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Methods: 114 cleft lip/palate and cleft palate patients older than 14 years of age were reviewed for demographics, dental anomalies, and Le Fort I advancement at the UCLA Craniofacial Clinic between 2008-2013. Chi square tests, t tests, and multivariate logistic regression analyses were performed to delineate the contribution of quantity and position of dental agenesis to maxillary advancement surgery.
Results: 114 patients were reviewed (mean age 18.9 years, range 14-23). In this cohort, 64.0% were male, 71.9% had some form of dental agenesis, and 59.6% required Le Fort I advancement. The types of clefts were isolated cleft palate (10.5%), unilateral cleft lip and palate (66.7%), and bilateral cleft lip and palate (22.8%). The type and laterality of clefts did not demonstrate any statistically significant correlation to Le Fort I advancement. In patients who did not exhibit dental agenesis, 18.8% required Le Fort I advancement versus 74.4% of patients with dental agenesis (p<0.0001). Requirement for Le Fort I advancement surgery was increased to 76.3% when dental agenesis was specifically at the lateral incisor position (p<0.0001) and 86.4% when patients were missing two or more teeth (p<0.0001). Using standard cephalometric measurements, both SNA and ANB were decreased in patients missing dentition at the lateral incisor position (p=0.003, p=0.04). Adjusting for multiple missing teeth and canine substitution, multivariate logistic regression analyses demonstrated that lateral incisor agenesis is an independent predictor for Le Fort I advancement surgery (OR 4.4, CI 1.42-13.64, p=0.01).
Conclusions: Lateral incisor agenesis correlated to maxillary hypoplasia and independently predicted the need for Le Fort I advancement in cleft patients, potentially as an anatomic readout of intrinsic growth deficiency. We suggest its utility as part of a treatment algorithm for cleft patients.