Evaluation of Dental Root Development Regarding Maxillary Canine Eruption Status after Secondary Alveolar Bone Grafting in Patients with Cleft Lip and Palate

Abstract

In children born with cleft lip and palate, the timing of the secondary alveolar bone graft (SABG) is crucial to its success; this involves estimating the eruption of the permanent maxillary canine. Altered dental eruption in this patient group gives impetus to the identification of dental developmental factors concerning maxillary canine eruption, which may steer the clinical decision of SABG timing. Records of over nine hundred patients who received SABG with pre- and post-operative cone beam computed tomography (CBCT) scans were analyzed for inclusion and divided into two groups (erupting or non-erupting canine after SABG). Roots of the maxillary canines and premolars were segmented from the cementoenamel junction then linear and volumetric measurements were performed. The pre- and post-operative root length and volume differences were calculated and compared statistically using independent sample tests and paired t-tests. No statistically significant differences were found in the volume change (%), or reciprocal of mean root length in the erupted and unerupted groups in the canine, first premolar, or second premolar roots except for an association between the post-operative dental root length of the canine and the maxillary canine eruption status. Therefore, assessment of root development from pre-treatment CBCT scans was not deemed worthy from a diagnostic perspective.

Keywords: cleft lip and palate; cone beam computer tomography (CBCT); maxillary canine eruption; secondary alveolar bone graft (SABG).

Figure 1

Root area was sectioned at the level of the CEJ and volumetric measurements (HU) were taken of the maxillary canine and premolar roots on the ipsilateral side with the alveolar cleft. This figure shows the volumetric measurements from a pre-graft CBCT.

Figure 2

The roots of the maxillary canines and premolars on the ipsilateral side of the cleft were measured on pre-operative and post-operative CBCTs. This figure shows the root length measurement of a maxillary canine on a pre-operative CBCT. (a) Pre-operative CBCT of a patient with cleft lip and palate included in our study. (b) The canine and premolars on the ipsilateral side to the cleft were clipped from the CBCT. (c) The canine on the ipsilateral side to the cleft was clipped from the CBCT. (d) The root length viewed in the axial view. (e) The root was sectioned from the crown at the level of the buccal CEJ. (f) The root length was measured. (g,h) The root length measurement of the maxillary canine shown from different views. (i) Clinical photo showing an alveolar cleft.