Chronology and sequence of eruption of the permanent teeth in patients with complete unilateral cleft lip and palate.

OBJECTIVE: To establish the chronology and sequence of eruption of the permanent teeth in subjects with complete unilateral cleft lip and palate. DESIGN: Cross-sectional. Data on children presenting complete cleft lip and palate were evaluated. SETTING: The study was carried out at the Hospital for Rehabilitation of Craniofacial Anomalies, Bauru, S?o Paulo, Brazil. SAMPLE: The sample comprised 477 patients with complete unilateral cleft lip and palate, aged 5 to 14 years. Of these patients, 166 were girls and 311 were boys. RESULTS: The girls presented, for all maxillary and mandibular teeth, a smaller mean age of eruption than the boys. The maxillary lateral incisor and cuspid adjacent to the cleft presented significantly higher mean ages of eruption than their homologous teeth on the noncleft side.     

Maxillary lateral incisors of subjects with cleft lip and/or palate: Part 2.

Maxillary lateral incisors on the alveolar cleft were investigated in 431 cleft children registered in the Department of Orthodontics, Kyushu University Dental Hospital. The majority of primary maxillary lateral incisors were located on the distal side of the alveolar cleft in both unilateral cleft lip and alveolus (UCLA) and unilateral cleft lip and palate (UCLP) subjects. Permanent teeth in UCLA tend to be located distally, but in UCLP they tend to be congenitally absent (p less than .01). The majority of primary teeth had normal shapes; the majority of permanent teeth were of intermediate type or were missing congenitally. One third of the UCLA and one half of the UCLP subjects who had primary maxillary lateral incisors were not followed by permanent replacements. The location of the majority of permanent maxillary lateral incisors tallied with that of the primary ones except in four UCLA, ten UCLP, and two bilateral cleft lip and palate (BCLP) subjects. Four UCLA and ten UCLP subjects who had primary lateral incisors on the distal side were followed by their permanent successors on the mesial side. Three UCLP and one BCLP subjects had permanent maxillary lateral incisors even though they had no temporary predecessors.     

Cephalometric analysis of maxillofacial morphology in unoperated cleft palate patients.

This study was designed to investigate maxillofacial morphology in adolescents and adults with unrepaired cleft palate, with or without cleft lip. Twenty-two Chinese patients with unilateral cleft lip and palate (the UCLP group), and 21 Chinese with cleft palate (the CP group) were cephalometrically evaluated and classified into the five ranges established from the means and standard deviations for matched normal Chinese populations. Many subjects in both UCLP and CP groups showed an intrinsic maxillary retrusion and a steeper mandible. The others had nearly normal maxillofacial morphology. The tendency for maxillary retrusion and a steeper mandible became increasingly remarkable with age. In the long axis of upper incisors in subjects with permanent dentition, there were no UCLP subjects with labial inclination, whereas three CP subjects exhibited labial inclination.     

Maxillary and sella turcica morphology in newborns with cleft lip and palate.

OBJECTIVE: The first aim was to examine maxillary developmental fields by analyzing bone size parameters within the maxillary bone complex in newborns with unilateral cleft lip (UCL) and unilateral cleft lip and palate (UCLP). The second aim was to evaluate sella turcica morphology in unilateral cleft lip and unilateral cleft lip and palate. SUBJECTS AND METHODS: Axial and profile radiographs from 40 newborns (boy-girl, 1:1) in each group (20 unilateral cleft lip and 20 unilateral cleft lip and palate) were randomly selected among radiographs taken for optimizing treatment planning. Analysis of maxillary bone size was performed on axial radiographs and size parameters were measured. Furthermore, analysis of sella turcica morphology was performed on profile radiographs. The results were divided into groups with normal morphology and severe deviations in the morphology. RESULTS: The maxillary areas were significantly shorter and broader in unilateral cleft lip and palate than in unilateral cleft lip. A profound asymmetry in the maxillary areas was seen in unilateral cleft lip and palate, but not in unilateral cleft lip. In both cleft types, approximately half of the individuals had deviations in sella turcica morphology. The most severe deviations occurred in newborns with unilateral cleft lip and palate. CONCLUSIONS: In newborns with unilateral cleft lip and palate, the maxillary areas are significantly shorter, broader, and more asymmetric than in newborns with unilateral cleft lip. The present study showed that bone structures are a suitable parameter for characterizing the craniofacial developmental fields. Additionally, a high incidence of deviations in sella turcica morphology might indicate that this area is affected in individuals with clefts.     

唇腭裂患者上颌前部牙槽骨厚度及骨开窗、骨开裂的三维评价研究

目的　利用锥形束CT（cone-beam CT,CBCT）评价不同类型唇腭裂患者上颌前部牙槽骨厚度和形态,以及上前牙骨开窗、骨开裂情况。方法　选择016年8月至019年10月间在南京医科大学附属口腔医院就诊拟行口腔正畸治疗的唇腭裂患者85例（男51例,女34例,平均年龄（14.65±4.95）岁）,其中单侧唇裂伴牙槽突裂（unilateral cleft lip and alveolus,UCLA）患者19例,单侧完全性唇腭裂（unilateral complete cleft lip and palate,UCLP）患者5例,双侧完全性唇腭裂（bilateral complete cleft lip and palate,BCLP）患者14例。在正畸治疗开始前均予以拍摄颌面部CBCT,应用Image J软件测量其上前牙唇腭侧牙槽骨厚度（alveolar bone thickness,ABT）,计算骨开窗、骨开裂发生率,并比较不同唇腭裂类型患者上颌前部ABT及上前牙骨开窗、骨开裂发生率的差异。结果　UCLP、UCLA患侧上前牙骨开裂发生率（34.9%、4.9%）显著高于其健侧（10.7%、11.1%）,但骨开窗发生率无统计学差异。UCLP健侧上中切牙（5.9%）、侧切牙（9.7%）骨开裂发生率低于UCLA。UCLA、UCLP、BCLP三组间患侧上前牙骨开裂及骨开窗发生率均无统计学差异。UCLP、UCLA患侧上前牙ABT在多部位小于其健侧。除UCLP/UCLA患侧侧切牙外,UCLA、UCLP、BCLP各类型上前牙唇侧平均ABT均小于腭侧。UCLA、UCLP、BCLP三组间患侧上前牙唇腭侧平均ABT无统计学差异。UCLP患侧上侧切牙、尖牙分别在唇侧和腭侧根颈处ABT大于UCLA。结论　单侧唇腭裂患者患侧上前牙骨开裂发生率高于健侧,ABT则在多部位小于其健侧;而三种类型患者上前牙唇侧ABT均小于其腭侧。单侧唇裂伴牙槽突裂与单侧完全性唇腭裂患者健侧上中切牙、侧切牙骨开裂发生率及患侧侧切牙、尖牙根颈处牙槽骨厚度存在差异;单侧与双侧完全性唇腭裂间上前牙骨开窗、骨开裂发生率及牙槽骨厚度则无差异。     

Comparison of craniofacial morphology in patients with bilateral complete cleft of primary versus secondary palate.

OBJECTIVE: To identify and compare the craniofacial morphology of patients with bilateral complete cleft of primary palate (BCCPP) and bilateral complete cleft of secondary palate (BCCSP). In addition, to evaluate the differential effects of lip repair and palatal repair on the craniofacial morphology in cleft patients. SUBJECTS: Twenty-four children, 10 boys and 14 girls, mean age of 5.8 years, with BCCPP (BCCPP group). Twenty-five children, 10 boys and 15 girls, mean age of 5.6 years, with BCCSP (BCCSP group). Design: Retrospective analysis. MAIN OUTCOME MEASURES: Cephalometric analysis was used to determine the craniofacial morphology at about 5 years of age. RESULTS: Compared with the BCCSP group, the BCCPP group demonstrated longer maxillary length, more protruded maxilla, more favorable jaw relation, more severely retroclined maxillary incisors, and larger overjet. CONCLUSIONS: The subjects with BCCPP had craniofacial characteristics that differed significantly from those with BCCSP. It could also be speculated that palatal repair had more adverse effect on the growth of the maxilla in length; however, that repair influenced less the anteroposterior position of maxillary incisors than lip repair did.     

The influence of bone grafting age on dental abnormalities and alveolar bone height in patients with unilateral cleft lip and palate

Individuals with total unilateral cleft lip, alveolus and palate, (UCLAP), bone grafted at three different ages were compared with regard to dental abnormalities and alveolar bone height in the cleft area. The primary groups, bone grafted prior to one year of age had fewer supernumerary teeth in the cleft area and a lower frequency of missing and severely malformed central incisors than the other groups. The early secondary group, bone grafted after eruption of the permanent incisors, showed the highest frequency of normal lateral incisors and the most favourable alveolar bone height in the cleft area. The secondary group, bone grafted after eruption of the canines, showed the highest frequency of missing teeth outside the cleft area. Early secondary bone grafting, after eruption of the permanent incisors and before eruption of the canines, seems to be preferable.     

Chronology of deciduous teeth eruption in children with cleft lip and palate.

OBJECTIVE: To determine the chronology and sequence of eruption of the deciduous teeth in children with complete unilateral cleft lip and palate. DESIGN: Cross-sectional study. SETTING: Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, Sao Paulo, Brazil. SAMPLE: A total of 435 children aged 0 to 48 months who presented with complete unilateral cleft lip and palate. RESULTS: All teeth on the cleft side in both jaws for both sexes presented a higher mean age of eruption than their homologues at the noncleft side. This difference was statistically significant for the maxillary lateral incisor, maxillary cuspid, and mandibular lateral incisor. There was a statistically significant sex difference regarding the mean age of eruption only for the maxillary second molar for the girls and mandibular cuspid for the boys. The maxillary lateral incisor on the cleft side was the last tooth to erupt, thus modifying the sequence of eruption of the deciduous teeth. CONCLUSIONS: The results suggest the interference of the cleft on the chronology of eruption of the deciduous teeth that are directly related to it.     

Evaluation of maxillary central incisors on the noncleft and cleft sides in patients with unilateral cleft lip and palate—Part 1: Relationship between root length and orthodontic tooth movement

Objectives:To measure the root lengths of maxillary central incisors (U1) and evaluate the relationship among U1 root length, tooth movement, and type of treatment appliance in patients with unilateral cleft lip and palate over a long-term follow-up period.Materials and Methods:Occlusal radiographs of 30 patients with unilateral cleft lip and palate, acquired less than 6 months before secondary alveolar bone grafting (SBG, T1) and after edgewise treatment (T2), were measured for U1 root length (R1 and R2, root lengths at T1 and T2, respectively). Frontal and lateral cephalometric radiographs acquired at eruption of U1 (T0), T1, and T2 were evaluated to determine the inclination and position of U1.Results:The average values of R1 and R2 on the cleft side were significantly lower than those on the noncleft side. Frontal cephalometric analysis revealed that the horizontal distance of the root apex from the median vertical line at T0 on the cleft side was significantly smaller than that on the noncleft side and was correlated with short U1 root length on the cleft side. On the other hand, R1 in patients treated with maxillary protraction appliances between T0 and T1 was significantly shorter than that in patients without maxillary protraction appliances. However, none of the changes in cephalometric measurements were correlated with root length.Conclusions:In patients with unilateral cleft lip and palate, the short root length of cleft-adjacent central incisors might be associated with the horizontal position of the root apex. In addition, orthodontic treatment with a maxillary protraction appliance before secondary alveolar bone grafting might be associated with short U1 root length.     

Long-term effects of lip repair on dentofacial morphology in patients with unilateral cleft lip and palate.

OBJECTIVE: Lateral cephalograms from the growth archive of the Sri Lankan Cleft Lip and Palate Project were analyzed in a cohort design to study the long-term effects of lip repair on dentofacial morphology in patients with unilateral cleft lip and palate. METHODS: A total of 71 patients were recruited, including 23 adult patients with nonsyndromic unilateral cleft lip and palate without surgical repair and 48 adult patients with nonsyndromic unilateral cleft lip and palate who had lip repair, but without management of alveolus or anterior vomer. The design utilized exact matching on ethnicity and statistical control for gender and age. RESULTS AND CONCLUSIONS: The data support the hypothesis that lip repair primarily produces a bone-bending effect on the anterior maxillary alveolus (alveolar molding), accompanied by controlled uprighting of maxillary incisors, and secondarily produces a bone-remodeling effect (bone resorption) in the base of the anterior maxillary alveolus. When analyzed by the age at lip repair and the surgeon who performed lip repair, early lip repair produced a greater bone-remodeling effect than did late lip repair, and variation in the surgeon who performed lip repair had an insignificant impact on dentofacial morphology after adjusting for covariates.     

Difference in the prevalence of enamel alterations affecting central incisors of children with complete unilateral cleft lip and palate.

OBJECTIVE: To evaluate the prevalence of enamel alterations affecting the deciduous and permanent central maxillary incisors of children with complete unilateral cleft lip and palate and to verify their characteristics. DESIGN: Cross-sectional. SETTING: Hospital for Rehabilitation of Craniofacial Anomalies-University of S?o Paulo, Bauru, S?o Paulo, Brazil. PATIENTS: A sample of 90 patients attending the Hospital for Rehabilitation of Craniofacial Anomalies, presenting with complete cleft lip and palate, of both genders, ages 2 to 11 years old. METHODOLOGY: The buccal surfaces of the maxillary central incisors of patients were analyzed for observation of the presence of enamel defects, their type, number, and location. The prevalence of defects was compared between deciduous and permanent teeth and between the incisors at the cleft and noncleft sides. RESULTS: There was a higher frequency of defects among incisors on the cleft side for both deciduous and permanent dentitions compared with the noncleft side (p < .05); the permanent central incisor was more frequently affected than the deciduous. Evaluation of the types of defects for both incisors in both dentitions demonstrated a homogeneous distribution, except for a lower proportion of yellow opacity in the permanent dentition on the cleft side. In general, the most affected area in all dentitions was the incisal third. CONCLUSION: The prevalence of enamel alterations affecting incisors adjacent to the cleft was higher than for incisors on the noncleft side. This difference also was present in the permanent dentition.     

Early assessment of dental arch development in repaired unilateral cleft lip and unilateral cleft lip and palate versus controls.

OBJECTIVE: To evaluate dental arch relationships and dimensions, relative to an age matched noncleft sample, in Caucasian 3-year-old children with repaired unilateral cleft lip (UCL) or unilateral cleft lip and palate (UCLP). DESIGN: Prospective, cross-sectional, case-control study performed in Scotland, U.K. PARTICIPANTS: Eleven children with repaired unilateral cleft lip, 16 children with repaired unilateral cleft lip and palate, and 78 children as controls. MAIN OUTCOME MEASURES: Dental arch relationships and linear arch dimensions. RESULTS: Prevalence of Class III incisor relationship was 31.3% in children with unilateral cleft lip and palate compared with 9.1% in children with unilateral cleft lip. A buccal crossbite was present in 36% of children with unilateral cleft lip, compared with 75.6% of children with unilateral cleft lip and palate.Mean linear maxillary arch dimensions did not differ significantly between children with unilateral cleft lip and the controls. Except for second intermolar width, statistically significant differences existed in mean linear maxillary arch dimensions between the unilateral cleft lip and the unilateral cleft lip and palate groups; the mean linear maxillary arch dimensions were significantly greater in the control group than in the unilateral cleft lip and palate group. The mean cleft-affected anterior quadrant length appeared to be the arch dimension with the greatest power of discrimination among the three groups. There were no significant differences in mean linear mandibular arch dimensions among the three groups. CONCLUSIONS: Anterior crossbite was almost three times more common in the unilateral cleft lip and palate group than in the unilateral cleft lip group. Mean linear maxillary arch dimensions differed significantly between the unilateral cleft lip and palate group and the control group. There were no significant differences in mean linear maxillary arch dimensions between unilateral cleft lip and controls or between mean linear mandibular arch dimensions for unilateral cleft lip, unilateral cleft lip and palate, and controls.     

Cleft size at the time of palate repair in complete unilateral cleft lip and palate as an indicator of maxillary growth

Cleft size at the time of palate repair might affect the difficulty of surgical repair and, thus, indirectly postoperative maxillary growth. This retrospective study aimed to determine whether a correlation existed between the cleft size at the time of palate repair and the growth of the maxilla. Maxillary dental casts of 39 infants with non-syndromic complete unilateral cleft lip and palate, taken at the time of palate repair, were used to measure cleft size. Cleft size was defined as the percentage of the total palatal area. The later growth of the maxilla was determined using lateral and postero-anterior cephalometric radiographs taken at 9 years of age. The Pearson correlation analysis was used for statistical analysis. The results showed negative correlations between cleft size and the maxillary length (PMP–ANS, PMP–A) and the maxillary protrusion (S–N–ANS, SNA). These data suggest that in patients with complete unilateral cleft lip and palate there is a significant correlation between the cleft size at the time of palate repair and the maxillary length and protrusion. Patients with a large cleft at the time of palate repair have a shorter and more retrusive maxilla than those with a small cleft by the age of 9 years.     

Dental development of Chinese children with cleft lip and palate.

OBJECTIVE: To compare the dental development and rate of tooth development between children with and without cleft lip and palate. Patients: Age- and gender-matched pairs (231 in all) of southern Chinese children ages 3 to 12 years, with and without cleft lip and palate. METHODS: Dental histories and radiographs were studied. From these, dental development was determined. RESULTS: Of 2946 tooth pairs in the children with cleft lip and palate, 252 (8.6%) were found to be asymmetric, significantly (p < .001) more than the 63 of 3179 (2.0%) tooth pairs observed in the children without cleft lip and palate. The teeth with the highest frequency of asymmetry were the maxillary lateral incisors (38.1%). Differences in dental development on the cleft versus noncleft sides of children with unilateral cleft lip and palate were significant for both maxillary and mandibular teeth (p < .001 and p = .039, respectively). The mean delay in tooth formation of the children with cleft lip and palate was 4.4 months relative to the children without cleft lip and palate. The majority of the teeth in the cleft lip and palate group were delayed by one developmental stage. This happened in 40.0% of the maxillary teeth and 30.1% of the mandibular teeth. The delay in tooth formation increased as the number of missing teeth increased in the children with cleft lip and palate, although not significantly. CONCLUSIONS: This group of southern Chinese children with cleft lip and palate demonstrated a higher prevalence of asymmetric and delayed dental development than did their counterparts who did not have cleft lip and palate.     

唇裂修复术对唇腭裂患者上颌骨生长发育的影响

目的:探讨唇裂修复术在单侧完全性唇腭裂患者上颌骨生长受限中的作用。方法:52例唇裂修复术后的单侧完全性唇腭裂恒牙列期患者,依是否已行腭裂修复分成两个实验组,通过头颅侧位头影测量片研究两组患者上颌骨生长变化规律,并与正常对照组比较。结果:唇腭裂均修复组与仅唇裂修复组具有基本相似的上颌骨生长抑制。结论:唇裂修复术是影响单侧完全性唇腭裂患者上颌骨生长受抑的重要因素。     

Cephalometric findings in a normal Nigerian population sample and adult Nigerians with unrepaired clefts

Cephalometric values have been established for twenty adult Nigerians, three adults with unrepaired unilateral cleft lip and alveolus (UCLA) and two adults with unrepaired unilateral cleft lip and palate (UCLP). Normal values for SNA and SNB were 85.5 degrees +/- 3.5 and 82.7 degrees +/- 3.2 respectively, and the mean ANB values were 3.1 degrees +/- 0.8. The cephalometric data for unilateral cleft lip and alveolus (UCLA) subjects whose clefts were not repaired until adulthood did not differ significantly from normal controls. However, in two adults with unrepaired unilateral cleft lip and palate (UCLP), the SNA values were less than normal controls and the ANB values were reduced to negative levels. Bimaxillary protrusion of the incisors appears to be a normal feature in Nigerians. There appears to be inhibition of maxillary growth in UCLP patients but not in UCLA cases.     

A preliminary study of facial growth and morphology in unoperated male unilateral cleft lip and palate subjects over 13 years of age

This paper investigates the effects of surgery on facial growth and morphology in Sri Lankan males with unilateral cleft lip and palate who were over 13 years of age at the time of study with cephalometry and dental study models. Three separate subgroups were analyzed: those who had totally unrepaired cleft lip and palate, those who received lip repair in infancy but not palatal repair, and those who had lip and palate repair in infancy. Twenty-three healthy noncleft Sri Lankan males over 13 years formed a control group from the same racial background. The results show that subjects who had no surgery had a potential for normal maxillary growth. Subjects who have had lip repair in early infancy show relatively normal maxillary growth, but maxillary hypoplasia is common when the palate has also been repaired early.     

Dentocraniofacial morphology of 21 patients with unilateral cleft lip and palate: a cephalometric study.

OBJECTIVE: To assess the skeletal and dental craniofacial proportions of unilateral cleft lip and palate patients who were operated upon using the Malek technique, and compare them with a normal group to highlight the effect of surgical correction on craniofacial development during growth. DESIGN: Retrospective. METHODS: The cleft palate was closed using the Malek technique in a single operation at 3 months for 11 patients (complete closure of lip and palate) and in a two-stage operation for 10 patients (soft palate at 3 months, lip and hard palate at 6 months). Comparisons were made with a normal control group. Angular and linear measurements of anterior and posterior dimensions of the upper and lower compartments of the face were measured in the 7th and 12th years. RESULTS AND CONCLUSION: No significant differences were observed between the two groups of palate technique repair, although significant differences were observed between craniofacial dimensions of normal versus cleft lip and palate patients. At a skeletal level, the maxilla and mandible were retrusive relative to the cranial base in the cleft lip and palate group. In fact, there was a backward rotation of the palatal plane with repercussions on the maxillo-mandibular complex position. Furthermore, the maxilla was shorter than in normal patients, whereas the mandible was normally shaped. The upper incisors were retroclined and they locked the lower incisors in linguoversion. There was a posterior skeletal deficit of the respiratory compartment, compensated by more marked posterior maxillary alveolar growth. Facial growth in cleft lip and palate patients followed the same pattern, but was delayed compared with normal patients.     

Bone augmentation and autogenous transplantation of premolar to the site of the fissure in a cleft palate patient

This article presents a case report of autogenous tooth transplantation to the site of the fissure, in addition to bone augmentation with graft of autogenous bone harvested from the iliac crest, performed in a cleft palate patient, who had insufficient bone volume. A non‐syndromic 10‐year‐old girl, with a unilateral cleft lip and palate, incisal transforamen fissures, agenesis of the maxillary left central incisor and both maxillary lateral incisors, was treated with autogenous bone graft in the cleft area. The orthodontic treatment plan was to replace the missing lateral incisors with the maxillary canines and to extract the mandibular first premolars. One of the mandibular premolars was extracted from its site with 2/3 of its root formation completed and transplanted to the maxillary left central incisor area. After orthodontic treatment, the anatomic crowns were characterized with composite resin. Autogenous tooth transplantation can be performed in the area of the fissure in young cleft palate patients, by performing bone graft augmentation before transplantation of the tooth, to gain sufficient recipient alveolar bone volume. A multidisciplinary approach is mandatory for the success of this clinical procedure, especially in cleft palate patients.     

Associations between severity of clefting and maxillary growth in patients with unilateral cleft lip and palate treated with infant orthopedics.

OBJECTIVE: The purpose of this study was to examine possible associations between severity of clefting in infants and maxillary growth in children with complete unilateral cleft lip and palate. DESIGN: This was a retrospective study of measurements made on infant maxillary study casts and maxillary cephalometric variables obtained at 5 to 6 years of follow-up. SETTING: The study was performed at the Institute of Reconstructive Plastic Surgery of New York University Medical Center, New York, New York. PATIENTS: Twenty-four consecutive nonsyndromic unilateral complete cleft lip and palate patients treated during the years 1987 to 1994. INTERVENTIONS: All the patients received uniform treatment (i.e., presurgical orthopedics followed by gingivoperiosteoplasty to close the alveolar cleft combined with repair of the lip and nose in a single stage at the age of 3 to 4 months). Closure of the palate was performed at the age of 12 to 14 months. RESULTS: Infant maxillary study cast measurements correlated in a statistically significant manner with maxillary cephalometric measurements at age 5 to 6 years. CONCLUSIONS: The results demonstrate the large variation in the severity of unilateral cleft lip and palate deformity at birth. Patients with large clefts and small arch circumference, arch length, or both demonstrated less favorable maxillary growth than those with small clefts and large arch circumference or arch length at birth.