A split-mouth study on periodontal and microbial parameters in children with complete unilateral cleft lip and palate.
BACKGROUND
Complete unilateral cleft lip and palate (UCLP) is a hereditary or multifactorial malformation that can be corrected successfully with a combined orthodontic, surgical and restorative treatment. Such multidisciplinary treatment takes many years and demands a lot of attention to both patients' teeth and periodontium.


OBJECTIVE
This split-mouth study aimed to compare the periodontal health as well as the microbial parameters between cleft and non-cleft region.


METHODS
75 patients (52 males, 23 females) between 8 and 20 years with a complete unilateral cleft lip and palate (before (n = 30), during (n = 34) and after (n = 11) the active orthodontic treatment) volunteered for this study. Four regions were defined for the split-mouth comparison: teeth neighbouring cleft (site 1), tooth in cleft (site 2), and the corresponding contra-lateral teeth, respectively, in the unaffected quadrants (sites 3 and 4). At all sites the following periodontal parameters were recorded: plaque and gingivitis indices, pocket depth, attachment loss, bleeding on probing, tooth mobility (visual and Periotest), radiographic bone loss and gingival width. In addition, three pooled subgingival plaque samples were taken (around tooth in cleft, teeth facing the cleft, and contra-lateral teeth of the latter).


RESULTS
The differences between the teeth neighbouring the cleft and the corresponding contra-lateral opponents were of borderline significance (P <or= 0.05) for the plaque index, the approximal probing depths and the attachment loss (teeth facing the cleft always had slightly higher parameters). When the tooth in the cleft was compared to the contra-lateral tooth, differences were only found for both the approximal probing depths, attachment loss and bone loss, which were significantly higher for the tooth in the cleft. The microbial analysis did not reveal differences between the different sites, neither in the proportion of aerobic and anaerobic bacteria (differences < 0.5 log), nor in the detection frequency of periopathogens.


CONCLUSIONS
These data indicate that the periodontium in UCLP patients can cope well with a long-term orthodontic treatment, even in unfavourable conditions (like absence of attached gingiva and poor oral hygiene).
Quirynen
M
M
Department of Periodontology, Research group for Microbial Adhesion, Catholic University of Leuven, Belgium. Marc.Quirynen@med.kuleuven.ac.be
Dewinter
G
G
Avontroodt
P
P
Heidbüchel
K
K
Verdonck
A
A
Carels
C
C
D000293:Adolescent; D000328:Adult; D016301:Alveolar Bone Loss / Q000000981:diagnostic imaging / Q000209:etiology; D000704:Analysis of Variance; D002648:Child; D002971:Cleft Lip / Q000150:complications* / Q000628:therapy; D002972:Cleft Palate / Q000150:complications* / Q000628:therapy; D003773:Dental Plaque / Q000382:microbiology*; D003774:Dental Plaque Index; D005260:Female; D005500:Follow-Up Studies; D005884:Gingival Hemorrhage / Q000209:etiology; D005889:Gingival Recession / Q000209:etiology; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006801:Humans; D008297:Male; D009971:Orthodontics, Corrective; D017622:Periodontal Attachment Loss / Q000209:etiology; D010510:Periodontal Diseases / Q000209:etiology* / Q000382:microbiology; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000209:etiology / Q000382:microbiology; D011859:Radiography; D018709:Statistics, Nonparametric; D014086:Tooth Mobility / Q000209:etiology