Abstract
Objective To determine in individuals with unilateral cleft lip and palate the correlation between initial cleft size and dental anomalies, and the outcome of alveolar bone grafting.Methods A total of 67 consecutive patients with non-syndromic unilateral complete cleft lip and palate (UCLP) were included from the cleft lip and palate-craniofacial center, Uppsala University Hospital, Sweden. All patients were operated by the same surgeon and treated according to the Uppsala protocol entailing: lip plasty at 3 months, soft palate closure at 6 months, closure of the residual cleft in the hard palate at 2 years of age, and secondary alveolar bone grafting (SABG) prior to the eruption of the permanent canine. Cleft size was measured on dental casts obtained at the time of primary lip plasty. Dental anomalies were registered on radiographs and dental casts obtained before bone grafting. Alveolar bone height was evaluated with the Modified Bergland Index (mBI) at 1 and 10-year follow-up.Results Anterior cleft width correlated positively with enamel hypoplasia and rotation of the central incisor adjacent to the cleft. There was, however, no correlation between initial cleft width and alveolar bone height at either 1 or 10 years follow-up.Conclusions Wider clefts did not seem to have an impact on the success of secondary alveolar bone grafting but appeared to be associated with a higher degree of some dental anomalies. This finding may have implications for patient counseling and treatment planning.
Highlights
Cleft width at birth is highly variable in the cleft lip and palate deformity [1,2,3]
Initial cleft size as measured prior to palate closure was shown to have no impact on dental arch relationship in mixed dentition as evaluated by the GOSLON Yardstick [9]
The data set was originally composed of 67 Caucasian subjects with non-syndromic unilateral complete cleft lip and palate (UCLP), who underwent Secondary alveolar bone grafting (SABG) between 1987 and 1997 by the same surgeon (Valdemar Skoog)
Summary
Cleft width at birth is highly variable in the cleft lip and palate deformity [1,2,3]. The impact of the initial cleft width on various treatment outcomes in these patients has been studied to some extent [1,2,5]. Wider clefts were correlated with increased transverse dental arch dimensions and less crossbite occlusion in the primary dentition [6], with inhibited maxillary growth [7] as well as with higher prevalence of velopharyngeal incompetence [8]. Initial cleft size as measured prior to palate closure was shown to have no impact on dental arch relationship in mixed dentition as evaluated by the GOSLON Yardstick [9]. Individuals with smaller initial cleft width and with more remaining palatal tissue showed better maxillofacial growth, as did patients with less facial deformities and more tissue volume of the upper lips at the time of lip repair [7,10]
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