Comparison of Angulation of Unerupted Maxillary Canines in Unilateral and Bilateral Cleft Lip and Palate Patients

Abdul Ahad; Abdullah Jan; Noor Javed; Maryam Naseem; Kinza Nisar; Kashif  Iqbal

doi:10.51253/pafmj.v76iSUPPL-9.14433

Authors

Abdul Ahad Department of Orthodontics, Armed Forces Institute of Dentistry/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Abdullah Jan Department of Orthodontics, Armed Forces Institute of Dentistry/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Noor Javed Department of Orthodontics, Armed Forces Institute of Dentistry/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Maryam Naseem Department of Operative Dentistry, Foundation University, Islamabad Pakistan
Kinza Nisar Department of Orthodontics, Armed Forces Institute of Dentistry/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Kashif Iqbal Department of Orthodontics, Armed Forces Institute of Dentistry/National University of Medical Sciences (NUMS), Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-9.14433

Keywords:

Cleft Lip Palate, Maxillary Canine, Panoramic Radiograph, Tooth Angulation, Unerupted Canine

Abstract

Objective: To compare the angulation of unerupted maxillary canines in patients with unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP).

Study Design: Comparative cross-sectional study.

Place and Duration of Study: Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from Dec 2025 to Mar 2026.

Methodology: A total of 60 subjects aged 12–18 years with either UCLP or BCLP and unerupted maxillary canines were included through non-probability consecutive sampling. Panoramic radiographs were used to measure the angle between the long axis of unerupted canines and the intercondylar line. Angulation was categorized as mild (0–15°), moderate (15–30°), or severe (>30°). Independent t-test was applied for comparison of mean values, while Chi-square test was used for categorical variables.

Results: The two groups did not differ significantly with respect to age (p=0.28) or gender (p=0.79). Canine angulation differed significantly, with higher mean angulation in BCLP group (30.97°±8.05) compared with UCLP group (17.03°±6.18) (p<0.001). Severe angulation was more common in BCLP patients (n=15, 50%) than UCLP patients (n=1, 3.3%), while mild angulation was more frequent in UCLP (n=14, 46.7%) than BCLP (n=1, 3.3%) (p<0.001). Moderate angulation was noted in similar proportion in both groups (BCLP: 46.7%; UCLP: 50%).

Conclusion: Patients with bilateral cleft lip and palate showed significantly greater angulation of unerupted maxillary canines compared with unilateral cleft cases.

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References

1. Rashid A, Jahangir U, Akram ME, Aamir N, Ansar Z, Akram E, et al. Impact of dental anomalies on function and aesthetics in cleft lip and palate patients. Link Med J 2025; 11: e38-e.

http://doi.org/10.61919/b3cykt10

2. Salari N, Darvishi N, Heydari M, Bokaee S, Darvishi F, Mohammadi M. Global prevalence of cleft palate, cleft lip and cleft palate and lip: A comprehensive systematic review and meta-analysis. J Stomatol Oral Maxillofac Surg 2022; 123(2): 110-120. http://doi.org/10.1016/j.jormas.2021.05.008

3. Rashid A, Akram ME, Noor S, Arshad M, Yasin M, Tahir M, et al. Genetic and developmental insights into dental anomalies in cleft lip and palate. J Med Health Sci Rev. 2025; 2: 5805-17.

http://doi.org/10.62019/3cfk5p93

4. Sanghvi R, Bhujel N. Common dental anomalies affecting patients with cleft lip and palate. Dental Update. 2022; 49(5): 395-401. http://doi.org/10.12968/denu.2022.49.5.395

5. Manfio ASC, Suri S, Dupuis A, Stevens K. Eruption path of permanent maxillary canines after secondary alveolar bone graft in patients with nonsyndromic complete unilateral cleft lip and palate. Am J Orthod Dentofacial Orthop. 2022; 161(5): e416-e428.

http://doi.org/10.1016/j.ajodo.2021.06.019

6. Peralta-Mamani M, López-López J, Honório H-M, Rubira-Bullen I-R-F. CBCT vs panoramic radiography in assessment of impacted upper canine and root resorption of the adjacent teeth: A systematic review and meta-analysis. J Clin Exper Dent. 2024; 16(2): e198. http://doi.org/10.4317/jced.61285

7. Korde SJ, Diagavane P, Kulshrestha R, Umale V, Chandurkar K, Hawaldar C. Radiographic evaluation of position and angulation of impacted maxillary canines in cleft palate cases. Archiv Dent. 2023; 5(1): 1-8.

http://doi.org/10.33696/dentistry.5.023

8. Westerlund A, Sjöström M, Björnström L, Ransjö M. What factors are associated with impacted canines in cleft patients? J Oral Maxillofac Surg. 2014; 72(11): 2109-2114.

http://doi.org/10.1016/j.joms.2014.05.030

9. Hoang E, Sheller B, Greenlee G, Susarla S, Mancl L. Factors contributing to canine impaction in patients with unilateral cleft lip and palate undergoing alveolar bone grafts. J Oral Maxillofac Surg. 2023; 81(10): 1286-94.

http://doi.org/10.1016/j.joms.2023.06.029

10. Rizell S, Alhakim Z, Mark H, Naoumova J. Predictive factors for canine position in patients with unilateral cleft lip and palate. Eur J Orthod. 2021; 43(4): 367-73.

http://doi.org/10.1093/ejo/cjaa034

11. Manor Y, Kaganovich M, Gamliel M, Sadan N, Shmuly T. Factors contributing to complications and failures of impacted canines undergoing surgical orthodontic treatment: a retrospective cohort study. J Clin Med. 2026; 15(4): 1463.

http://doi.org/10.3390/jcm15041463

12. Russell KA, McLeod CE. Canine eruption in patients with complete cleft lip and palate. Cleft Palate Craniofac J. 2008; 45(1): 73-80. http://doi.org/10.1597/07-049.1

13. Alqerban A. Impacted maxillary canine in unilateral cleft lip and palate: a literature review. Saudi Dent J. 2019; 31(1): 84-92.

http://doi.org/10.1016/j.sdentj.2018.11.001

14. Kadi H, Jacobs R, Shujaat S, Lemberger M, Benchimol D, Karsten A, et al. A CBCT based assessment of canine eruption and development following alveolar bone grafting in patients born with unilateral cleft lip and/or palate. Cleft Palate Craniofac J. 2023; 60(4): 386-394.

http://doi.org/10.1177/10556656211064477

15. Paradowska-Stolarz A, Kawala B. Dental anomalies in maxillary incisors and canines among patients with total cleft lip and palate. Appl Sci. 2023; 13(11): 6635.

http://doi.org/10.3390/app13116635

16. Hereman V, Cadenas De Llano-Pérula M, Willems G, Coucke W, Wyatt J, Verdonck A. Associated parameters of canine impaction in patients with unilateral cleft lip and palate after secondary alveolar bone grafting: a retrospective study. Eur J Orthod. 2018; 40(6): 575-582. http://doi.org/10.1093/ejo/cjy011

17. Elhaddaoui R, Bahije L, Zaoui F, Rerhrhaye W. Timing of alveolar bone graft and sequences of canine eruption in cases of cleft lip and palate: a systematic review. L'Orthodontie francaise. 2017; 88(2): 193-198.

http://doi.org/10.1051/orthodfr/2017011

18. Lacerda-Santos R, Batista RG, Neves SS, dos Santos Araújo JL, Vieira RA, de Carvalho FG, et al. Effectiveness of secondary alveolar bone graft on canine eruption: systematic review. Eur J Dent. 2022; 15(03): 5795-87.

http://doi.org/10.1055/s-0041-1723070