Distribution Patterns of Primary and Permanent Dentition in Children with Unilateral Complete Cleft Lip and Palate

Abstract

Objective To investigate the distribution patterns of primary and permanent teeth in the cleft area and the numerical variation in teeth in unilateral complete cleft lip and palate (UCLP) patients. Design A survey of the dentition in UCLP patients. Setting Craniofacial Center, Chang Gung Memorial Hospital, Taipei, Taiwan. Patients 137 UCLP patients who met the following criteria: (1) have had at least one panoramic film taken, (2) the first panoramic film illustrates either primary or early mixed dentition. Evaluation of both permanent and primary dentition was available in 91 cases. Main Outcome Measures Two evaluators performed independent evaluations of number and distribution of teeth in UCLP patients. The hypothesis that there are two odontogenic origins for maxillary lateral incisors was proposed to explain the occurrence of distribution patterns of dentition in the cleft area and to explain differences between primary and permanent dentition in UCLP patients. Results Four distribution patterns in the cleft area were identified in both the primary and the permanent dentition. In the primary dentition, placement of the lateral incisor distal to the alveolar cleft was the predominant pattern (pattern y, 82.4%), followed by absence of the cleft side maxillary lateral incisor (pattern ab, 9.9%), presence of one tooth on each side of the alveolar cleft (pattern xy, 5.5%), and placement of the lateral incisor mesial to the alveolar cleft (pattern x, 2.2%). In the permanent dentition, the most common pattern was the absence of the maxillary lateral incisor on the cleft side (pattern AB, 51.8%), followed by lateral incisor placement distal to the alveolar cleft (pattern Y, 46%), lateral incisor placement mesial to the alveolar cleft (pattern X, 1.5%) and the presence of one tooth on each side of the alveolar cleft (pattern XY, 0.7%). The discrepancy between the distribution patterns of primary dentition and permanent dentition successors is 57.1%. Variations in tooth number in both primary and permanent dentition of UCLP patients occurred most often in the cleft area. Abnormalities in the number of teeth (hypodontia or hyper-dontia) outside the cleft area were more common in the permanent dentition than in the primary dentition (24.1% versus 4.4%). Conclusions Four distribution patterns in the cleft area were identified in both sets of dentition. Our findings of distribution patterns in UCLP patients support the hypothesis that there may be two odontogenic origins for maxillary lateral incisors. Clinicians involved in managing the dentition of UCLP patients should consider the high frequency of numerical variation both in and outside the cleft area before starting dental treatment.

Early development of the human dentition revisited

“…It carries two upper central and two lateral incisors. During embryogenesis, however, the maxillary processes also provide material to the prospective premaxilla in humans, and the incisive suture between the maxilla and premaxilla bones does not have to be located in the area of the previous fusion of the medial nasal and maxillary processes but instead can be located more posteriorly (Lisson & Kjaer, 1997;Tsai et al 1998;Barteczko & Jacob, 2004). Indeed, two subcomponents of the premaxillathe *Anlage represents an embryonic area capable of forming a structure, i.e.…”

“…5I) of the lateral incisor can also occur. Tsai et al (1998) have described four different patterns for the location of the deciduous lateral incisor in patients affected by a complete cleft lip and palate, depending on the location of the lateral incisor with regard to the position of the cleft (Fig. 5F-I).…”

Dental agenesis: genetic and clinical perspectives

“…The upper lateral incisor is the most frequently affected tooth in the cleft area both in primary (circa 10%) and in permanent (circa 50%) dentitions. A higher incidence of dental agenesis outside the cleft region, more in particular involving the permanent maxillary dentition, has also been reported (5, 255–258) and suggestion has been made to distinguish clefting associated with dental agenesis from clefting occurring alone (150, 259). Successive linkage analysis studies have indicated involvement in non‐syndromic CL/CLP of different loci, mapped respectively to chromosome 6p24 (OFC1, Orofacial cleft‐1; OMIM Entry 119530) (260–262), 2p13 (OFC2; OMIM Entry 602966), 19q13 (OFC3; OMIM Entry 600757), and regions on 4q (OFC4; OMIM Entry 608371).…”

Maxillary dental anomalies in children with cleft lip and palate: a controlled study

“…Tooth anomalies represent an interesting chapter of orofacial pathology, for both their aetiological background and clinical implications. Several studies [1][2][3][4][5][6][7][8][9] have demonstrated that dental anomalies in number, size, shape, timing of formation, eruption and enamel dysplasia are more frequent in children affected by cleft lip, cleft palate or both (CLP) than in the general population. These studies showed that both primary and permanent dentitions can be affected, and that the dental anomalies are more frequent on the cleft side of the maxilla.…”

“…Missing or supernumerary teeth, and delayed dental development are the most common types of dental anomalies observed. In CLP subjects, the lateral incisor in the region of the alveolar cleft is very sensitive to developmental disorders 1,[3][4][5] . Some authors 1,4,[6][7][8][9] claim that teeth outside the cleft area are also affected more frequently than in children without CLP.…”