intergroup comparisons were performed using 
 anova ( p<0.05).resultsthe results showed a mean of 36.5 mm for unilateral cleft lip and palate group , 
 34.8 mm for bilateral cleft lip and palate group and 27.52 mm for the control 
 group . 
 there was a statistically significant difference between the control group 
 and both groups of patients with cleft lip and palate . 
 there was no statistically 
 significant difference between complete unilateral and bilateral cleft lip and 
 palate groups.conclusionspatients with complete cleft lip and palate were born with an increased anterior 
 dimension of the maxillary dental arch compared to non cleft patients .