Prevalence of intranasal ectopic teeth in children with complete unilateral and bilateral cleft lip and palate.

OBJECTIVE: The objective of this study was to determine the prevalence of ectopic eruption of intranasal teeth. DESIGN: This was a retrospective study, where records of children with repaired cleft lip and palate were analyzed. SETTING: The study was conducted at a large craniofacial center, the Hospital for Rehabilitation of Craniofacial Anomalies, USP, Bauru, S?o Paulo, Brazil. SUBJECTS: The sample consisted of 815 records from patients with bilateral cleft lip and palate (BCLP) and 1,495 records from patients with unilateral cleft lip and palate (UCLP). The age of the subjects was 5 to 10 years old and the groups included both males and females. RESULTS: The results showed that 0.61% of the children with BCLP and 0.40% of those with UCLP had an intranasal tooth. The prevalence of an intranasal tooth for the whole group was 0.48%, and it appeared to be more common in females.     

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.     

Assessment of dental arch relationships in Japanese patients with unilateral cleft lip and palate.

OBJECTIVE: Evaluation of the dental arch relationships of Japanese patients with unilateral cleft lip and palate (UCLP) from the orthodontic clinic of the University of Tokyo Hospital (UTH) compared with patients treated by the Oslo Cleft Team, Norway. DESIGN: Retrospective study and comparison with previous reports. MATERIALS: Dental models of 24 patients with UCLP in UTH taken before orthodontic treatment and before alveolar bone grafting were included. Surgeons in many hospitals performed primary surgeries. These models were matched for age and gender with 24 models from a consecutive series of patients treated by the Oslo Cleft Team as part of the Eurocran Good Practice Archive. A total of 48 models were evaluated. MAIN OUTCOME MEASURE: Dental arch relationship was rated with the Goslon Yardstick. The strength of agreement of rating was assessed with weighted kappa statistics. RESULTS: Intra- and interexaminer agreements evaluated by weighted kappa statistics were high, indicating good reproducibility. Almost 60% of the patients in UTH were classified into poor or very poor categories, and the mean Goslon score was 3.50. These results show a contrast to those in Oslo and were the poorest in comparison with previous reports. CONCLUSION: Dental arch relationships in patients with UCLP in UTH were poor. This seemed to be attributable to surgical procedures, but a factor of racial difference in the craniofacial morphology was also considered. Further intercenter research is required to clarify this point.     

Periodontal disease in patients with cleft palate and patients with unilateral and bilateral clefts of lip, palate, and alveolus

BACKGROUND: Long-term health of the stomatognathic system, as well as esthetics, is the therapeutic goal in patients with facial clefts. The aim of this study was to analyze the periodontal situation of patients with cleft palate (CP) and cleft lip, palate, and alveolus (CLPA) to elicit the differing degrees and localization of periodontal disease. METHODS: In 30 patients with unilateral cleft lip, palate, and alveolus (UCLPA), 30 patients with cleft palate (CP), and 20 patients with bilateral cleft lip, palate, and alveolus (BCLPA), the gingival situation was identified and classified according to the sulcus bleeding index (SBI). Periodontal attachment loss and pathological loosening of teeth were noted for identification of periodontal lesions. The state of oral hygiene was recorded by the approximal plaque index (API). RESULTS: In general, poor oral hygiene was found in all patients. The SBI showed a high incidence of gingivitis in patients with cleft lip, palate, and alveolus. Patients with cleft palate had a minor extent of sulcus bleeding. Periodontal disease was found to a similar extent to that in the general population in patients with cleft palate, whereas patients with cleft lip, palate, and alveolus had a predisposition to deep periodontal destruction of teeth adjacent to the cleft. The registration of pathological loosening of teeth, a result of attachment loss, corresponded to the degree of periodontal disease shown by the attachment loss. CONCLUSIONS: A critical periodontal situation was found in patients with unilateral and bilateral cleft lip, palate, and alveolus, ultimately leading to tooth loss in the front tooth region. In contrast, patients with cleft palate exhibited periodontal situations similar to that found in the general population with additional damage, which may be attributed to orthodontic treatment.     

Palate morphology after unilateral and bilateral cleft lip and palate closure

The aim of the present study was to compare the morphology of the hard palate of patients with uni- and bilateral cleft lip and palate after palatoplasty using vomer and palatal pedicled flaps with the palatal morphology of non-cleft individuals. Eighty patients were enrolled into this retrospective study: 40 patients with cleft lip and palate (30 unilateral, 10 bilateral) and 40 non-cleft patients with class I occlusion, who served as controls. Analysis of the development of the maxillary arch and evaluation of palatal morphology were accomplished from reformatted CT scans from plaster casts of the maxilla at the age of 4, 10 and 15 years (cleft patients) and 10 years (controls). Width and symmetry of the maxillary arch and morphology of the hard palate were assessed in the canine and molar region and compared both among the cleft groups and the controls. Maxillary arch width as assessed from plaster casts did not differ significantly between uni- and bilateral cleft patients and was not significantly different from controls at the age of 10. Deviation from symmetry was present in both types of cleft and significant in unilateral clefts when compared to bilateral clefts and non-cleft patients. Palatal morphology did not differ significantly between uni- and bilateral clefts until the age of 15, but was significantly different from control patients in the molar area at the age of 10 presumably due to the medial shift of soft tissue flaps used for palatoplasty. It is concluded that palatoplasty significantly alters hard palate morphology particularly in the posterior area. The relevance of this alteration for speech and articulation remains to be explored.     

Canine eruption in patients with complete cleft lip and palate

OBJECTIVE: To describe erupting maxillary canine positions in patients with bone-grafted alveolar clefts. SAMPLE: The sample consisted of 101 cleft sites from patients with complete unilateral or bilateral cleft lip and palate who had early (< or =9 years) or late (>9 years) secondary alveolar bone grafts. METHODS: Canine position was assessed using panoramic radiographs taken before and after alveolar bone grafts. Vertical canine positions were assessed using the long axis of the maxillary permanent canine relative to a 90 degrees vertical reference line. Lateral canine positions were defined using the relationship between the canine tip and the midplane of the lateral incisor root. Anomalous lateral incisors were recorded. Statistical analysis included Student's t tests and chi-square tests. RESULTS: Patients with alveolar clefts had a 20-fold increased risk for canine impaction, based on erupting canine positions. Abnormal vertical canine positions decreased following early and late alveolar bone grafts (p < .05), whereas abnormal lateral canine positions increased following late alveolar bone grafts (p < .01). Of the cleft sites with altered canine positions, 61% also had a lateral incisor anomaly. Based on canine position, the non-cleft-side canine had the same risk for impaction as the cleft-side canine. CONCLUSIONS: Patients with alveolar clefts have a significantly higher risk for canine impaction compared with patients without clefts. Timing of alveolar bone grafts and lateral incisor anomalies influenced the risk for canine impaction. An alveolar bone graft should be planned in accordance with maxillofacial development, including the eruption of teeth adjacent to the cleft.     

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.     

Congenital missing permanent teeth in Korean unilateral cleft lip and alveolus and unilateral cleft lip and palate patients

OBJECTIVE: To investigate the differences in the congenital missing teeth pattern in terms of tooth type (permanent maxillary lateral incisor [MLI] and maxillary second premolar [MSP]) and sidedness (cleft vs noncleft) between boys and girls in Korean unilateral cleft lip and alveolus (UCLA) and unilateral cleft lip and palate (UCLP) patients. MATERIALS AND METHODS: This study used the charts, models, radiographs, and intraoral photographs of 90 UCLA patients and 204 UCLP patients (ages 6 to 13 years). Binomial test, chi-square test, Fisher exact test, maximum likelihood analysis of variance, and the odds ratio were performed. RESULTS: According to the relationship between the congenital missing teeth pattern and the cleft type, the UCLP patients had 2.98 times more missing MLIs and 1.80 times more missing MSPs than did the UCLA patients. The MLI was congenitally missing more in boys than in girls, but the MSP showed the opposite tendency. Boys had a higher frequency of congenital missing MLIs and MSPs on the cleft side than did girls. However, on the noncleft side and both sides, girls had a higher frequency of congenital missing MLIs and MSPs than did boys. Results showed a gender-dominant pattern of congenital missing MLIs and MSPs. CONCLUSION: These results suggest that gender and cleft type might affect the congenital missing teeth pattern in terms of tooth type and sidedness.     

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.     

Prevalence of cleft lip and palate in a hospital-based population in the Sudan

Cleft lip and palate represents one of the most common developmental deformities seen in oral surgery clinics. It is usually associated with problems which include not only cosmetic and dental abnormalities, but also speech, hearing and facial growth difficulties. OBJECTIVES: The purpose of the present study was to determine the prevalence of cleft lip and palate in births taking place in hospitals in the Sudan. METHODS: The records of 15,890 Sudanese new-borns delivered at three hospitals during the period from 1997 to 2000 were examined. RESULTS: Thirteen cases of cleft lip and palate were found, demonstrating a prevalence of 0.9 per 1000. There were more girls than boys, with a male:female ratio of 3:10. Fifty-four per cent of the cases had cleft lip with cleft palate, 30% had only cleft palate and the remaining 16% had cleft lip alone. CONCLUSIONS: The present study was confined to hospital-based births in one city, and the true incidence of cleft lip and/or palate in the Sudan is not yet known. Findings differ from reports from other countries in terms of suggesting a higher incidence in girls.     

单侧完全性唇腭裂术后患者牙弓间宽度不调的矫治

目的　通过对单侧完全性唇腭裂术后患者上下颌间牙弓宽度不调的研究及对患者正畸治疗的临床观察 ,总结该类患者正畸治疗的特点。方法　对 4 8例单侧完全性唇腭裂术后患者进行临床检查 ,记录其上下牙弓间的宽度关系 ;根据患者错情况制定不同的治疗方案进行临床治疗。结果　 (1)单侧完全性唇腭裂术后患者中出现上下颌牙弓宽度不调的比率为 6 0 .4 % ,双侧后牙反为 33.3% ,单侧后牙反为 16 .7%。男女之间差异无显著性。 (2 )宽度不调以双尖牙区为重 ,上尖牙区是扩弓治疗的重点。 (3)磨牙区牙弓宽度的不协调常较轻微 ,一些患者甚至上颌最后磨牙区略宽 ,对 5例患者 (占 10 4 % )进行了上颌磨牙的腭向移动。结论　单侧完全性唇腭裂患者正畸治疗中上颌多需扩弓 ,且扩弓潜力较大。对于严重拥挤的患者 ,拔牙决定应在扩弓后作出。扩弓治疗应在牙槽突植骨前进行 ,扩弓后需延长保持时间     

Dento-alveolar development in unilateral cleft lip, alveolus and palate.

BACKGROUND AND OBJECTIVE: Palatal surgery for cleft lip, alveolus and palate is considered to have the most powerful negative impact on maxillary growth. The aim of this study was to compare dento-alveolar development of the permanent dentition and morphology of the palate after surgery in unilateral cleft lip, alveolus and palate patients following two types of palatoplasty: supraperiosteal flap vs mucoperiosteal flap technique.PATIENTS: Thirty-eight patients born between 1976 and 1983 with a complete unilateral cleft of lip, alveolus and palate were studied. Fifteen patients were treated with supraperiosteal flaps (SP group), and the other 23 patients with mucoperiosteal flaps (MP group). In this cross-sectional study, dental casts of stage IV A of Hellman's dental age in each patient were used. METHODS: The following distances were measured: (1). transverse distance C-C', (2). transverse distance M-M', (3). palatal length, (4). palatal height. RESULTS: No statistically differences were seen between the SP and MP groups regarding C-C' and M-M'. However, palatal length and palatal height were significantly greater in the SP than in the MP group. CONCLUSION: The technique that leaves no denuded palatal bone is considered to be advantageous for the development of the alveolar process.     

Maxillary protraction in patients with unilateral cleft lip and palate

Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie - The aim of this study was to evaluate the hard and soft tissue effects and differences of the Alt-RAMEC protocol to the...     

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.     

Tooth agenesis code (TAC) in complete unilateral and bilateral cleft lip and palate patients

The objective of this study is to characterize and compare tooth agenesis codes and their prevalence in a population of Spanish patients with unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP), and to determine if the extent of the cleft (BCLP or UCLP) was associated with the number of absent teeth. This retrospective cross-sectional human study included 118 patients with complete BCLP (29) or UCLP (89) and permanent dentition from first molar to first molar. Congenitally missing teeth were identified on panoramic radiographs using the tooth agenesis code (TAC) to identify agenesis codes. Agenesis prevalence was 50.6 and 51.7% for UCLP and BCLP patients, respectively. The lateral upper incisor was the most frequently absent tooth, especially in the cleft quadrant. Numbers of absent teeth ranged from 1 to 6. This study represents a different approach from previous agenesis investigations in cleft patients. These Spanish patients showed a high number of ageneses, presenting nineteen different tooth agenesis codes. A total of five TACs were unique, in other words, observed in a single patient in the sample. No statistically significant relationship was found between the extent of the cleft and the number of absent teeth. The TAC system makes it possible to identify agenesis codes with simultaneous absence of teeth not detected in general prevalence studies.     

A cephalometric evaluation of lower lip in patients with unilateral cleft lip and palate.

OBJECTIVE: The aim of this study was to evaluate cephalometrically the lower lip position and area of patients with unilateral cleft lip and palate (UCLP) comparatively with Class I skeletodental normal subjects. PATIENTS: Lateral cephalometric and hand-wrist radiographs obtained from 24 patients with UCLP (mean age 12.86 years), along with 20 normal individuals (mean age 12.33 years) used as a control group, were examined. DESIGN: In addition to standard cephalometric dentofacial variables, lower lip area (superior, middle, inferior) was also measured using a digital planimeter on the lateral cephalograms. RESULTS: The superior and middle part of the lower lip areas were significantly smaller (p < .05) in the UCLP group, compared to the control group. The inferior and total lower lip areas of patients with UCLP were found to be significantly smaller than controls. The labiomental angle was also smaller (38.79 degrees). CONCLUSIONS: The results suggest that the lower lip of patients with UCLP is smaller, retruded, and curved, with a deep labiomental sulcus, compared with normal individuals during puberty. Therefore, practitioners should focus not only on the upper lip of patients with UCLP but also should consider the lower lip as it was found distinct from normal individuals during puberty.