Dental age in children with a complete unilateral cleft lip and palate

Developmental characteristics of the permanent upper lateral incisor in unilateral cleft lip and palate

OBJECTIVES

This study aims to provide insights into the developmental characteristics of the upper lateral incisor in individuals with unilateral clefts.

MATERIALS AND METHODS

Panoramic radiographs of a consistent group of Caucasian children taken over time (ages 6, 9, and 12) were extensively reviewed. The study assessed the distribution pattern, eruption path, tooth development, and crown size of the upper lateral incisor within the cleft region.

RESULTS

The most commonly observed distribution pattern was the lateral incisor located distal to the cleft, accounting for 49.2% of cases. Furthermore, a significant delay in tooth development of the upper lateral incisor on the cleft side was noted at ages 6 and 9 (p > 0.001). Compared with the non-cleft side, these incisors often erupted along the alveolar cleft and exhibited microdontia (88.3%, p < 0.041).

CONCLUSION

Lateral incisors on the cleft side display unique distribution patterns, microdontia, and delayed tooth development. Careful monitoring of the cuspid eruption is essential, as it can influence the eruption of the lateral incisor.

CLINICAL RELEVANCE

A comprehensive understanding of the development of the upper lateral incisor relative to the cleft is vital for determining its prognosis over time. The position of the upper lateral incisor can also influence the timing and prognosis of secondary alveolar bone grafting. Preserving the upper lateral incisor favors arch length, perimeter, and symmetry in individuals with unilateral clefts.

Dental Age Estimation According to European Formula and Willems Method: Comparison Between Children With and Without Cleft Lip and Palate

OBJECTIVE

To assess dental age and deviations of dental from chronological age according to the Willems and Cameriere methods (European formula) in patients with cleft lip and/or cleft palate (CL/P) and compare it with control group.

DESIGN

Retrospective cross-sectional study.

SETTING

Clinic of Orthodontics.

PARTICIPANTS

Sixty-nine patients with CL/P between 6 and 15 years of age (55 with unilateral and 14 with bilateral CL/P) with 148 panoramic radiographs. The same number of radiographs was examined in the age-matched control group.

MAIN OUTCOME MEASURES

Estimation and comparison of dental age and differences of dental from chronological age in relation to the type of cleft, sex, and age in the group of patients with and without CL/P according to Willems and Cameriere method.

RESULTS

No significant intersex and intergroup differences were found in deviations of dental from chronological age according to Cameriere method (P > .05). Significant difference in deviation of dental from chronological age was found between the patients with and without CL/P according to Willems method (P < .001).

CONCLUSION

Cameriere European formula for dental age estimation, which is not influenced by sex and tooth morphology, showed similar dental development of children with and without CL/P. However, Willems method detected that deviation of dental from chronological age significantly differed between children with and without clefts.

Dental development in patients with and without unilateral cleft lip and palate (UCLP): a case control study

OBJECTIVE

To evaluate if the presence of unilateral cleft lip and palate (UCLP) causes delay in dental age and tooth development.

MATERIALS AND METHODS

Panoramic radiographs of 189 non-syndromic UCLP patients, aged from 6 to 20 years, were collected. Two measures of tooth development were examined: dental maturity scale for the seven left mandibular teeth (dental age-DA) and the degree of each tooth development (developmental score-DS). All the teeth except third molars were staged according to the Demirjian's method. The data of the cleft group were compared with a control group matched for age and gender, based on the findings observed in other 189 panoramic radiographs.

RESULTS

At all ages, DA was lower in the UCLP group, but not always significantly; the highest difference was - 1.411 for females at 13 years old and - 0.776 for males at 12 years old. DS of all teeth was significantly lower in the UCLP group, at all ages under 17 in females, and at all ages under 18 in males. In UCLP group, tooth development was more delayed in the maxilla compared with the mandible. No evidence of a slower development at the cleft side compared with the non-cleft side was highlighted.

CONCLUSIONS

Significant lower dental development was observed in UCLP patients compared with control ones by using DS and DA indexes.

CLINICAL RELEVANCE

These findings can help the clinicians in establishing a proper orthodontic and surgical diagnosis and treatment planning in UCLP patients and for forensic age estimation's purposes.

Are Dental Maturation, Skeletal Maturation, and Chronological Age Associated With Complete Cleft Lip and Palate?

OBJECTIVE

The relationship between dental and skeletal development levels was determined in individuals with cleft lip and palate and a control group comprising individuals without cleft lip and palate.

DESIGN

Retrospective, cross-sectional study.

SETTING

A university clinic specializing in orthodontic and pedodontic care.

PATIENTS

A total of 198 patients with cleft lip and palate (99 females, 11.66 ± 2.36 years; 99 males, 12.44 ± 2.33 years) and 198 patients without cleft lip and palate (99 females, 11.88 ± 2.26 years; 99 males, 12.99 ± 2.25 years).

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

The Demirjian method and cervical vertebra maturation method were used to evaluate panoramic and lateral cephalometric radiographs, respectively. The Fishman maturation predictors were determined from hand-wrist radiographs.

RESULTS

Statistically significant correlations were found between the chronological age and the dental age in both the groups (P < .05). Significant correlations between skeletal maturation indicators and dental maturation indicators were observed in both groups and sexes (P < .05), with a stronger correlation among teeth with incomplete dental maturation. Dental age was found to be significantly lower (female, P = .001; male, P = .001) in individuals with cleft lip and palate (female, 11.71 ± 2.58 years; male, 12.51 ± 2.62 years) compared to those in the control group (female, 12.95 ± 2.47 years; male, 13.64 ± 2.37 years).

CONCLUSIONS

A high correlation between the results of the evaluated radiographic methods and chronological age supports their use for accurate age estimation in the patients with cleft lip and palate.

Analysis of permanent second molar development in children born with cleft lip and palate

OBJECTIVE

The study of dental development in individuals born with cleft lip and palate (CLP) serves to determine when orthodontic intervention should start. To evaluate the permanent second molar development in children born with cleft lip and palate according to Demirjian's and Nolla's methods.

METHODOLOGY

Out of a total of 513 digital panoramic radiographs, 113 pairs of children aged 3 to 16 years were selected. The exams were from children born with or without cleft lip and palate, of the same sex, with an age difference of up to 30 days. The images were analyzed by three examiners and reliability was checked through intra-examiner agreement by the Kappa test. The data were analyzed by Wilcoxon's and Mann-Whitney tests according to each dataset.

RESULTS

The findings indicated delayed development of the permanent second molars in children with CLP (P<0.001). The development of the right permanent second molar was delayed compared to the left molar in children with CLP. Moreover, mandibular teeth showed significantly earlier development than maxillary teeth in both the case and control groups. There was no significant difference in the development of permanent second molars between sexes.

CONCLUSION

Children with CLP presented delay in the development of permanent second molars.

A Retrospective Mixed Longitudinal Study of Tooth Formation in Children With Clefts

OBJECTIVE

To test for systematic age changes in cleft children based on dental age.

DESIGN

Retrospective case-control longitudinal study.

SETTING

One orthodontic solo practice.

PATIENTS

Nonsyndromic, complete cleft lip and palateCLP cases, either unilateral or bilateral (102 children; 370 radiographs), between 4 and 16 years of age.

INTERVENTIONS

Children were treated with a team approach, but only orthodontic radiographs were studied.

MAIN OUTCOME MEASURE

The principal outcome measure was dental age of the cleft cases compared to a sex-specific sample of phenotypically normal children (1107 children), from the same geographical region. Multiple panoramic radiographs taken during the course of orthodontic treatment were examined to track patterns of dental age as children matured. Analysis used linear mixed models primarily testing for sex, cleft type (unilateral, bilateral), and hypodontia differences. Initial expectation was that cleft children would exhibit delayed dental ages from postnatal stressors and would become more deviant with maturity.

RESULTS

In childhood (4-6 years), both sexes were significantly delayed (P < .001), but dental age normalized around 8 to 10 years. Boys experienced faster maturation thereafter than girls (P < .001). Only trivial differences occurred between unilateral CLP and bilateral CLP samples.Hypodontia further depressed maturation rates (P < .001). Dental age improved in a decidedly curvilinear fashion (P < .001), with greater change at earlier ages.

CONCLUSIONS

This report agrees with other contemporary studies, showing childhood catch-up. Older studies observed that clefting caused significant delays that worsened with growth. This potential "seachange" suggests better recovery and quicker normalization of children with clefts, perhaps due to improved management.

Asymmetric Dental Development Investigated by Cone-Beam Computed Tomography in Patients With Unilateral Cleft Lip and Alveolus

OBJECTIVE

To investigate a possible delay in dental development of cleft-side teeth compared with the contralateral teeth in patients with unilateral cleft lip and alveolus with or without cleft palate (UCLA ± CP) and to correlate this delay to developmental stages of the corresponding teeth.

DESIGN

Cross-sectional study.

SETTING

Cleft Lip and Palate Care Center of Shanghai Ninth People's Hospital, Shanghai, China.

PATIENTS

Forty Chinese patients with UCLA ± CP.

MAIN OUTCOME MEASURE

Crown height (CH), root length (RL), and full length (FL) of permanent incisors, canines, premolars, and first molars were measured using cone-beam computed tomography and compared between cleft and noncleft sides. Discrepancies in tooth length between sides during different developmental stages of delayed teeth were also compared.

RESULTS

There were no statistically significant differences in tooth length between sides in the mandible, except for RL of lateral incisors and RL and FL of the second premolars. In the maxilla, CH, RL and FL of cleft-side incisors, as well as RL and FL of cleft-side canines and first premolars, were all significantly shorter than those on the noncleft side (P < .05). The lateral incisors showed the highest reductions in RL and FL (47% and 29%). Moreover, reduction of RL of cleft-side maxillary central incisors was most evident in the early developmental stage (23%) and decreased with dental maturation (5%).

CONCLUSIONS

Asymmetric dental development was presented in both jaws but mainly in maxillary anterior region. The RL deficiency of cleft-side central incisors differed at different developmental stages.

Dental age in 6-year-old children with submucous cleft palate and cleft of the soft palate

OBJECTIVE

To evaluate dental age in 6-year-old children with submucous cleft palate (SMCP) and to compare this in age-matched and sex-matched children with clefts of the soft palate (CPs).

MATERIAL AND METHODS

The dental maturity of 73 children (39 girls) with SMCP was evaluated from panoramic radiographs and compared in age-matched and sex-matched controls with CPs. Mean biological age of the children was 6.1, ranging from 5.5 to 6.8 (boys 6.2 years, range 5.7-6.8; girls 6.1 years, range 5.5-6.7). Dental stages were assessed following the method of Demirjian, and dental age was calculated in accordance with the Finnish dental maturity reference values. Student's paired t-test was used in the statistical analysis.

RESULTS

There were no significant differences in dental age between the sexes, such that boys and girls were combined in the further analyses. Dental age of the children with SMCP (6.2 years, range 4.9-7.4) was similar to their biological age (NS). Dental age of those with CPs was 0.2 years delayed (dental age 5.9 years, range 4.6-7.5; p<0.001) compared to their biological age. Children with CPs had a lower dental age than children with SMCP (p<0.001).

CONCLUSION

Dental maturation in 6-year-old children with submucous cleft palate is not delayed, whereas in children with clefts of the soft palate dental age is slightly delayed.

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.