Académique Documents
Professionnel Documents
Culture Documents
INTRODUCTION
Complete cleft of the lip, alveolus, and/or palate
(CLAP) is the most common congenital malformation
of the face.1 Most affected children show a deficiency
in soft tissues and the alveolus and malformation of the
teeth at the cleft region. Problems are commonly seen
in feeding, speaking, and hearing; many esthetic,
dental, and psychological problems may also be
encountered.2 Additionally, children and youths with
CLAP are at increased risk for the development of
a
Assistant Professor, Department of Periodontology, Karadeniz Technical University, Trabzon, Turkey.
b
Associate Professor, Department of Orthodontics, Akdeniz
University, Antalya, Turkey.
c
Research Assistant, Department of Orthodontics, Ordu
University, Ordu, Turkey.
d
Assistant Professor, Department of Oral and Maxillofacial
Radiology, Erciyes University, Kayseri, Turkey.
Corresponding author: Dr Esra Ercan, Karadeniz Technical
University, Department of Periodontology, 61080 Trabzon,
Turkey
(e-mail: esraercan82@gmail.com)
Figure 1. Three-dimensional model and axial, coronal, and sagittal views using the SimPlant software.
significantly more bone loss compared with contralateral noncleft control teeth. However, approximal
probing depth and attachment loss values were also
significantly higher than for contralateral teeth. Bone
loss was evaluated by means of parallel intraoral xrays using special film holders. Mutthineni et al.9
compared bone loss between patients with unilateral
cleft lip and palate (UCLP) and patients with cleft
palate (CP) using parallel periapical radiographs.9
Patients with UCLP had poorer periodontal status
and higher bone loss than patients with CP.
To our knowledge, no previous study investigated
the bone support of the teeth in patients affected by
cleft lip and palate (CLP) using cone-beam computed
tomography (CBCT). CBCT technology facilitates true
(1:1 size) images without magnification and shows
high intraobserver and interobserver reproducibility
compared with conventional radiographs;1315 thus, it
Number
Canine
Cleft Side
Normal Side
Cleft Side
Normal Side
31
31
18
22
Table 2. Comparison of the Bone Thickness Distribution at Different Levels in Central and Canine Teeth
Central
a
Bone Thickness
M0
M1
M2
M4
a
b
Cleft Side
0.91
1.02
1.11
1.69
6
6
6
6
0.24
0.28
0.38
1.19
Canine
b
P Value
Normal Side
1.09
1.04
1.30
1.65
6
6
6
6
0.26
0.27
0.35
0.55
.001
.700
.048
.862
Cleft Side
1.24
1.14
1.48
1.66
6
6
6
6
0.69
0.55
0.74
0.58
Normal Side
1.33
1.22
1.32
1.42
6
6
6
6
0.51
0.45
0.61
0.60
P Value
.522
.335
.366
.153
M0, M1, M2, and M4: thickness of the buccal bone at 0, 1, 2, and 4 mm, respectively.
P values determined by paired t-test.
RESULTS
DISCUSSION
Table 3. Mean 6 Standard Deviation, Median, and Interquartile Range CEJ-AC Valuesa
Central
CEJ-AC distance
P valueb
a
b
Canine
Cleft Side
Normal Side
Cleft Side
Normal Side
2.34 6 1.09
1.53 6 0.69
2.51 6 1.11
2.15 6 0.81
.002
CEJ-AC is the distance between the cementoenamel junction and the alveolar bone crest.
P values determined by Students t-test.
.312
CONCLUSIONS
N The bone thickness of the central incisor at the crest
and 2 mm apically was statistically significantly
thinner at the cleft region (P , .01). However, the
values for M1 and M4 for central teeth as well as M0,
M1, M2, and M4 measurements for canine teeth
were similar in the cleft and noncleft regions.
N The mean CEJ-AC distance for central teeth in the
cleft region was 2.34 6 1.09 mm, compared with
1.53 6 0.69 mm for the noncleft region (P 5 .002),
while these distances for canine teeth in the cleft and
noncleft regions were similar.
N Reduced bone support might cause several problems in the future. Thus, regular and strict professional dental control is essential for maintaining the
periodontal health of these patients.
REFERENCES
1. Perdikogianni H, Papaioannou W, Nakou M, Oulis C,
Papagiannoulis L. Periodontal and microbiological parameters in children and adolescents with cleft lip and/or palate.
Int J Paediatr Dent. 2009;19:455467.
2. Quirynen M, Dewinter G, Avontroodt P, Heidbuchel K,
Verdonck A, Carels C. A split-mouth study on periodontal
and microbial parameters in children with complete unilateral cleft lip and palate. J Clin Periodontol. 2003;30:4956.
3. Lages EM, Marcos B, Pordeus IA. Oral health of individuals
with cleft lip, cleft palate, or both. Cleft Palate Craniofac J.
2004;41:5963.
4. Boloor V, Thomas B. Comparison of periodontal status
among patients with cleft lip, cleft palate, and cleft lip along
with a cleft in palate and alveolus. J Indian Soc Periodontol.
2010;14:168172.
5. Quirynen M, De Soete M, Dierickx K, van Steenberghe D.
The intra-oral translocation of periodontopathogens jeopardises the outcome of periodontal therapy. A review of the
literature. J Clin Periodontol. 2001;28:499507.
6. Wehrbein H, Diedrich P. The periodontal changes following
orthodontic tooth movementa retrospective histological
study in man. 2 [in German]. Fortschritte der Kieferorthopadie. 1992;53:203210.
7. Gaggl A, Schultes G, Karcher H, Mossbock R. Periodontal
disease in patients with cleft palate and patients with
unilateral and bilateral clefts of lip, palate, and alveolus.
J Periodontol. 1999;70:171178.
8. Salvi GE, Bragger U, Lang NP. Periodontal attachment loss
over 14 years in cleft lip, alveolus and palate (CLAP, CL,
CP) subjects not enrolled in a supportive periodontal therapy
program. J Clin Periodontol. 2003;30:840845.
9. Mutthineni RB, Nutalapati R, Kasagani SK. Comparison of
oral hygiene and periodontal status in patients with clefts of
palate and patients with unilateral cleft lip, palate and
alveolus. J Indian Soc Periodontol. 2010;14:236240.
10. de Almeida AL, Gonzalez MK, Greghi SL, Conti PC,
Pegoraro LF. Are teeth close to the cleft more susceptible
to periodontal disease? Cleft Palate Craniofac J. 2009;46:
161165.
11. Teja Z, Persson R, Omnell ML. Periodontal status of teeth
adjacent to nongrafted unilateral alveolar clefts. Cleft Palate
Craniofac J. 1992;29:357362.
Angle Orthodontist, Vol 00, No 0, 0000
6
12. Bragger U, Nyman S, Lang NP, von Wyttenbach T, Salvi
G, Schurch E Jr. The significance of alveolar bone in
periodontal disease. A long-term observation in patients with
cleft lip, alveolus and palate. J Clin Periodontol. 1990;17:
379384.
13. Celikoglu M, Halicioglu K, Buyuk SK, Sekerci AE, Ucar FI.
Condylar and ramal vertical asymmetry in adolescent
patients with cleft lip and palate evaluated with cone-beam
computed tomography. Am J Orthod Dentofacial Orthop.
2013;144:691697.
14. Celikoglu M, Nur M, Kilkis D, Sezgin OS, Bayram M.
Mesiodistal tooth dimensions and anterior and overall Bolton
ratios evaluated by cone beam computed tomography. Aust
Orthod J. 2013;29:153158.
15. Celikoglu M, Buyuk SK, Sekerci AE, Ucar FI, Cantekin K.
Three-dimensional evaluation of the pharyngeal airway
volumes in patients affected by unilateral cleft lip and
palate. Am J Orthod Dentofacial Orthop. 2014;145:780786.
16. Bragger U, Schurch E Jr, Salvi G, von Wyttenbach T, Lang NP.
Periodontal conditions in adult patients with cleft lip, alveolus,
and palate. Cleft Palate Craniofac J. 1992;29:179185.
17. Papapanou PN, Wennstrom JL, Grondahl K. Periodontal
status in relation to age and tooth type. A cross-sectional
radiographic study. J Clin Periodontol. 1988;15:469478.
18. Costa B, Lima JE, Gomide MR, Rosa OP. Clinical and
microbiological evaluation of the periodontal status of
19.
20.
21.
22.
23.
24.