Impact of orthodontic gap closure versus prosthetic replacement of missing maxillary lateral incisor on dental arch relationships and symmetry on 212 cleft patients: a retrospective study Missing lateral incisor gap in cleft patients (39/40 characters max)

Abstract

left lip and cleft palate are the most common congenital orofacial deformities, affecting one in 1000 births in Europe. 1 Patients with cleft lip and/or cleft palate need medical care as newborns, throughout their childhood and adolescence, and until early adulthood, coordinated by a multidisciplinary team involving surgeons and dental practitioners.Several dental anomalies are often associated with this deformity. 2 Maxillary lateral incisor agenesis or hypoplasia is the most frequent for patients with cleft lip and/or palate. [3][4][5][6][7][8] Maxillary lateral incisors are often missing because of agenesis or extraction and the orthodontist and surgeon collaborate to plan the best option to manage the gap left by the missing incisors.The first option is orthodontic gap closure. This treatment brings the homolateral canine

Dental Rehabilitation of the Unilateral Cleft Dental Gap: A Single Institution Experience With Long-Term Follow-Up

“…Implants at the cleft site demonstrate comparable osteointegration and survival rates to that of noncleft controls, albeit with the caveat that there may be some unfavorable soft tissue esthetics 14–16 . However, the soft tissue esthetics seen with implants are not necessarily worse than what would be seen with canine substitution 2 …”

“…There are a variety of considerations that warrant discussion when deciding between canine substitution and single-tooth implantation. Although our institution favored orthodontic closure, at some centers, the preference is toward prosthetic rehabilitation 2 . It is often difficult to transpose an entire hemi-arch into the lateral incisor dead space.…”

“…A residual dental gap often persists after successful alveolar bone grafting (ABG). Up to half of patients with unilateral cleft lip and alveolus or palate (UCLA±P) are congenitally missing the lateral incisor at the cleft site 1,2 . Furthermore, even when the permanent lateral incisor develops, it is often dysmorphic and requires extraction before secondary ABG to facilitate graft-to-bone contact.…”

“…All patients with UCLA±P characteristically have asymmetry of the nose, lip, and teeth. Maintaining the space for a fixed dental prosthetic is thought to preserve better symmetry of the maxillary arch and dentition 2 . The disadvantages of this strategy include cost and delayed gratification for the patient and provider 5 …”

The usefulness of cone beam computed tomography according to age in cleft lip and palate

“…This therapy is intensified during the mixed and permanent dentition. Prosthetic rehabilitation of the missing maxillary incisors or gap closure with orthodontics can be performed [ 7 ]. Conservative dental treatments complete the multidisciplinary management of clefts at all ages, as numerous dental pathologic conditions accompany the malformation: impacted teeth, supernumerary teeth, root resorption, and hypodontia [ 8 , 9 ].…”