Impact of Space Opening for Prosthetic Replacement of Missing Maxillary Lateral Incisors on Alveolar Bone, Soft Tissue, and Airway in Cleft Lip and Palate Patients: A CBCT Study

This is a retrospective study for adolescents and young adults with cleft lip and palate and subsequent missing maxillary lateral incisors. Our aim is to compare several variables: alveolar bone height, width, density, and volume, soft tissue linear measurements and airway volume in these patients whose missing laterals were treated either with canine substitution or space opening for prosthetic replacement of the missing tooth. We also recorded the occurrence of tertiary bone grafting in the cleft site. After our inclusion and exclusion criteria, 21 patients receiving orthognathic surgery or implant placement at the University of Nebraska Medical Center were evaluated. Alveolar bone measurements were made on InVivo 5.0. Soft tissue and airway measurements were made on Dolphin software. There was no significant difference between the canine substitution and space opening groups when comparing airway volume and linear soft tissue measurements. There is, however, a significant difference with increased alveolar bone volume (p=0.0082) and width (p=0.0209) in the canine substitution group. Significantly more patients in the space opening group needed tertiary bone grafting (p=0.0075). Provided the esthetic and periodontal benefits of canine substitution mentioned in previous studies(Gibson, 2023; Oosterkamp et al., 2010), patients should not be concerned with a difference in airway or soft tissue if this treatment is chosen. However, the results of this study may not represent clinical outcomes and larger sample sizes may be helpful to conclude clinically significant differences between our variables.