A Retrospective Mixed Longitudinal Study of Tooth Formation in Children With Clefts.

OBJECTIVE

To test for systematic age changes in cleft children based on dental age.

DESIGN

Retrospective case-control longitudinal study.

SETTING

One orthodontic solo practice.

PATIENTS: Nonsyndromic, complete cleft lip and palateCLP cases, either unilateral or bilateral (102 children; 370 radiographs), between 4 and 16 years of age.

INTERVENTIONS: Children were treated with a team approach, but only orthodontic radiographs were studied.

MAIN OUTCOME MEASURE: The principal outcome measure was dental age of the cleft cases compared to a sex-specific sample of phenotypically normal children (1107 children), from the same geographical region. Multiple panoramic radiographs taken during the course of orthodontic treatment were examined to track patterns of dental age as children matured. Analysis used linear mixed models primarily testing for sex, cleft type (unilateral, bilateral), and hypodontia differences. Initial expectation was that cleft children would exhibit delayed dental ages from postnatal stressors and would become more deviant with maturity.

RESULTS

In childhood (4-6 years), both sexes were significantly delayed (P < .001), but dental age normalized around 8 to 10 years. Boys experienced faster maturation thereafter than girls (P < .001). Only trivial differences occurred between unilateral CLP and bilateral CLP samples.Hypodontia further depressed maturation rates (P < .001). Dental age improved in a decidedly curvilinear fashion (P < .001), with greater change at earlier ages.

CONCLUSIONS

This report agrees with other contemporary studies, showing childhood catch-up. Older studies observed that clefting caused significant delays that worsened with growth. This potential "seachange" suggests better recovery and quicker normalization of children with clefts, perhaps due to improved management.