Position of Upper Permanent Central Incisors prior to Eruption in Unilateral Cleft Lip and Palate

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The position and degree of eruption of permanent central incisors within the premaxilla were measured on x-ray films obtained in 102 patients with unilateral cleft lip and palate and in 52 normal individuals aged 5 years. The patients were subdivided according to sex and to the method of surgical repair (bone grafting or periosteal flap surgery). Individuals with rotated incisors were assessed separately. The results showed that maxillary depth was not significantly reduced prior to palate surgery while the alveolar process was markedly retroclined. An unerupted central upper incisor on the side of the cleft was situated more anteriorly than in controls. Because of the distortion of the alveolar process, it was retroclined and produced a deformation of the subspinal concavity. Both this deformation and the distortion of the alveolar process interfered with the measurements of maxillary depth and rendered it inadequate. The incisor on the normal side was situated more posteriorly than in controls and was less retroclined than the incisor on the affected side. The degree of eruption of incisors on both the normal and affected sides did not differ from controls. The type of surgical repair influenced only the retroclination of the alveolar process and of the incisors within this process. The retroclination was more marked after primary bone grafting than after periosteal flap surgery. The position and degree of eruption of rotated incisors did not differ from nonrotated incisors, and the presence of rotated incisors was not related to the degree of the shortening of maxillary depth. There were no significant differences between males and females.