Indices to assess malocclusions in patients with cleft lip and palate

Eur J Orthod. 2013 Dec;35(6):772-82. doi: 10.1093/ejo/cjt009. Epub 2013 Mar 15.


Background: Several indices are now available to assess the severity of the malocclusion in cleft lip and/or palate (CLP) patients; and although it has been quite some time since the introduction of these indices, there is no consensus as to which index should be used for CLP populations.

Objective: To systematically review the available literature on the indices used to assess the occlusal schemes in dental models of CLP patients, with respect to the most commonly used index and the index that most fulfils the World Health Organization (WHO) criteria.

Search methods: Ten electronic databases, grey literature, and reference list searches were conducted.

Selection criteria: The inclusion criteria consisted of studies that aimed to assess a particular malocclusion index on study models of patients with CLP.

Data collection and analysis: Full articles were retrieved from abstracts/titles that appeared to have met the inclusion -exclusion criteria which were subsequently reviewed using more detailed criteria for a final selection decision. The Quality Assessment of Diagnostic Accuracy Studies tool was used to appraise the methodological quality of the finally included studies. Due to the heterogeneity of the data, only a qualitative analysis was performed.

Results: A total of 13 studies met the inclusion -exclusion criteria. These studies revealed seven utilized indices, namely the GOSLON Yardstick, Five-Year-Old, Bauru-Bilateral Cleft Lip and Palate Yardstick, Huddart -Bodenham, Modified Huddart -Bodenham, EUROCRAN Yardstick, and GOAL Yardstick. The GOSLON Yardstick was the most commonly used index, and the Modified Huddart -Bodenham performed the best according to the WHO criteria.

Conclusions: Current evidence suggests that the Modified Huddart -Bodenham Index equalled or outperformed the rest of the indices on all the WHO criteria and that the GOSLON Yardstick was the most commonly used index, possibly due to a longer time in use. Therefore, the Modified Huddart -Bodenham could be considered as the standard to measure outcomes of patients with CLP.

Publication types

  • Review

MeSH terms

  • Cleft Lip / complications*
  • Cleft Palate / complications*
  • Humans
  • Malocclusion / diagnosis*
  • Malocclusion / etiology
  • Models, Dental
  • Severity of Illness Index*