Dentoalveolar and Skeletal Compensations in Untreated Unilateral Cleft-Lip and Palate

Objectives: The purpose of this study is to quantitatively assess the dentoalveolar and skeletal compensations exhibited in patients with untreated unilateral cleft lip and palate (UCLP). This knowledge allows the provider to better understand, diagnose, and treatment plan for patients with UCLP in the absence of 3D imaging.
Methods: Thirty patients (age 10.7yrs ±2.2) with UCLP received Cone Beam CT (CBCT) scans as part of their routine initial orthodontic records. In addition, thirty patients with unilateral crossbite without CLP (age 9.4yrs ±1.8) received CBCT scans. A custom analysis was created after IRB approval using the OnDemand 3D software to assess 39 parameters including axial inclinations of teeth and skeletal dimensions. Alveolar thickness and height measurements were made at 2mm increments along incisor roots using the half-maximum method for reproducibility. Additional measurements were made of cleft-facing bone support. Two-sample t-tests were used to analyze continuous variables. Generalized linear mixed models were used when multilevel data arose. All tests were two-sided with a 5% significance level.
Results: Intraclass correlation showed good reliability with measurements over 0.75 considered as valid. Preliminary comparison of groups showed statistically significant differences between maxillary incisor inclination, inter-antegonial distance, maxillary canine position from midsagittal plane, and SNB. Cleft-adjacent alveolar measurements indicate minimal bone support (~0.3mm) in the coronal half in contrast to bone coverage in the apical half of the root. No differences were found in alveolar height between cleft and control.
Conclusions: Dentoalveolar and skeletal differences between patients with UCLP and unilateral crossbites were detected and would be beneficial for the clinician to understand.