Cone beam computed tomography evaluation of maxillary central incisor abnormalities in cleft lip and palate patients

Abstract

Objectives: This study aimed to investigate tooth structural abnormalities, including the enamel thickness, enamel density, dentine thickness, and mesiodistal width in maxillary central incisors in patients with cleft lip and palate (CLP). Methods: A retrospective record review was conducted at CMH-Lahore Medical College and Institute of Dentistry. Eighty-four nonsyndromic CLP patients (41 unilateral CLP (UCLP) and 43 bilateral CLP (BCLP)) and 39 controls were included. Cone beam computed tomography images were used to measure mesial enamel thickness, distal enamel thickness, dentine thickness, and mesiodistal width perpendicular to the long axis of the tooth. Two-way analysis of variance with interaction effects was conducted to determine whether gender influenced the teeth measurements in addition to the cleft. Results: In central incisors, enamel thickness, enamel density, and mesiodistal width were significantly smaller in the CLP group compared with the non-cleft group (p < 0.05), but no significant difference was found in dentine thickness (p > 0.05). Total enamel thickness was 1.94 0.32 mm in the non-cleft group, 1.52 +- 0.25 mm in UCLP, and 1.32 +- 0.34 mm in BCLP. Mesiodistal width measured 8.44 +- 0.54 mm in the non-cleft group, 7.65 +- 0.63 mm in UCLP, and 7.48 +- 0.87 mm in BCLP, with a significant difference between the non-cleft group and BCLP (p < 0.05). A similar trend was observed for enamel density. Gender and cleft type exhibited substantial interaction effects for all measures (p < 0.05), except for mesiodistal width in the left central incisor, which was not significant (p > 0.05). Conclusions: Maxillary central incisors were smaller in CLP patients, with significantly reduced enamel thickness and density, but dentine was largely unaffected. This study provides evidence that cleft conditions affect enamel more significantly than dentine. Hence, it is suggested that clinicians should adopt a conservative approach and use appropriate resin bonding materials to minimise enamel damage during restoration and orthodontic treatment.