Deciduous Tooth Dimensions In Cleft Lip and Palate AZIZ ABDULLA, B.D.S.* CYRIL SADOWSKY, B.D.S., M.S. ELLEN A. BEGOLE, Ph.D. Chicago, Illinois 60680
The deciduous teeth of 40 subjects with complete unilateral cleft lip and palate (CUCLP) and 42 noncleft controls were measured. The mesiodistal and faciolingual dimensions of several maxillary teeth in the vicinity of the cleft were smaller than their correspond- ing antimeres. No such differences were apparent in the mandibular arch. In the control sample there were no differences in either maxillary or mandibular arches. The CUCLP group generally demonstrated significantly smaller dimensions for both mesiodistal and faciolingual dimensions for both maxillary and mandibular arches when compared to the control group. These findings lend possible support to the hypothesis that tissue deficiency may be a factor in cleft lip and palate development. Various studies in the literature have the lip and palate and those of the palate demonstrated differences in the size of the alone have a multifactorial etiology (Fraser, jaws and other related facial structures be- 1970). Experimental evidence on chick em- tween cleft and noncleft populations bryos has revealed the important contri- (Bimm et al., 1960; Aduss et al., 1971). bution of neural crest cells in the formation The differences noted have been greater of facial structures (Johnston, 1966). Le- in the midfacial region where the clefting jour (1970) induced clefting in rats by de- occurs, than in the lower face (Ho Kim, stroying mesenchymal tissue at a critical 1958). The cleft population also demon- time during palate development. These strates an increased frequency of disturbed and other studies support the general con- dental morphology (Pruzansky, 1955; cept of mesenchymal tissue deficiency in Dixon, 1968.) The occurrence of agenesis the etiopathogenesis of cleft lip and palate. and supernumerary teeth is reported to be Tonge (1957, 1958, 1963) has demon- higher in cleft populations (Bohn, 1950; strated that a close embryological relation- Jordan et al., 1966). Foster and Lavelle ship exists between developing teeth and (1971) demonstrated that most permanent the palate. Developmentally, cleft lip and teeth are smaller in the cleft population. palate and isolated clefts of the palate are | Embryologists have stated that clefts of regarded as different entities (Patten, 1968; Slavkin, 1979). The cleft of the lip develops earlier (around the 28th day in The authors are affiliated with the Department of Orthodontics, College of Dentistry, University of IIli- utero) and is perhaps therefore more nois at Chicago, Chicago, Illinois 60680. closely related developmentally to tooth Address correspondence to Dr. Cyril Sadowsky, formation than cleft palate which occurs Department of Orthodontics, College of Dentistry, around the ninth week (Sperber, 1976). University of Illinois at Chicago, Health Sciences Cen- ter, P.O. Box 6998, Chicago, Illinois 60680 Tel. (312) Based on the above, it is possible to hy- 996-7505. pothesize that the size of the teeth may to * Submitted as partial fulfillment of the require- some extent reflect the quantity of tissue ments for Orthodontic Certification. present. The purpose of this investigation 301 302 Cleft Palate journal, October 1984, Vol. 21 No. 4
was, therefore, to stddy the size of the measuring technique, seven sets of models deciduous dentition in subjects with com- (four control and three experimental) were plete unilateral cleft lip and palate, testing selected and all teeth were measured on the hypothesis that the size of the teeth two separate occasions by the same exam- vary with the occurrence of the cleft. ner. Using the Student's t-test, no statisti- cally significant difference was found be- Materials and Methods tween the duplicate measurements at the 1% level of confidence. _The sample consisted of 40 sets of dental study models of 20 male and 20 female subjects with complete unilateral cleft lip Findings and palate from available records at the In the cleft group the mean values for Center for Craniofacial Anomalies, Univer- the cleft side were usually less than for the sity of Illinois at Chicago, Health Sciences noncleft side (Table 1). The difference was Center. statistically significant (p<0.01) only for the A control sample consisted of 42 sets of mesiodistal dimension of the maxillary cen- dental study models of noncleft subjects, tral incisor and the maxillary lateral incisor 20 males and 22 females from the longitu- and for the faciolingual dimension of the dinal records of the Child Research Council central incisor and the cuspid. in association with the University of Colo- A comparison of the mandibular decid- rado School of Dental Medicine (Waldo, uous teeth of the cleft and noncleft sides 1936). Duplicate models from that source (based on maxilla), revealed no statistically are available in the Department of Ortho- significant differences between antimeres dontics, College of Dentistry, University of for either mesiodistal or faciolingual di- Illinois at Chicago. mensions (Table 2). All subjects in both groups were Cauca- A comparison of maxillary and mandib- sian. The criteria applied in the selection ular deciduous tooth dimensions for the of the study models were that both maxil- right and left sides in the noncleft control lary and mandibular arches possessed a full group showed no statistically significant dif- complement of deciduous teeth and that ferences in any of the dimensions (Tables there was no apparent loss of tooth sub- 3 and 4). stance due to marked attrition, caries, or The maxillary deciduous tooth dimen- restorations. When more than one set of sions were compared between the complete models existed, the earliest set was utilized. unilateral cleft lip and palate and the non- Though the lateral incisors were present in cleft groups (Table 5). The mean values approximately 75% of the cleft subjects, an were obtained by pooling the left and right accurate measurement was not possible in sides in the noncleft group, and the cleft many of the cases due to their position and and noncleft sides in the complete unilat- partial eruption, which was generally pala- eral cleft lip and palate group. The cleft tal. Supernumerary or obviously mal- group showed significantly smaller meso- formed lateral incisors were not measured. distal dimensions for all teeth (p<0.05), Data were recorded using a dial vernier with the central incisor, cuspid and pri- caliper calibrated to the nearest 0.05 milli- mary first molar being highly significant meter. The variables recorded were the (p<0.01). The cleft group also had signifi- mesiodistal width, defined as the greatest cantly smaller faciolingual dimensions for mesiodistal dimension of the tooth crown, all teeth except the first molar. Differences and the faciolingual width defined as the for the central incisor, lateral incisor and greatest distance between the facial and second molar were highly significant lingual surfaces of the tooth crown. (p<0.01). Similarly, the mandibular me- Student's t-tests were performed to de- siodistal dimensions were significantly termine whether statistically significant dif- smaller (p<0.05) in the complete unilateral ferences existed between and within the cleft lip and palate group as compared to experimental and control groups. the noncleft group (Table 6). When consid- In order to test the reliability of the ering the faciolingual dimension, only the Abdulla et al., DECIDUOUS TOOTH DIMENSIONS 303
TABLE 1. Comparison of Maxillary Deciduous Tooth Dimensibns in Millimeters for the Cleft and Noncleft Sides in Cleft Group ‘
Dimension Tooth N Cleft Side Noncleft Side . Mean SD of T Value Mean S.D. Mean S.D. Difference Difference _-
Central Incisor 35 6.48 0.44 6.57 0.43 0.09 0.12 4,4! ** Lateral Incisor 12 5.22 0.63 5.59 0.53 0.37 0.34 3.74** Mesiodistal Cuspid 40 7.11 0.48 7.06 0.39 -0.05 0.31 -1.05 First Molar 40 7.24 0.49 7.26 0.46 0.02 0:16 0.61 Second Molar 40 9.08 0.52 9.11 0.53 0.03 _ 0.17 1.13 Central Incisor 28 _ 4.60 0.53 4.92 0.47 0.32 0.45 3.82** Lateral Incisor 9 3.88 0.68 4.56 0.37 0.68 0.70 2.90 Faciolingual Cuspid 36 5.80 0.63 6.07 0.45 0.27 0.39 4,22** First _ Molar 40 8.46 0.57 8.48 0.55 0.01 0.35 0.27 Second Molar 39 9.63 0.64 9.49 0.99 -0.14 0.88 -0.97 _-
** statistically significant at p < 0.01
TABLE 2. Comparison of Mandibular Deciduous Tooth Dimensions In Millimeters Between ThéCleft Side and Noncleft Side (Based on Maxilla) In Cleft Group
Cleft side Noncleft Side Dimension Tooth N ft s ft S BMW" SD of T Value"" Mean S.D. Mean S.D. ifference Difference ' -_
Central , Incisor 37 4.28 0.31 4.30 0.26 0.01 0.14 0.55 Lateral Incisor 38 4.81 0.36 4.81 0.36 0.00 0.19 0.08 Mesiodistal Cuspid 40 6.10 0.33 6.14 0.36 0.04 0.16 1.41 _-- First . Molar 39 7.89 0.43 7.89 0.52 -0.00 0.18 -0.09 _ Second ‘ ' > - Molar 37 9.93 0.48 9.92 0.48 -0.01 0.22 -0.40
Central - Incisor 38 3.84 0.40 3.89 0.34 0.05 0.26 1.24 Lateral - Incisor 39 4.27 0.42 4.30 0.36 0.03 0.21 0.77 Faciolingual Cuspid 40 5.56 0.48 5.57 0.47 0.10 -0.18 - 0.34 _- First ' Molar 38 7.25 0.37 7.20 0.42 -0.04 0.24 -1.11 _- Second ' _- Molar 37 8.78 0.49 8.76 0.51 -0.02 0.21 - -0.64
(@*) = not significant p > 0.05
- 304 Cleft Palate Journal, October 1984, Vol. 21 No. 4
TABLE 3. Comparison of Maxillary Deciduous Tooth Dlmensmns In Millimeters of The Right and Left Sides In The Noncleft Control Group
Dimension Tooth N _ Right Side Left Side Mean SD of T Value"" Mean S.D. Mean S.D. Piference Difference
Central Incisor 41 7.09 0.52 7.08 0.49 0.01 0.12 -0.46 Lateral V Incisor 42 5.83 0.35 5.82 0.36 -0.01 0.18 -0.39 Mesiodistal Cuspid 42 7.47 0.40 748 0.42 0.02 0.14 0.87 First Molar 42 7.66 0.50 7.70 0.52 0.05 0.17 1.75 Second . Molar 42 9.33 0.52 9.36 0.71 0.03 0.62 0.36
Central ' Incisor 42 5.34 0.45 5.31 0.50 -0.03 0.16 -1.15 Lateral Incisor 42 4.81 0.55 4.79 0.57 -0.02 0.20 -0.62 Faciolingual Cuspid 42 6.25 0.49 6.22 0.54 -0.02 0.18 -0.88 First l Molar 42 8.65 0.51 8.69 0.52 0.04 0.25 0.97 Second . Molar 42 9.98 0.56 10.01 0.58 0.03 0.25 0.90
(n.s.) = not significant p > 0.05
TABLE 4. Comparision of Mandibular Deciduous Tooth Dimensions In Millimeters of The Right and Left Sides In The Noncleft Control Group
Dimension Tooth N Right Side Left Side BMW" 8.D. C T Value "* Mean S.D. Mean S.D. ifference - Difference
Central Incisor 41 4.56 0.40 4.64 0.54 -0.09 0.41 -1.34 Lateral Incisor 41 5.24 0.42 5.20 0.43 0.04 0.14 1.85 Mesiodistal Cuspid 42 6.53 0.42 6.48 0.42 0.05 0.18 1.60 First Molar 42 8.48 0.45 8.42 0.46 0.05 0.14 2.55 Second Molar 42 10.24 0.47 10.23 0.46 0.00 0.08 0.39
Central Incisor 42 4.09 0.73 4.10 0.74 -0.01 0.16 -0.55 Lateral Incisor 41 4.46 0.28 4,43 0.29 0.03 0.14 1.20 Faciolingual Cuspid 42 5.72 0.47 5.63 0.46 0.10 0.27 2.25 First _ Molar 42 7.74 0.44 7.66 0.44 0.08 0.35 1.50 Second Molar 42 9.29 - 0.50 9.24 0.46 0.05 0.24 1.32
(@*) = not significant p > 0.05 Abdulla et al., DECIDUOUS TOOTH DIMENSIONS 305
TABLE 5. Comparison of Maxillary Deciduous Tooth Dimensions In Millimeters In The Cleft and Noncleft Groups . ‘ |
Dimension Tooth M M Mean T Value Mean 8.D. Mean S.D. Difference
Central . , Incisor 6.53 0.43 7.08 0.49 0.55 5.21 ** Lateral Incisor 5.40 0.56 5.82 0.35 0.42 2.46* Mesiodistal Cuspid 7.08 0.41 7.48 0.40 0.40 4,39** First Molar 7.25 0.47 7.68 0.50 0.43 4.03 ** Second Molar 9.09 0.52 9.35 0.54 0.26 2.17*
Central Incisor 4.76 0.45 5.33 0.47 0.57 5.07** Lateral Incisor 4,22 0.42 4.80 0.55 0.58 3.57** Faciolingual Cuspid 5.94 0.51 6.24 0.51 0.30 2.60* First Molar 8.47 -0.53 8.67 0.50 0.20 1.78 Second Molar 9.56 0.71 9.99 0.55 0.43 3.03**
* statistically significant at p < 0.05 ** statistically significant at p < 0.01
TABLE 6. Comparison of Mandibular Deciduous Tooth Dimensions In Millimeters In The Cleft and Noncleft Groups
' Cleft Group Control Group Dimension Tooth T Value Mean S.D. Mean S. D.
Central Incisor 4,29 0.28 4.60 0.43 3.81 ** Lateral ' Incisor 4.81 0.34 5.22 0.42 4.8] ** Mesiodistal Cuspid 6.12 0.37 6.51 0.41 4.69* First Molar 7.89 0.49 8.45 0.44 5.32* Second Molar 9.92 0.47 10.24 0.47 2.95%
Central Incisor 3.87 0.35 4.10 0.73 1.81 Lateral Incisor 4.28 0.38 4.44 0.28 2.17 Faciolingual Cuspid 5.56 0.46 5.68 0.45 1.15 Fist Molar 7.22 0.37 7.70 0.40 5.44* Second Molar 8.77 0.49 9.26 0.47 4.55%
* statistically significant at p < 0.05 *# c: statistically significant at p < 0.01 306 - Cleft Palate Journal, October 1984, Vol. 21 No. 4 first and second molar showed statistically incisor. In the present study the maxillary smaller dimensions (p<0.05) in the cleft lateral incisor did not show a statistically group. significant difference between the cleft and noncleft sides, possibly due to the small Discussion number of teeth that were measurable. So- In this study an attempt was made to faer in his study suggested that major local control some of the factors that may influ- disturbances related to the formation of ence tooth dimensions. The subjects in the cleft may lead to a generally high level both the experimental and control groups of developmental instability, which in turn were Caucasian, because it has been re- may lead to a difference in tooth size be- ported that racial factors may affect tooth tween the cleft and noncleft sides. dimensions (Moorrees, 1957) Both groups When the cleft and control groups were had approximately the same sex distribu- compared the mesiodistal and faciolingual tion and were almost equally divided be- dimensions of antimeric teeth in the max- tween males and females. Because sexual illary and mandibular arches were gener- dimorphism in the deciduous dentition has ally smaller in the cleft group (Tables 5 and been reported in the literature to be mini- 6). These findings are in agreement with mal or nonexistent, this was not thought to those of Foster and Lavelle (1971) who be important with regard to the present reported measurements on permanent study (Garn et al., 1964, Margetts et al., teeth. They suggested that the factors re- 1978). The inability to control genetic in- sponsible for producing the cleft may have fluences and prenatal, maternal and gesta- an adverse effect on dental development. tional factors (Horowitz et al., 1958; Garn Olin (1964) in his study on dental anoma- et al., 1965, 1979, 1980; Moorrees and lies in cleft lip and palate patients theorized Reed, 1964, and Townsend and Brown, that "an overall insufficiency of certain tis- 1978) must be kept in mind when inter- sue" existed in addition to the possible dam- preting the findings. age to dental tooth germs during surgical This study found that in the noncleft repair of the cleft defect. The latter expla- control sample the mesiodistal and facio- nation seems to be rather questionable in lingual dimensions of the teeth were not the present study as the crowns of the pri- significantly different between the two mary teeth were fully calcified at the time sides in either maxillary or mandibular of surgical repair of the cleft. The defi- arches (Tables 3 and 4). These findings are ciency of "certain tissue" offers an attrac- consistent with those of Barrett et al. tive explanation as it lends some support to (1963a, 1963b, 1964) who found that de- the embryologists' hypothesis that there ciduous antimeric teeth in Australian abo- may be some deficiency of tissue at the time rigines were not statistically different from of jaw and/or tooth development in cleft each other. Ballard's (1944) results also palate subjects (Ross and Johnston, 1972). showed that antimeric teeth were not the It is assumed that this tissue deficiency di- same width, but these were not statistically rectly reflects the size of teeth after erup- analyzed, therefore no definitive conclu- tion. The present study lends some support sions could be drawn. to the tissue deficiency hypothesis. In the present study, however, some of The effect of the presence of unerupted the mesiodistal and faciolingual dimensions supernumerary deciduous teeth or congen- on the maxillary cleft side were signifi- itally absent deciduous teeth on the tissue cantly smaller than those of their antimeres deficiency hypothesis was not evaluated in on the noncleft side (Table 1). The man- this study. Future studies of radiographic dibular dimensions were not significantly records could prove useful in that regard. different. These findings are in agreement References with the findings of Sofaer (1970), who also ApUss, H., PRUZANSKY, S. and MILLER, M.: Interor- reported tooth size asymmetry in the cleft bital distance in cleft lip and palate. Teratology, Vol. group. In that study, tooth size asymmetry 4.2: 771-781, 1971. was most marked for the maxillary lateral BALLARD, M. L.: Asymmetry in tooth size: A factor in Abdulla et al., DECIDUOUS TOOTH DIMENSIONS 307 the etiology diagnosis and treatment of malocclu- Am. J. Orthod., 44: 391-392, 1958. e sion. Angle Orthod., 14: 67-70, 1944. JonnsTON, M. C.; A radioautographic study of the BARRETT, M. J., BRoOwN, T. and MACDONALD, M. R.: migration and fate of cranial neural crest cells in Dental observations on the Australian aborigines: the chick embryo. Anat. Rec., 56: 143-156, 1966. Mesiodistal crown diameter of permanent teeth. JORDAN, R. E., KRAUSE, B. S. and NEPTUNE, C. M.: Austr. Dent. J., 8: 150-155. 19682. 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