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Page 6 of 10 Guagnano et al. Plast Aesthet Res 2020;7:37 I http://dx.doi.org/10.20517/2347-9264.2020.21

Table 3. Enamel defects on permanent teeth (Aine index) by gender, ethnicity types of cleft, and surgical protocols (mean ± SD)
Aine
Variables
0 1 2 3
Gender
Male (n = 42) 14.0 ± 7.0 0.4 ± 1.1 0.1 ± 0.4 0.1 ± 0.2
Female (n = 23) 13.3 ± 8.5 1.1 ± 2.8 0.5 ± 0.9 0.1 ± 0.4
Ethnicity
Caucasian (n = 53) 14.7 ± 7.8* 0.7 ± 1.7 0.3 ± 0.6 0.1 ± 0.2
Asian (n = 5) 4.2 ± 1.8 0.4 ± 0.9 0.2 ± 0.5 0.0 ± 0.0
Hispanic (n = 3) 13.0 ± 7.8 0.0 ± 0.0 0.3 ± 0.6 1.0 ± 0.9
Indian (n = 1) 10.0 0.0 0.0 0.0
African (n = 3) 10.3 ± 10.1 5.0 ± 8.7 2.3 ± 2.1 0.0 ± 0.0
Cleft type
CLP (n = 50) 14.0 ± 8.3 1.0 ± 0.7* 0.4 ± 0.8 0.1 ± 0.4
CP (n =5) 9.6 ±1.8 0.0 ± 0.0 0.0 ± 0.0 0.0 ± 0.0
CLA (n =10) 13.3 ± 8.2 0.2 ± 0.4 0.4 ± 0.7 0.1 ± 0.3
Surgical protocol
EPP (n = 16) 15.3 ± 7.9** 1.0 ± 2.7 0.5 ± 0.9** 0.0 ± 0.2
DPR (n = 49) 8.1 ± 5.8 0.2 ± 0.6 0.1 ± 0.4 0.2 ± 0.6
Values with superscript asterisks show statistically significant difference between groups: *P < 0.05; CLP: lip palate cleft; CP: palate cleft;
CLA: lip alveolar cleft; EPP: early palate periosteal plastic; DPR: delayed palate plastic

Tooth impaction was observed in seven subjects (8.4%), involving one tooth in five subjects (6%) and two
teeth in two subjects (2.4%). The upper central incisors (3.7%) and canines (1.8%) were the most frequently
impacted teeth. A minority of subjects (7.2%) presented with ectopic eruption of permanent molars, with
two teeth erupted ectopically in only one case.

Morphological abnormalities of dental crowns were detected in 17 subjects (20.5%) affecting one (15.6%) or
two teeth (4.8%) and were observed more frequently in B-CLP subjects (42.9%) (P = 0.001). Twelve patients
(14.5%) exhibited microdontic upper lateral incisors and five patients (6.0%) the fusion of two deciduous
teeth (lower lateral incisor with canine 4.7% and upper central incisors together 1.2%). No primary fused
teeth were found in children younger than 6 years of age.

Logistic analysis adjusted for gender, age, ethnicity and cleft type showed a significant association between
timing of palate surgery, tooth rotation and agenesis. DPR children exhibited a 3.5-fold higher likelihood
of having at least one rotated tooth than EPP children (OR = 3.50, 95%CI: 1.10-11.13, P = 0.034) but lower
likelihood of having at least one agenesis tooth (OR = 0.26, 95%CI: 0.08-0.87, P = 0.029).

As summarised in Table 3, in total 984 permanent teeth were also examined in 65 patients for enamel
defects: 13 patients (20%) showed opacities and discolorations (Aine 1), 15 (23%) mild (Aine 2) and 4 (6%)
evident structural defects (Aine 3). No Aine 4 defects were found. As described in Table 3, CLP subjects
showed higher mean number of enamel defects (Aine 1) compared to CLA and CP subjects (P = 0.012).
More severe enamel defects (Aine 3) were also observed in patients submitted to EPP compared to those
who underwent DPR (P <0.01). The upper central and lateral incisors were the most frequently involved
teeth [Table 1].

Table 4 summarises data on caries experience in both primary and permanent dentition. The mean dmft
index was higher in EPP subjects compared to DPR subjects (P = 0.002), while no statistically significant
differences were observed among males and females, ethnic groups and cleft types. In addition, no
statistically significant differences were observed for DMTF index scores.

DISCUSSION
A recent systematic review on frequency of dental anomalies in cleft patients emphasised that data in the
literature are difficult to compare because of the heterogeneity in terms of surgical cleft closure techniques,