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Guagnano et al. Plast Aesthet Res 2020;7:37 Plastic and
DOI: 10.20517/2347-9264.2020.21 Aesthetic Research

Original Article Open Access

Impact of different surgical protocols on dental
development in oro-facial cleft children

Rosa Guagnano , Federica Romano , Ernesto Pepe , Patrizia Defabianis
2
1
3
1
1 Department of Surgical Sciences C.I.R. Dental School - Section of Paediatric Dentistry, University of Turin, Turin 10126, Italy.
2 Department of Sciences C.I.R. Dental School - Section of Periodontology, University of Turin, Turin 10126, Italy.
3 Pediatric Plastic Surgery Division, City of Health and Science, Regina Margherita Children Hospital, Turin 10126, Italy.
Correspondence to: Prof. Patrizia Defabianis, Department of Surgical Sciences C.I.R. Dental School - Section of Paediatric
Dentistry, University of Turin, Via Nizza 230, Turin 10126, Italy. E-mail: patrizia.defabianis@unito.it

How to cite this article: Guagnano R, Romano F, Pepe E, Defabianis P. Impact of different surgical protocols on dental development
in oro-facial cleft children. Plast Aesthet Res 2020;7:37. http://dx.doi.org/10.20517/2347-9264.2020.21
Received: 13 Mar 2020 First Decision: 11 May 2020 Revised: 8 Jun 2020 Accepted: 25 Jun 2020 Published: 19 Jul 2020

Academic Editors: Carroll Ann Trotman, Xu Qian Copy Editor: Cai-Hong Wang Production Editor: Tian Zhang

Abstract
Aim: To determine the association between dental anomalies and type of facial cleft, gender, ethnicity and timing
of hard palate repair surgery.

Methods: This observational study comprised a total of 85 non-syndromic cleft children (mean age 9.7 ± 3.2 years)
of different ethnicity (68 Caucasians, 7 Asians, 4 Africans, 5 Hispanics and 1 Indian). Sixty-four patients were
affected by lip palate cleft, 11 by lip alveolus cleft and 10 by palate cleft. Sixty-one children underwent delayed
palate repair at 4.3 years of age, while 21 underwent early palate periosteoplasty at 7.2 months of age. Patients
were examined clinically and radiologically to assess dental anomalies. Dental cavities were registered using
dmft/DMFT indexes in primary and permanent dentition, while enamel defects were evaluated only in permanent
teeth using Aine index.

Results: Tooth rotation and agenesis were the most common tooth anomalies affecting 59% and 42.2% of cleft
patients, respectively. While a late closure of the cleft palate was associated with a higher number of rotations (P
= 0.03), an early surgical correction was associated to a higher frequency of tooth agenesis (P = 0.02), number of
carious lesions in primary dentition (P = 0.002) and more severe enamel defects in permanent teeth (P < 0.01).
A late palate repair increased 3.5 times the likelihood of having at least one rotated tooth (P = 0.034), while
decreased the odds of having agenesis by 70% (P = 0.029) compared to an early surgical repair.

Conclusion: Early surgical approaches seem to have more detrimental effects on dental development in both
primary and permanent dentition than late surgical protocols. Dental abnormalities in cleft patients have complex
etiology combining genetic and external factors and their prevalence can also depend on timing of hard palate
surgery.
© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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