Daniel Levy-Bercowski

Georgia Regents University, Augusta, Georgia, United States

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Publications (8)6.13 Total impact

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    ABSTRACT: Conventional orthognathic surgery and orthodontic techniques occasionally fail to completely correct the occlusal relationship and esthetic deficits of patients with cleft lip and palate and severe midface deficiency. Prosthodontic rehabilitation is often required to establish adequate occlusion and provide a more proportional facial appearance. This clinical report describes the interdisciplinary management of an adult with complete bilateral cleft lip and palate who was treated with distraction osteogenesis using a rigid external distraction device for maxillary advancement and his prosthodontic rehabilitation with a dual path removable partial overdenture to develop definitive facial and dental esthetic form. Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.
    The Journal of prosthetic dentistry 06/2015; 114(4). DOI:10.1016/j.prosdent.2014.09.031 · 1.75 Impact Factor
  • Pedro E Santiago · Lindsay A Schuster · Daniel Levy-Bercowski ·
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    ABSTRACT: Orthopedic and orthodontic management of patients born with clefts of the lip, alveolus and palate is based on the application of basic biomechanical principles adapted to the individualized cleft anatomy. This article focuses on orthopedic and orthodontic preparation for 2 stages of interdisciplinary orthodontic/surgical cleft care: presurgical infant orthopedics (nasoalveolar molding) for lip/alveolus/nasal surgical repair and maxillary arch preparation for secondary alveolar bone grafting. These preparatory stages of orthopedic/orthodontic therapy are undertaken with the goal of restoring normal anatomic relationships to assist the surgeon in providing the best possible surgical care.
    Clinics in plastic surgery 04/2014; 41(2):219-232. DOI:10.1016/j.cps.2014.01.001 · 0.91 Impact Factor
  • Daniel Levy-Bercowski · Eladio DeLeon · John W. Stockstill · Jack C. Yu ·
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    ABSTRACT: In some cases early intervention and multiphase orthodontic treatment are insufficient to correct the skeletal and soft-tissue disharmonies present in cleft lip and palate patients. Commonly, midface deficiency with skeletal and dental Class III malocclusion is present in combination with other dental anomalies. In cleft lip and palate patients, orthognathic surgery may involve maxillary advancement with a LeFort surgical procedure, maxillary distraction osteogenesis, and mandibular setback in combination with maxillary advancement, and, on rare occasions, isolated mandibular setback. The selection of the optimal treatment for a specific patient depends on the patient's age, amount of needed advancement, severity of the maxillomandibular discrepancy, impact of the surgery on the speech, relapse/stability relationship, esthetic outcome, and the consideration of the possible complications. The need for multidisciplinary treatment planning and sequentially staged treatment is essential for successful patient outcomes. The purpose of this article is to outline multidisciplinary strategies in cleft lip and palate patient care.
    Seminars in Orthodontics 09/2011; 17(3):197-206. DOI:10.1053/j.sodo.2011.02.004
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    ABSTRACT: To outline three main categories of nasoalveolar molding complications, describe their etiologies and manifestations, and prescribe preventive and palliative therapy for their proper management. Estimates of the incidence of each complication also are provided. Materials and Data were collected retrospectively from the charts of 27 patients with complete unilateral cleft lip and palate treated by the first author (D.L.-B.) at the University of Puerto Rico (n = 12) and the Medical College of Georgia (n = 15). Confidence intervals for the true incidence of each complication were calculated using exact methods based on the binomial distribution. A significance level of .05 was used for all statistical tests. Of the soft and hard tissue complications considered, only one (tissue irritation) had an estimated incidence greater than 10%. Compliance issues were of greater concern, with an estimated incidence of 30% for broken appointments and an estimated incidence of 26% for removal of the nasoalveolar molding appliance by the tongue. Although benefits outnumber the complications, it is important to address all complications in order to prevent any deleterious outcomes.
    The Cleft Palate-Craniofacial Journal 09/2009; 46(5):521-8. DOI:10.1597/07-236.1 · 1.20 Impact Factor
  • John W Stockstill · Daniel Levy-Bercowski · Eladio Deleon ·

    Journal of clinical orthodontics: JCO 08/2008; 42(7):412-4.
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    G D Singh · D Levy-Bercowski · MA Yáñez · P E Santiago ·
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    ABSTRACT: To evaluate three-dimensional (3D) facial morphology in patients surgically corrected for unilateral cleft lip and palate (UCLP) following pre-surgical nasoalveolar molding (NAM). Prospective, longitudinal study. Digital stereophotogrammetry was used to capture 3D facial images, and x, y, and z coordinates of five landmarks were digitized to compute mean morphologies. The sample comprised 15 patients with left UCLP and 10 matched control subjects. Facial form differences at age 37 weeks, using principal components analysis and finite-element scaling analysis (FESA) were assessed. Using the first two principal components, which accounted for 63% of the total shape-change, UCLP and control groups showed similar distributions in the modal space (p > 0.05). For the UCLP group, the mean 3D facial form was smaller and less protrusive when superimposed on the non-cleft mean. Using FESA, reductions in facial volume were found in the UCLP group, involving the columella (29%), labial tubercle (51%), lower lip (29%) and lateral aspects of the face (19%). The UCLP group also showed increases in size above the tip of the nose (25%) and laterally to the columella directly below the nares (29%). Following surgical repair of UCLP in patients previously treated with NAM, 3D facial morphology was virtually indistinguishable from the non-cleft mean. Clinically, the apparent improvement in the facial soft tissues may mask dysmorphic skeletal growth, and further studies are required to characterize the underlying bony changes associated with the soft tissue changes reported here.
    Orthodontics and Craniofacial Research 09/2007; 10(3):161-6. DOI:10.1111/j.1601-6343.2007.00390.x · 1.06 Impact Factor
  • Daniel Levy-Bercowski · Eladio DeLeon · John W Stockstill ·

    Journal of clinical orthodontics: JCO 06/2007; 41(5):285.
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    G Dave Singh · Daniel Levy-Bercowski · Pedro E Santiago ·
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    ABSTRACT: To evaluate three-dimensional changes in nasal morphology in patients with unilateral cleft lip and palate treated with presurgical nasoalveolar molding (NAM) to correct naso-labio-alveolar deformity. This was a prospective, longitudinal study. Digital stereophotogrammetry was used to capture three-dimensional facial images, and x, y, and z coordinates of 28 nasal landmarks were digitized. Ten patients with unilateral cleft lip and palate. Nasal form changes between T1 (age: 28 +/- 2 days, pre-NAM) and T2 (age: 140 +/- 2 days, post-NAM), using conventional measurements and finite-element scaling analysis. Overall nasal changes were statistically different (p < .01), but no linear or curvilinear changes were found. Specifically, relative size increases were found on the noncleft side, involving the upper nose (30%), alar depth (20%), alar dome (30%), columella height (30%), and lateral wall of the nostril (17%). On the cleft side, the following showed a size increase: upper nose (8%), alar dome (5%), columella height (30%), and lateral wall of the nostril (30%). The cleft-side alar curvature, however, showed a large decrease in size (80%), but no changes on the noncleft side were found. Corresponding shape changes and angular changes were also found. Using NAM, bilateral nasal symmetry in patients with unilateral cleft lip and palate was improved before surgical repair. Furthermore, slight overcorrection of the alar dome on the cleft side using pressure exerted by the nasal stent is indicated to maintain the NAM result.
    The Cleft Palate-Craniofacial Journal 07/2005; 42(4):403-9. DOI:10.1597/04-063.1 · 1.20 Impact Factor