Permanent Tooth Agenesis and Maxillary Hypoplasia in Patients with Unilateral Cleft Lip and Palate

Plast Reconstr Surg. 2015 Nov;136(5):648e-656e. doi: 10.1097/PRS.0000000000001694.


Background: Maxillary growth in patients with clefts is highly variable. The authors' aim was to investigate whether severity of maxillary hypoplasia is associated with the presence of permanent tooth agenesis in children with complete unilateral cleft lip and palate.

Methods: Fifty children with complete unilateral cleft lip and palate were divided into two groups of 25 children. One group had tooth agenesis of the cleft maxillary lateral incisor, whereas the other did not. Panoramic radiographs, lateral cephalometric radiographs, and dental casts were available for all children in the mixed dentition phase before preparation for alveolar bone grafting. The Modified Huddart/Bodenham scoring system was used to determine dental arch relationships on dental casts. Lateral cephalometric radiographs were traced and analyzed. Differences between groups were investigated using independent samples t tests.

Results: Children with complete unilateral cleft lip and palate and tooth agenesis presented with more negative Modified Huddart/Bodenham scores (-12.4 ± 5.2) than those without tooth agenesis (-5.4 ± 3.5) (p < 0.001), representing more severe arch constriction. These children also presented cephalometrically with reduced basal maxillary length (2.2 mm shorter; p = 0.043), alveolar maxillary length (2.9 mm shorter; p = 0.009), and alveolar maxillary protrusion (2.9 degrees less; p = 0.049) compared to those without tooth agenesis.

Conclusions: Individuals with complete unilateral cleft lip and palate and tooth agenesis demonstrate more deficient maxillary growth than those without tooth agenesis. This is evident in both the sagittal and vertical dimensions, and when looking at the dentoalveolar intermaxillary relationships.

Clinical question/level of evidence: Risk, II.

Publication types

  • Comparative Study

MeSH terms

  • Analysis of Variance
  • Cephalometry
  • Chi-Square Distribution
  • Child
  • Cleft Lip / complications*
  • Cleft Lip / surgery
  • Cleft Palate / complications*
  • Cleft Palate / surgery
  • Cross-Sectional Studies
  • Dentition, Permanent*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Maxilla / abnormalities*
  • Maxilla / diagnostic imaging
  • Radiography, Panoramic / methods
  • Reference Values
  • Retrospective Studies
  • Risk Assessment
  • Tooth Abnormalities / diagnostic imaging*
  • Tooth Abnormalities / physiopathology