{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:34:49Z","timestamp":1787240089072,"version":"build-2736575974"},"reference-count":58,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,5]],"date-time":"2023-01-05T00:00:00Z","timestamp":1672876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: To assess the long-term functional orthodontic outcome of the T\u00fcbingen palatal plate (TPP) in children with Robin sequence (RS) in comparison to age- and sex-matched healthy controls. Methods: Between 09\/2019 and 10\/2020, we performed orthodontic assessments in 41 children at our Department of Orthodontics. Included were patients with RS (17 non-syndromic; four syndromic) and healthy controls (n = 22, average age in both groups 9.9 y). Facial analyses of 2D images, digital study casts and cephalometric measurements were made. Results: The orthodontic examinations showed no statistically significant group differences regarding functional extraoral, intraoral and pharyngeal parameters, or in skeletal patterns. The relationship between the upper and lower incisors was significantly increased (overjet 4 (2\u201310) vs. 3 (0\u20139) mm; p = 0.01) with a significant deficit in the lower face proportions (Jaw Index 4.15 (1.9\u20139.6) vs. 2.98 (0\u20139); p = 0.02; Facial convexity angle 157 (149\u2013173) vs. 159 (149\u2013170); p = 0.01). Conclusion: Children with RS treated with the TPP showed normal long-term functional orthodontic outcomes, thanks to the functional adaption of the stomatognathic system. However, soft tissue growth did not completely match skeletal growth, resulting in a more convex facial profile.<\/jats:p>","DOI":"10.3390\/jcm12020448","type":"journal-article","created":{"date-parts":[[2023,1,6]],"date-time":"2023-01-06T02:20:30Z","timestamp":1672971630000},"page":"448","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Prospective Evaluation of Children with Robin Sequence following T\u00fcbingen Palatal Plate Therapy"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7298-9397","authenticated-orcid":false,"given":"Josephine","family":"Effert","sequence":"first","affiliation":[{"name":"Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2491-7748","authenticated-orcid":false,"given":"Simone","family":"Uhlig","sequence":"additional","affiliation":[{"name":"Department of Neonatology, University Hospital Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6850-6249","authenticated-orcid":false,"given":"Cornelia","family":"Wiechers","sequence":"additional","affiliation":[{"name":"Department of Neonatology, University Hospital Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirja","family":"Quante","sequence":"additional","affiliation":[{"name":"Department of Neonatology, University Hospital Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1072-0066","authenticated-orcid":false,"given":"Christian F.","family":"Poets","sequence":"additional","affiliation":[{"name":"Department of Neonatology, University Hospital Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7641-4814","authenticated-orcid":false,"given":"Matthias C.","family":"Schulz","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5106-7908","authenticated-orcid":false,"given":"Siegmar","family":"Reinert","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8428-725X","authenticated-orcid":false,"given":"Michael","family":"Krimmel","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd","family":"Koos","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1771-0650","authenticated-orcid":false,"given":"Christina","family":"Weise","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076 Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1097\/00006534-199405000-00032","article-title":"A fall of the base of the tongue considered as a new cause of nasopharyngeal respiratory impairment: Pierre Robin sequence, a translation. 1923","volume":"93","author":"Robin","year":"1994","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/1750-1172-9-9","article-title":"Birth prevalence and initial treatment of Robin sequence in Germany: A prospective epidemiologic study","volume":"9","author":"Vatlach","year":"2014","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1597\/02-055","article-title":"Pierre Robin sequence in Denmark: A retrospective population-based epidemiological study","volume":"41","author":"Printzlau","year":"2004","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.ijporl.2015.01.035","article-title":"Pierre Robin sequence: Review of diagnostic and treatment challenges","volume":"79","author":"Fanous","year":"2015","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1111\/ppe.12776","article-title":"Epidemiology of Pierre-Robin sequence in Europe: A population-based EUROCAT study","volume":"35","author":"Santoro","year":"2021","journal-title":"Paediatr. Perinat. Epidemiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1542\/peds.2010-2615","article-title":"Robin sequence: From diagnosis to development of an effective management plan","volume":"127","author":"Evans","year":"2011","journal-title":"Pediatrics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1626","DOI":"10.1016\/j.jcms.2015.07.008","article-title":"Robin sequence: A European survey on current practice patterns","volume":"43","author":"Joosten","year":"2015","journal-title":"J. Cranio Maxillofac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"375e","DOI":"10.1097\/01.prs.0000475769.06773.86","article-title":"Long-Term Results of Mandibular Distraction Osteogenesis with a Resorbable Device in Infants with Robin Sequence: Effects on Developing Molars and Mandibular Growth","volume":"137","author":"Paes","year":"2016","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.jpeds.2007.02.063","article-title":"A randomized clinical trial of a new orthodontic appliance to improve upper airway obstruction in infants with Pierre Robin sequence","volume":"151","author":"Buchenau","year":"2007","journal-title":"J. Pediatr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/s13023-017-0602-8","article-title":"Multicenter study on the effectiveness of the pre-epiglottic baton plate for airway obstruction and feeding problems in Robin sequence","volume":"12","author":"Poets","year":"2017","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"101281","DOI":"10.1016\/j.siny.2021.101281","article-title":"Evidence and practical aspects of treatment with the T\u00fcbingen palatal plate","volume":"26","author":"Wiechers","year":"2021","journal-title":"Semin. Fetal Neonatal Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1016\/j.jcms.2019.08.002","article-title":"The T\u00fcbingen palatal plate approach to Robin sequence: Summary of current evidence","volume":"47","author":"Poets","year":"2019","journal-title":"J. Cranio Maxillofac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1887","DOI":"10.1002\/ppul.25317","article-title":"Pierre Robin and breathing: What to do and when?","volume":"57","author":"Poets","year":"2022","journal-title":"Pediatr. Pulmonol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1186\/s13023-021-01959-2","article-title":"Retrospective study on growth in infants with isolated Robin sequence treated with the Tuebingen Palate Plate","volume":"16","author":"Wiechers","year":"2021","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1597\/09-091","article-title":"An Oral Appliance with Velar Extension for Treatment of Obstructive Sleep Apnea in Infants with Pierre Robin Sequence","volume":"48","author":"Bacher","year":"2011","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1093\/ejo\/cjab068","article-title":"Intraoral scanning of neonates and infants with craniofacial disorders: Feasibility, scanning duration, and clinical experience","volume":"44","author":"Weise","year":"2022","journal-title":"Eur. J. Orthod."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Aretxabaleta, M., Xepapadeas, A.B., Poets, C.F., Koos, B., and Spintzyk, S. (2021). Fracture Load of an Orthodontic Appliance for Robin Sequence Treatment in a Digital Workflow. Materials, 14.","DOI":"10.3390\/ma14020344"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Xepapadeas, A.B., Weise, C., Frank, K., Spintzyk, S., Poets, C.F., Wiechers, C., Arand, J., and Koos, B. (2020). Technical note on introducing a digital workflow for newborns with craniofacial anomalies based on intraoral scans\u2014Part II: 3D printed T\u00fcbingen palatal plate prototype for newborns with Robin sequence. BMC Oral Health, 20.","DOI":"10.1186\/s12903-020-01159-7"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1177\/1055665618774025","article-title":"Mandibular Catch-Up Growth in Pierre Robin Sequence: A Systematic Review","volume":"56","author":"Purnell","year":"2019","journal-title":"Cleft Palate-Craniofac. J."},{"key":"ref_20","first-page":"89","article-title":"Clefts of the secondary palate associated with the \u201cPierre Robin syndrome\u201d. Management by early maxillary orthopaedics","volume":"15","author":"Hotz","year":"1982","journal-title":"Swed. Dent. J. Suppl."},{"key":"ref_21","first-page":"29","article-title":"Growth of mandible in infants with micrognathia; clinical implications","volume":"88","author":"Pruzansky","year":"1954","journal-title":"AMA Am. J. Dis. Child."},{"key":"ref_22","first-page":"120","article-title":"Not all dwarfed mandibles are alike","volume":"5","author":"Pruzansky","year":"1969","journal-title":"Birth Defects"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1067\/mod.2001.115038","article-title":"The mandibular catch-up growth controversy in Pierre Robin sequence","volume":"120","author":"Daskalogiannakis","year":"2001","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2323","DOI":"10.1016\/j.joms.2009.06.010","article-title":"Effect of a Syndromic Diagnosis on Mandibular Size and Sagittal Position in Robin Sequence","volume":"67","author":"Rogers","year":"2009","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1097\/SCS.0b013e3182074799","article-title":"Controversies in the Diagnosis and Management of the Robin Sequence","volume":"22","author":"Mackay","year":"2011","journal-title":"J. Craniofac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1016\/j.ajodo.2008.07.020","article-title":"Craniofacial morphology and adolescent facial growth in Pierre Robin sequence","volume":"137","author":"Suri","year":"2010","journal-title":"Am. J. Orthod Dentofac. Orthop."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"177","DOI":"10.3109\/02844319209016010","article-title":"Cephalometric measurements in patients with Pierre Robin syndrome and isolated cleft palate","volume":"26","author":"Laitinen","year":"1992","journal-title":"Scand. J. Plast. Reconstr. Surg. Hand Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1111\/ocr.12036","article-title":"Short mandible\u2014A possible risk factor for cleft palate with\/without a cleft lip","volume":"17","author":"Hermann","year":"2014","journal-title":"Orthod. Craniofac. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1597\/1545-1569_2002_039_0604_ecmagi_2.0.co_2","article-title":"Early Craniofacial Morphology and Growth in Children with Unoperated Isolated Cleft Palate","volume":"39","author":"Hermann","year":"2002","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_30","first-page":"898","article-title":"Skeletal characteristics and treatment outcome of five patients with Robin sequence","volume":"76","author":"Matsuda","year":"2006","journal-title":"Angle Orthod."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1597\/1545-1569_1991_028_0425_mtaaip_2.3.co_2","article-title":"Mandible, tongue, and airway in Pierre Robin sequence: A longitudinal cephalometric study","volume":"28","author":"Figueroa","year":"1991","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1097\/SCS.0b013e318275ed60","article-title":"Three-Dimensional Assessment of Facial Development in Children with Unilateral Cleft Lip with and without Alveolar Cleft","volume":"24","author":"Krimmel","year":"2013","journal-title":"J. Craniofac. Surg."},{"key":"ref_33","first-page":"350","article-title":"Classification of malocclusion","volume":"41","author":"Angle","year":"1899","journal-title":"Dent. Cosm."},{"key":"ref_34","unstructured":"American Board of Orthodontics (2022, November 01). Photograph Requirements. Available online: https:\/\/ntiiiby.americanboardortho.com\/media\/krgfhpdg\/example-photos-radiographs.pdf."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1597\/1545-1569_1997_034_0240_tjingd_2.3.co_2","article-title":"The jaw index: New guide defining micrognathia in newborns","volume":"34","author":"Mulder","year":"1997","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_36","unstructured":"Rakosi, T.J.I. (1989). Kieferorthop\u00e4die Diagnostik, Georg Thieme Verlag."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/S0094-1298(20)31936-2","article-title":"Divine proportion in facial esthetics","volume":"9","author":"Ricketts","year":"1982","journal-title":"Clin. Plast. Surg."},{"key":"ref_38","unstructured":"Schwarz, A.M. (1958). R\u00f6ntgenstatik, Urban & Schwarzenberg."},{"key":"ref_39","unstructured":"Moyers, R.E. (1988). Handbook of Orthodontics, Year Book Medical Publishers. [4th ed.]."},{"key":"ref_40","first-page":"1537","article-title":"Biometrische Untersuchungen \u00dcber die Dimensionen des Normalgebisses in Verschiedenen Lebensaltern: Intramaxill\u00e4re Beziehgn","volume":"48","author":"Harth","year":"1930","journal-title":"Dtsch. Mschr. Zahnheilk."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1597\/1545-1569_2003_040_0498_caotpa_2.0.co_2","article-title":"Cephalometric Assessment of the Posterior Airway Space in Patients with Cleft Palate after Palatoplasty","volume":"40","author":"Rose","year":"2003","journal-title":"Cleft Palate Craniofacial J."},{"key":"ref_42","unstructured":"Segner, D., and Hasund, A. (2003). Individualisierte Kephalometrie, Segner. [4th ed.]. unver\u00e4nd. Aufl."},{"key":"ref_43","unstructured":"Fischer-Brandies, H., and Stahl, A.N.F. (1990). Kieferorthop\u00e4dische Technik: Mit Hinweisen auf Indikation und Klinik, Georg Thieme Verlag."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1007\/s11818-016-0079-z","article-title":"Das p\u00e4diatrische obstruktive Schlafapnoesyndrom","volume":"20","author":"Koos","year":"2016","journal-title":"Somnologie"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1597\/10-020","article-title":"Facial Profile Evaluation of Isolated Pierre Robin Sequence","volume":"49","author":"Ozawa","year":"2012","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.ajodo.2005.09.026","article-title":"Mandibular morphology and growth with and without hypodontia in subjects with Pierre Robin sequence","volume":"130","author":"Suri","year":"2006","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"223","DOI":"10.3109\/00016359709115421","article-title":"Craniofacial morphology in young adults with the Pierre Robin sequence and isolated cleft palate","volume":"55","author":"Laitinen","year":"1997","journal-title":"Acta Odontol. Scand."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/0002-9416(66)90169-2","article-title":"A morphogenetic analysis of facial growth","volume":"52","author":"Enlow","year":"1966","journal-title":"Am. J. Orthod."},{"key":"ref_49","unstructured":"Enlow, D.H. (1990). Facial Growth, Saunders. [3rd ed.]."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"30","DOI":"10.52010\/ijom.1993.19.1.6","article-title":"The Castillo-Morales approach to orofacial pathology in Down syndrome","volume":"19","author":"Limbrock","year":"1993","journal-title":"Int. J. Orofac. Myol."},{"key":"ref_51","first-page":"382","article-title":"Objective diagnosis of micrognathia in the fetus: The jaw index","volume":"93","author":"Paladini","year":"1999","journal-title":"Obstet. Gynecol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1177\/1055665619885726","article-title":"The Reproducibility of the Jaw Index in the Measurement of Healthy Newborns","volume":"57","author":"Mermans","year":"2020","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_53","first-page":"154","article-title":"Pierre Robin syndrome: Mandibular growth during the first year of life","volume":"42","author":"Vegter","year":"1999","journal-title":"Ann. Plast. Surg."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s13005-019-0200-1","article-title":"Mandibular growth in infants with Robin sequence treated with the T\u00fcbingen palatal plate","volume":"15","author":"Wiechers","year":"2019","journal-title":"Head Face Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1597\/04-113.1","article-title":"Early postnatal development of the mandible in children with isolated cleft palate and children with nonsyndromic Robin sequence","volume":"43","author":"Eriksen","year":"2006","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1097\/SCS.0000000000000640","article-title":"Complications Associated with Neonatal Mandibular Distraction Osteogenesis in the Treatment of Robin Sequence","volume":"25","author":"Murage","year":"2014","journal-title":"J. Craniofac. Surg."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2344","DOI":"10.1016\/j.joms.2008.07.003","article-title":"Skeletal Stability and Complications of Bilateral Sagittal Split Osteotomies and Mandibular Distraction Osteogenesis: An Evidence-Based Review","volume":"67","author":"Ow","year":"2009","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Salzmann, J.A. (1974). Orthodontics in Daily Practice, J.B. Lippincott & Co.","DOI":"10.1016\/0002-9416(74)90062-1"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/2\/448\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:00:31Z","timestamp":1760119231000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/2\/448"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,5]]},"references-count":58,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["jcm12020448"],"URL":"https:\/\/doi.org\/10.3390\/jcm12020448","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,5]]}}}