Dual embryonic origin of maxillary lateral incisors: clinical implications in patients with cleft lip and palate

Abstract

Introduction: Cleft lip and palate are craniofacial anomalies highly prevalent in the overall population. In oral clefts involving the alveolar ridge, variations of number, shape, size and position are observed in maxillary lateral incisors. The objective of this manuscript is to elucidate the embryonic origin of maxillary lateral incisors in order to understand the etiology of these variations. Contextualization: The hypothesis that orofacial clefts would split maxillary lateral incisor buds has been previously reported. However, recent studies showed that maxillary lateral incisors have dual embryonic origin, being partially formed by both the medial nasal process and the maxillary process. In other words, the mesial half of the lateral incisor seems to come from the medial nasal process while the distal half of the lateral incisor originates from the maxillary process. In cleft patients, these processes do not fuse, which results in different numerical and positional patterns for lateral incisors relating to the alveolar cleft. In addition to these considerations, this study proposes a nomenclature for maxillary lateral incisors in patients with cleft lip and palate, based on embryology and lateral incisors position in relation to the alveolar cleft. Conclusion: Embryological knowledge on the dual origin of maxillary lateral incisors and the use of a proper nomenclature for their numerical and positional variations renders appropriate communication among professionals and treatment planning easier, in addition to standardizing research analysis.

Orthodontic treatment of unilateral cleft lip and palate associated with maxillary canine/premolar transposition: case report

“…1,2,[4][5][6]18 Even after a successful secondary graft in the cleft region, there is a tendency to remain a vertical defect in this region, which in most situations contraindicates rehabilitation through implant and prosthesis. 2,5,19 In addition, implant and prosthesis rehabilitation in the long term tends to have a greater aesthetic compromise due to non-vertical physiological migration of the implant, which would imply the need for a new rehabilitation to original article Souza RM, Oliveira HT, Farret MM restore vertical symmetry in this region. 5,19 Thus, two options are usually considered: space closure with orthodontic movement, or rehabilitation with conventional prostheses.…”

“…The cleft lip and palate is a congenital malformation characterized by the absence of fusion of the palatine processes during the embryonic phase, with high prevalence, present in 1 in 1,100 births in the world, being the more frequent craniofacial anomaly. [1][2][3][4][5][6] Clinically the clefts are classified according to the incisive foramen, and divided into four types: pre-foramen clefts or lip cleft, post-foramen clefts or palate cleft, transforaminal cleft or cleft lip and palate, and the rare fissures of the face. 6 In addition, fissures can be found unilaterally, bilaterally or medial, with unilateral clefts being the most frequent.…”

“…6 In addition, fissures can be found unilaterally, bilaterally or medial, with unilateral clefts being the most frequent. 2,7 In the region of the cleft, it is common to observe problems of occlusal relationship such as posterior or anterior crossbite due to contraction of the upper arch, absence of permanent lateral incisor, rotations, changes of crown shape and, in some situations, the dental transpositions. 1,3,[8][9][10][11][12] The dental transposition is considered a subdivision of the ectopic eruption, and is an order or position disturb with prevalence of 0.4% in the population.…”

“…This decision must be based on many factors as the age of the patient, occlusal relationship, bone condition, smile esthetics and mainly the long-term functional and esthetic result. 1,2,[4][5][6] Based on that, this manuscript presents a case of a patient with left unilateral transforaminal cleft, with anterior and posterior crossbite, lateral incisor absence and transposition between canine and first premolar. The patient was treated with slow maxillary expansion and orthodontic mechanics to close the spaces through the mesialization of the posterior teeth, accepting the transposition and positioning the upper left first premolar at the place of the absent left lateral incisor.…”

Expression of Nestin, Transcription Factor SOX3 and Homeobox Protein DLX-4 in the Facial Tissue of Children with Cleft Lip and Palate

“…The failure of fusion of these processes results into CLP. In complete unilateral cleft lip and palate (CUCLP) the maxilla is divided into one bigger and one smaller segment, while in complete bilateral cleft lip and palate (CBCLP) the maxilla is segmented into two posterior segments and the pre-maxilla (Spina, 1973;Garib et al, 2015).…”