Length of the cleft in relation to the incidence of hypodontia of the second premolar and to inheritance of cleft lip and palate in children with isolated cleft palate

Dental anomalies frequency in submucous cleft palate versus complete cleft palate

BACKGROUND/OBJECTIVES

This retrospective study evaluated the prevalence of dental anomalies of number in different subphenotypes of isolated cleft palate.

MATERIALS/METHODS

The sample comprised 26 individuals with submucous cleft palate (group S) and 68 individuals with complete cleft palate (group C) aged between 9 and 12 years from a single centre. Panoramic radiographs were evaluated regarding the presence of dental anomalies of number in permanent teeth. Intergroup comparison was performed using chi-square tests (P < 0.05).

RESULTS

Tooth agenesis was found in 34.61 and 36.76 per cent of group S and group C, respectively. The most commonly missing teeth were the maxillary second premolar, maxillary lateral incisor, and mandibular second premolar. Supernumerary teeth were found in none and 1.47 per cent of the individuals with submucous and complete cleft palate, respectively. No statistically significant difference was found between groups for the frequency of tooth agenesis and supernumerary teeth.

LIMITATIONS

Only dental anomalies of number were evaluated.

CONCLUSIONS/IMPLICATIONS

Individuals with submucous and complete cleft palate showed similar prevalence for tooth agenesis and supernumerary teeth. Dental anomalies frequency seems not to be a discriminator for subphenotypes of cleft palate.

Delayed maturation and reduced crown width of the permanent first mandibular molar in all subgroups of cleft lip and palate

OBJECTIVES

Surgical closure of the cleft damages nerves and blood supply in the area and may possibly negatively influence dental development in children with cleft lip and palate (CLP). Previous studies of the permanent first mandibular molar (M1_inf ) in children with unilateral complete CLP found delayed maturation and decreased follicle/crown width before any surgical interventions. This study aimed to investigate if these findings are representative for the total population of individuals born with CLP.

SETTING AND SAMPLE POPULATION

A population-based consecutive longitudinal sample of 224 children with clefts: 183 with CLP (66 with complete [47 unilateral, 19 bilateral], 117 with incomplete [70 unilateral, 47 bilateral], and 41 with unilateral incomplete cleft lip (controls), was examined pre- and post-lip closure (at 2 and 22 months of age).

MATERIAL AND METHODS

In lateral cephalometric X-rays (obtained as part of a standard treatment protocol), M1_inf follicle maturation and follicle/crown width were assessed. Mantel-Haenszel test and Pearson's correlation coefficient R were used to describe relationships. Differences between group means were tested using Wilcoxon rank sum test. Significance level was set to 5%.

RESULTS

Follicle maturation was significantly delayed in all groups with CLP compared to that in controls (P < .01). Follicle and crown width were significantly reduced in all CLP groups compared with those in controls (P < .01). Sex did not influence these variables.

CONCLUSION

Delayed follicle maturation and decreased follicle/crown/tooth size were found to be part of the congenital traits characterizing individuals with all types of CLP and not a result of surgical iatrogenesis.

Early post-natal development of the mandibular permanent first molar in infants with unilateral complete cleft lip and palate

OBJECTIVES

Studies have shown that the mandibular permanent first molar (M1_inf ) in young children with isolated cleft palate is characterized by delay in maturation and has reduced crown width. Consequently, it is of interest to investigate the early maturation and width of the follicle and crown of M1_inf in children with combined cleft lip and palate.

DESIGN

Retrospective, longitudinal study. Cephalometric X-rays of 47 consecutive Danish children with UCCLP (37 males; 10 females) and 44 with unilateral incomplete cleft lip (UICL) (29 males; 15 females) examined at 2 and 22 months of age. UICL served as control group. Maturation (according to Haavikko), width of follicle (FW) and crown (CW) of M1_inf were assessed.

RESULTS

The maturation of the first mandibular molar was delayed in both genders at 2 and 22 months of age. FW and CW were smaller in children with UCCLP at both 2 and 22 months of age. There was a positive correlation between maturation and FW.

CONCLUSIONS

Maturation of the first mandibular molar is delayed in both genders, and FW and CW were reduced in UCCLP compared to controls. Maturation was correlated with FW.

Presurgical Unilateral Cleft Lip Anthropometrics and the Presence of Dental Anomalies

Objective

To investigate associations between cleft lip anthropometrics and dental anomalies in the permanent dentition in unilateral cleft lip patients.

Design

Retrospective cross-sectional study.

Patients

Children with unilateral clefts of the lip, with or without cleft palate.

Methods

Anthropometric lip measurements, made immediately prior to lip repair, were available for each patient. The presence of dental anomalies in the permanent dentition was assessed radiographically. The presence of associations between anthropometric lip measurements and prevalence rates of different dental anomalies were determined using logistic regression analyses.

Results

In the 122 included patients, the cleft lateral lip element was deficient in height in 80% and in transverse length in 84% of patients. Patients with more deficient cleft side lateral lip height and less deficient cleft side lateral lip transverse length were more likely to present with cleft side maxillary lateral incisor agenesis. On the other hand, patients with a less deficient cleft side lateral lip height and more deficient cleft side lateral lip transverse length were more likely to present with a cleft side supernumerary maxillary lateral incisor. When looking only at incomplete clefts, the cleft side lateral lip transverse length deficiency was more predictive of the presence of supernumerary maxillary lateral incisors (P= .030), while for complete clefts, the cleft side lateral lip height deficiency was more predictive of the presence of maxillary lateral incisor agenesis ( P = .035).

Conclusions

In patients with unilateral clefts, cleft lip anthropometrics have a predictive role in determining the occurrence of dental anomalies.

Clefts of the secondary palate referred to the Oslo Cleft Team: epidemiology and cleft severity in 994 individuals

OBJECTIVE

To describe Norwegian individuals born with cleft of the secondary palate (CP) in relation to cleft severity, Pierre Robin sequence, associated anomalies, syndromes, and hypodontia and to present estimated longitudinal prevalences.

PATIENTS

Nine hundred ninety-four individuals with CP born between 1960 and 2002 referred to the Oslo Cleft Team (OCT).

METHOD

Data were collected retrospectively from the archives of the OCT.

RESULTS

Among all CP, 7.6% had recognized syndromes, 30.5% had associated anomalies, and in 61.9%, CP was the only malformation. Pierre Robin sequence was recorded in 11.7%. Female predominance was observed both in general and in each cleft severity subgroup. Of 610 individuals with CP, only 25.1% were diagnosed with a submucous cleft palate, 45.9% had a cleft of the soft palate only, and in 29%, the cleft extended into the hard palate. Among 309 individuals over the age of 10 years with CP only, hypodontia was found in 28.5%, and in individuals with Pierre Robin sequence, hypodontia was found in 44.1%. During the period 1965 to 1999, the estimated prevalence of individuals with CP in the OCT uptake area was found to be 0.59 per 1000 live births. The estimated prevalence increased slightly over time, both overall and within the cleft severity subgroups.

CONCLUSION

A large proportion of a Norwegian population with CP had syndrome or additional anomalies. The estimated prevalence of CP in this population increased slightly during the observation period.

Prevalence of second premolar hypodontia in the Polish cleft lip and palate population

Background

Cleft lip and/or palate is the most frequent congenital abnormality occurring in the craniofacial region and is often associated with numerous dental defects such as tooth agenesis, supernumerary teeth, microdontia, taurodontism, crown malformations, or delay in eruption. The prevalence of hypodontia in cleft-affected patients is much higher in comparison with a healthy population. The aim of this study was to evaluate the prevalence of second premolar hypodontia in patients with cleft lip and/or palate.

Material/Methods

We performed a retrospective, evaluation of panoramic radiographs and dental casts in the Department of Dentofacial Orthopeadics and Orthodontics, Wroclaw Medical University. Two independent observers evaluated the records of 469 patients with various types of clefts and analyzed dental casts and panoramic radiographs.

Results

202 individuals met inclusion criteria. The sample comprised 120 UCLP patients, 38 BCLP patients, 28 CP patients, and 17 CLA patients. Hypodontia in the premolar region was observed in 39 individuals (19.3%). A total number of 58 second premolars were missing, of which 35 were maxillary second premolars (U5) and 23 were mandibular second premolars (L5).

Conclusions

Estimated hypodontia in the Polish CL/P sample was considerably higher than the hypodontia in permanent dentition reported for a European healthy population. The number of congenitally missing second premolars was higher in the maxillary arch than in the mandibular.

Early postnatal development of the mandibular permanent first molar in infants with isolated cleft palate

BACKGROUND

Based on measurements on dental casts, smaller permanent teeth in children with cleft palate have previously been reported in the literature; however, the early maturation of teeth and the size of the follicles and crowns have not been investigated.

HYPOTHESIS

The maturation of the mandibular permanent first molar (M1(inf)) is delayed, and the mesiodistal diameters of the follicle and crown of M1(inf), respectively, are reduced in children with isolated cleft palate (ICP).

DESIGN

Retrospective, longitudinal. Cephalometric X-rays were available for 2 and 22 months old children with clefts (64 children with ICP, and a control group of 38 children with unilateral incomplete cleft lip). The width of the follicle and the crown of M1(inf), and the maturation of M1(inf) were assessed. Intra-observer error was acceptable.

RESULTS

M1(inf) maturation was delayed in children with ICP at both 2 and 22 months of age. The mesiodistal diameter of the crown of M1(inf) in the ICP group was reduced. Thus, the two hypotheses could not be refuted.

CONCLUSIONS

Children with ICP showed smaller dimensions of the M1(inf) , and in addition, the maturation of M1(inf) was delayed.

Dental agenesis: genetic and clinical perspectives

Dental agenesis is the most common developmental anomaly in humans and is frequently associated with several other oral abnormalities. Whereas the incidence of missing teeth may vary considerably depending on dentition, gender, and demographic or geographic profiles, distinct patterns of agenesis have been detected in the permanent dentition. These frequently involve the last teeth of a class to develop (I2, P2, M3) suggesting a possible link with evolutionary trends. Hypodontia can either occur as an isolated condition (non-syndromic hypodontia) involving one (80% of cases), a few (less than 10%) or many teeth (less than 1%), or can be associated with a systemic condition or syndrome (syndromic hypodontia), essentially reflecting the genetically and phenotypically heterogeneity of the condition. Based on our present knowledge of genes and transcription factors that are involved in tooth development, it is assumed that different phenotypic forms are caused by different genes involving different interacting molecular pathways, providing an explanation not only for the wide variety in agenesis patterns but also for associations of dental agenesis with other oral anomalies. At present, the list of genes involved in human non-syndromic hypodontia includes not only those encoding a signaling molecule (TGFA) and transcription factors (MSX1 and PAX9) that play critical roles during early craniofacial development, but also genes coding for a protein involved in canonical Wnt signaling (AXIN2), and a transmembrane receptor of fibroblast growth factors (FGFR1). Our objective was to review the current literature on the molecular mechanisms that are responsible for selective dental agenesis in humans and to present a detailed overview of syndromes with hypodontia and their causative genes. These new perspectives and future challenges in the field of identification of possible candidate genes involved in dental agenesis are discussed.

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.