Evaluation of maxillary central incisors on the noncleft and cleft sides in patients with unilateral cleft lip and palate—Part 2: Relationship between root resorption,horizontal tooth movement,and quantity of grafted autogenous bone

Objective:To evaluate the relationship between external apical root resorption (EARR) of the maxillary central incisors (U1), horizontal orthodontic tooth movement, and quantity of grafted bone in subjects with unilateral cleft lip and palate (UCLP) over an average duration of 8 years.Materials and Methods:Thirty subjects with UCLP were evaluated for EARR of U1 after edgewise treatment (T2). The teeth were classified as having no EARR, moderate EARR (combined into “no/moderate” EARR), or severe EARR. Frontal cephalometric radiographs acquired at eruption of U1 (T0), less than 6 months before secondary alveolar bone grafting (T1), and T2 were evaluated to determine the horizontal inclination (U1-axis angle) and distance of the root apex from the median line (U1-root–VL distance). On the cleft side, the quantities of grafted bone at less than 12 months postsecondary bone grafting and at T2 were evaluated using the alveolar bone graft (ABG) scale.Results:Cleft-adjacent teeth exhibited more severe EARR than did teeth on the noncleft side. The cleft side exhibited greater changes in U1-axis angle and U1-root–VL distance between T0 and T2 than did the noncleft side. On the cleft side, the ABG score at T2 in the severe EARR group was significantly lower than that in the no/moderate EARR group. These measurements were correlated with EARR grade.Conclusions:Cleft-adjacent U1 exhibited more severe EARR than did the U1 on the noncleft side, which might be associated with orthodontic treatment-induced changes in horizontal inclination and root apex movement. On the cleft side, severity of EARR may be correlated with the success of ABG.     

Evaluation of dehiscence and fenestration in adolescent patients affected by unilateral cleft lip and palate: A retrospective cone beam computed tomography study

Objective:To evaluate the presence of dehiscence and fenestration defects around anterior teeth in the cleft region and to compare these findings with the noncleft side in the same patients using cone beam computed tomography (CBCT).Materials and Methods:CBCT scans of 44 patients (26 males, 18 females; mean age, 14.04 ± 3.81 years) with unilateral cleft lip and palate (UCLP) were assessed to define dehiscences and fenestrations of the anterior teeth in both cleft and noncleft sides of the UCLP patients and a control group of noncleft patients (51 patients; 21 males, 30 females; mean age, 14.52 ± 1.16 years). Data were analyzed using Pearson’s χ² and Student’s t-test.Results:The prevalence of dehiscences at the maxillary central incisors, lateral incisors, and canines teeth were 43.2%, 70.6%, and 34.1% on the cleft side and 22.7%, 53.1%, and 27.3% on the noncleft side of UCLP patients, and 13.7%, 7.8%, and 13.7% in controls, respectively (statistically no difference between the sides of cleft patients). The cleft patients had a statistically significantly higher prevalence of dehiscences than did the controls on both the cleft and noncleft sides (P < .05), except for the maxillary central incisors. Fenestrations for these teeth were significantly more common on the cleft side in UCLP patients compared with controls (P < .05), whereas the difference for maxillary lateral incisors was not statistically significant.Conclusions:Patients with UCLP showed a higher prevalence of dehiscence and fenestration defects around the maxillary anterior teeth.     

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.     

单侧完全性唇腭裂患者上颌前牵引后软组织的侧貌变化

目的　评价单侧完全性唇腭裂患者经上颌前牵引治疗后的软组织侧貌改变。方法　12例患者接受上颌前牵引治疗,根据X线头颅侧位定位片上软组织的测量标志点,对治疗前后软组织的侧貌改变进行比较分析。结果　上颌骨前牵引治疗后,患者鼻突度有明显改变,软组织上颌突度增加了3.8°(P＜0.01),代表软组织面突度角也有明显改变(P＜0.01)。而下颌软组织突度矢状方向S-Ns-SM角减少1°,无统计学意义。垂直方向,上面高无变化,而全面高度增加显著(P＜0.01)。结论　上颌前牵引后,在矢状方向上软组织突度发生显著变化,主要包括轻度的鼻隆起,下颌及颏部的后缩也有一定改善。     

Midfacial morphology in adult unoperated complete unilateral cleft lip and palate patients

OBJECTIVE: To examine lateral cephalometric radiographs of adult unoperated cleft lip and palate patients for the purpose of clarifying whether maxillary deficiencies observed in treated cleft patients result from intrinsic defects or surgical intervention early in life. MATERIALS AND METHODS: This retrospective study examined lateral cephalograms of 30 adult patients with nonsyndromic complete unilateral cleft lip and palate (CUCLP). The lateral cephalograms were traced and evaluated for size and position of the cranial base, maxilla, maxillary dentition, mandible, and mandibular dentition as well as for vertical relationships. Comparisons with 30 adult noncleft individuals were made. RESULTS: In unoperated adult cleft lip and palate patients, the cranial base angle was increased with the anterior cranial base reduced in length. The maxilla was found to be normal in size and somewhat prognathic in position. Both the maxillary and mandibular incisors were relatively upright. The mandible was smaller in size and posteriorly positioned. CONCLUSIONS: The potential for normal growth of the maxilla exists in patients with CUCLP. It is likely that disturbances of maxillary growth in surgically operated cleft patients are related primarily to the surgical intervention.     

Maxillary protraction effects on anterior crossbites. Repaired unilateral cleft versus noncleft prepubertal boys

OBJECTIVE: To test the hypothesis that there is no difference between the effects of maxillary protraction on anterior crossbites in repaired unilateral cleft lip and palate (UCLP) and noncleft prepubertal boys. MATERIALS AND METHODS: Eighteen operated UCLP boys with anterior crossbite (aged 9.54 +/- 1.21 years) were the experimental subjects. Eighteen noncleft boys with similar malocclusion (aged 9.75 +/- 1.46 years) were selected as a control group. A Hyrax appliance and reverse headgear were applied. Lateral cephalometric radiographs were taken before and after the treatment. Computerized cephalometric analysis and statistics were carried out. RESULTS: There were no significant differences in anterior movement of point A between the two groups (P > .05). ANB increased by 3.82 degrees and A-Pg (FH) increased by 5.89 mm in the UCLP group. ANB increased by 2.68 degrees and A-Pg (FH) increased by 3.66 mm in the noncleft group. The change of sagittal skeletal intermaxillary relationships was significantly larger in the UCLP group than in the noncleft group (P < .05). The change of lower lip in the UCLP group was less than in the noncleft group (P < .05). : The hypothesis is rejected. The changes of sagittal skeletal intermaxillary relationship and mandibular clockwise rotation were larger in the operated UCLP patients than in the noncleft subjects. The amount of the lower lip retrusion was significantly less in the UCLP patients.     

Asymmetry of the maxilla in children with complete unilateral cleft lip and palate

Craniofacial asymmetry was analyzed in 31 children with unilateral cleft lip and palate (UCLP) and compared to a group of 24 children with incomplete clefts of the lip (CL). Symmetry was evaluated from 32 variables on posteroanterior cephalometric radiographs. Two types of asymmetry were identified: In the first, there was a positional deviation and a change of arch shape of the maxillary segment on the cleft side. The basal maxillary width was similar in the two groups. At the dentoalveolar level a decrease in width was localized to the cleft side in the UCLP group. Maxillary height of the cleft segment was reduced. The second type was related to the anterior part of the maxilla and the nasal septum. The inferior border of the bony part of the nasal septum deviated towards the cleft side. The anterior nasal spine and the midpoint between the upper central incisors deviated toward the noncleft side, but to a different degree indicating a vertical tilting of the premaxillary region.     

Changes of vertical skeletal morphology in patients with complete unilateral and bilateral cleft lip and palate.

OBJECTIVE: The aim of this retrospective investigation was to qualify and quantify changes of the vertical skeletal morphology during puberty in cleft patients compared with an age-matched noncleft control. METHODS: Patients with unilateral cleft lip and palate (UCLP; n = 12) and bilateral cleft lip and palate (BCLP; n = 11) who fulfilled strict inclusion criteria according to the Hanover treatment protocol were evaluated by means of cephalometric analysis. Lateral cephalograms were analyzed for each cleft patient at age 10 and 15 and compared with corresponding data of a noncleft control (n = 20). RESULTS AND CONCLUSIONS: It was concluded that a vertical growth impairment of the maxilla is found in patients with cleft lip and palate. The maxilla of cleft patients shows a significant clockwise rotation, whereas the inclination of the mandible shows little difference. Consequently, there is a skeletal superposition of the jaws. The posterior height of the maxilla is significantly shorter in patients both with UCLP and BCLP at T(0) and T(1). An increase of the anterior height of the mandible is found in the cleft groups.     

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.     

New treatment modality for maxillary hypoplasia in cleft patients: protraction facemask with miniplate anchorage

Objective:To present cleft patients treated with protraction facemask and miniplate anchorage (FM/MP) in order to demonstrate the effects of FM/MP on maxillary hypoplasia.Materials and Methods:The cases consisted of cleft palate only (12 year 1 month old girl, treatment duration  =  16 months), unilateral cleft lip and alveolus (12 year 1 month old boy, treatment duration  =  24 months), and unilateral cleft lip and palate (7 year 2 month old boy, treatment duration  =  13 months). Curvilinear type surgical miniplates (Martin, Tuttlinger, Germany) were placed into the zygomatic buttress areas of the maxilla. After 4 weeks, mobility of the miniplates was checked, and the orthopedic force (500 g per side, 30° downward and forward from the occlusal plane) was applied 12 to 14 hours per day.Results:In all cases, there was significant forward displacement of the point A. Side effects such as labial tipping of the upper incisors, extrusion of the upper molars, clockwise rotations of the mandibular plane, and bite opening, were considered minimal relative to that usually observed with conventional protraction facemask with tooth-borne anchorage.Conclusions:FM/MP can be an effective alternative treatment modality for maxillary hypoplasia with minimal unwanted side effects in cleft patients.     

非综合征性单侧完全性唇腭裂恒牙发育异常的研究

目的 经回顾性研究了解非综合征性单侧完全性唇腭裂患者恒牙发育异常的情况.方法 收集244例植骨期非综合征性单侧完全性唇腭裂患者的影像学资料,记录和统计分析恒牙发育异常.结果 在本研究中各种恒牙异常的发生率为:先天缺失163例(269颗)(163/244,66.8%),最常累及的牙位是上颌侧切牙;畸形牙82例(85颗)(82/244,33.6%),绝大多数为上颌侧切牙的小牙畸形;额外牙12例(12颗)(12/244,4.9%),多发生于裂区,表现为畸形小牙.牙位发育异常的性别比较发现,非裂侧上颌仅侧切牙缺失,男性高于女性(P<0.05).裂侧的先天缺牙、额外牙和畸形牙的发生率均高于非裂侧,差异有统计学意义(P<0.01),上下颌均有相同发现.结论 非综合征性单侧完全性唇腭裂患者各类牙齿发育异常的患病率均高于健康人群.裂侧的牙齿发育异常较非裂侧更为多见.

Abstract：

Objective To investigate the prevalence of dentM anomalies in Chinese children with complete unilateral cleft lip and palate(UCLP).Methods Dental histories and radiographs of 244 Chinese children with UCLP were collected.The diagnosis of dental anomalies waft based on panoramic radiographs before alveolar bone grafting.All patients were over 8 years old.Results In the UCLP group,66.8% of the patients was presented with hypodontia.The maxillary lateral incisors were the most common teeth affected,followed by maxillary second premolars,mandibular incisors and mandibulax second premolars.A total of 33.6%the patients Was presented with dental malformation,most were mierodontic laterel incisors.A total of 4.9% the patients was presented with hyperdontim The supernumerary teeth were more frequently found in the cleft region.The prevalence of missing maxillary lateral incisor in the noneleft side was statistically different between genders,which was higher in male(P<0.050).This group of Chinese children with UCLP demonstrated significantly higher prevalence of hypodontia,hyperdontia,and malformation on the cleft side than on the noncleft side(P<0.01).Conclusions Hypodontia is the most common type of dental anomalies.The prevalence of dental anomalies is higher in the UCLP patients than in the normal population.Dental anomalies occur more frequently on the cleft side than on the nonclefi side.     

Unoperated adult cleft lip and palate: changes in form and function after operation

This report describes the occlusion and craniofacial morphology--together with changes in tongue activity during swallowing before and after surgical correction--in a 26-year-old female patient with unilateral cleft lip and palate. Cross-bites were not observed before or after repair. Lateral cephalometric findings revealed a convex profile with a normal anterior cranial base length, a flat mandibular plane, and a short lower-anterior face height. Preoperative cineradiographic appraisal showed atypical tongue activity during swallowing. The dorsum of the tongue remained high to seal the cleft. The bolus was kept on the floor of the mouth and passed along the lateral margins of the tongue. The swallow duration, as determined by EMG of the tongue, was extremely long when compared with infant-operated cleft lip and palate patients and to noncleft subjects. Postoperatively, tongue function was similar to that in both cleft patients in whom closure was performed in infancy and to noncleft controls.     

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.     

Root development of permanent lateral incisor in cleft lip and palate children: a radiographic study.

OBJECTIVE: The objective of this study was to compare the root development of lateral incisor on the cleft side with the root development of its contralateral tooth in cleft lip and palate children. SETTING: Cleft lip and palate wing, Meenakshi Ammal Dental College and Hospital, Chennai, South India. MATERIALS AND METHODS: A sample of 96 orthopantamograms of patients with unilateral orbilateral cleft lip and/or cleft palate was selected, regardless of sex and race. MAIN OUTCOME MEASURE: Orthopantamograms were analyzed for root development of lateral incisor on the cleft and non cleft side. Associated anomalies like hypodontia, supernumerary teeth, malformed lateral incisors and root development of canine, if present, were recorded. FINDINGS AND CONCLUSIONS: Root development of permanent lateral incisor was delayed on the cleft side compared to the non cleft side. There was a statistically significant relationship between levels of root development of lateral incisors on the cleft side within the different study groups(P < 0.05). Incidence of hypodontia increased in proportion to cleft severity. Frequency of missing second premolars, supernumerary teeth and malformed lateral incisors increased in cleft lip and palate patients. Root development of canine showed a slight delay on the cleft side when compared to the canine on the noncleft side.     

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.     

Comparison of tooth development stage of the maxillary anterior teeth before and after secondary alveolar bone graft: Unilateral cleft lip and alveolus vs unilateral cleft lip and palate

Objective:To compare the effect of secondary alveolar bone graft (SABG) on the tooth development stage of the maxillary central incisor (MXCI) and maxillary canine (MXC) in terms of the severity of unilateral cleft.Materials and Methods:The subjects consisted of 50 boys with unilateral cleft lip and alveolus (UCLA) or unilateral cleft lip, alveolus, and palate (UCLP). The age- and sex-matched subjects were divided into group 1 (UCLA, n = 25; 9.3 ± 0.8 years old) and group 2 (UCLP, n = 25; 9.4 ± 0.6 years old). In panoramic radiographs taken 1 month before (T0) and 1 year after SABG (T1), tooth development stage was evaluated according to the Nolla developmental (ND) stage. A panoramic radiograph taken 3 years after SABG was used as a reference for the final root length of individual tooth.Results:In groups 1 and 2, the ND stage of the MXCI did not exhibit differences between the cleft and non-cleft sides at T0 and T1, respectively. However, although the ND stage of the MXC of group 2 was delayed on the cleft side compared with the non-cleft side at T0 (P < .05), the MXC on the cleft side developed faster than that on the non-cleft side after SABG (P < .01). In terms of tooth development speed, group 2 showed a higher rate of faster developed MXCs on the cleft side compared with the non-cleft side after SABG than group 1 (36.0% vs 8.0%, P < .05).Conclusion:SABG performed at approximately 9 years of age might increase tooth development speed of MXC in patients with UCLP compared with patients with UCLA.     

Biomechanical evaluation of sagittal maxillary internal distraction osteogenesis in unilateral cleft lip and palate patient and noncleft patients: A three-dimensional finite element analysis

Objective:To compare the pattern and amount of stress and displacement during maxillary sagittal distraction osteogenesis (DO) between a patient with unilateral cleft lip and palate (UCLP) and a noncleft patient.Materials and Methods:Three-dimensional finite element models for both skulls were constructed. Displacements of the surface landmarks and stress distributions in the circummaxillary sutures were analyzed after an anterior displacement of 6 mm was loaded to the elements where the inferior plates of the distractor were assumed to be fixed and were below the Le Fort I osteotomy line.Results:In sagittal plane, more forward movement was found on the noncleft side in the UCLP model (−6.401 mm on cleft side and −6.651 mm on noncleft side for the central incisor region). However, similar amounts of forward movement were seen in the control model. In the vertical plane, a clockwise rotation occurred in the UCLP model, whereas a counterclockwise rotation was seen in the control model. The mathematical UCLP model also showed higher stress values on the sutura nasomaxillaris, frontonasalis, and zygomatiomaxillaris on the cleft side than on the normal side.Conclusions:Not only did the sagittal distraction forces produce advancement forces at the intermaxillary sutures, but more stress was also present on the sutura nasomaxillaris, sutura frontonasalis, and sutura zygomaticomaxillaris on the cleft side than on the noncleft side.     

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.     

Maxillary expansion and protraction in correction of midface retrusion in a complete unilateral cleft lip and palate patient

A 7-year-old girl with a cleft lip and palate had a midface retrusion due to growth inhibition of the maxillary complex. She presented for correction of a severe total crossbite with a Class III skeletal pattern. Initially, maxillary expansion was provided to widen the maxilla and then maxillary protraction headgear was worn to improve the sagittal skeletal relation. Fixed orthodontic appliances were placed to align the dentition and Class III elastics were used to establish intercuspation and stability. The maxillary expansion and protraction usually provide effective improvement in skeletal Class III patients with repaired cleft lip and palate patients. The success of the orthopedic procedure essentially depends on the individual growth of the maxilla and the mandible. This case report shows the significant growth of the mandible after maxillary expansion and protraction in late adolescence.