Gingival recession in maxillary canines and central incisors of individuals with clefts Ana Lúcia Pompéia Fraga de Almeida, DDS, MSc, PhD, a Michyele Cristhiane Sbrana, DDS, b Luis Augusto Esper, DDS, b Sebastião Luiz Aguiar Greghi, DDS, MSc, PhD, c and Paulo César Rodrigues Conti, DDS, MSc, PhD, d Bauru, Brazil UNIVERSITY OF SÃO PAULO Background. Mucogingival alterations are inherent to clefts and may be worsened by the several plastic surgeries required in these individuals. Objective. The aim of this study was to evaluate the prevalence, severity, and some possible etiologic factors of gingival recessions in teeth adjacent to the cleft. Study design. A total of 641 teeth (maxillary canines and central incisors) of 193 individuals with cleft lip and/or palate were examined. A generalized linear model was used, and the Wilcoxon test was used to compare the recession with cleft types. Results. Comparison among cleft types as to the presence of recession revealed a statistically significant positive relationship for the maxillary right and left central incisors only in the group with left cleft lip, alveolus, and palate (P = .034). The most frequently affected tooth was the right maxillary canine (26.16%). Conclusion. The prevalence of recession in teeth close to the cleft was higher, although it was not very severe. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:37-45) Cleft lip and palate are the third or fourth most frequent congenital defects and occur due to lack of fusion between the embryonic facial processes. In the town of Bauru, Brazil, Nagem Filho et al. (1968) 1 found a prevalence of 1 in 650 individuals with this anomaly. Patients with cleft lip and palate receive multidisci- plinary treatment; their rehabilitation is initiated at 3 months of age and is continued until adulthood. The surgical protocol of the Hospital for Rehabilitation of Craniofacial Anomalies (HRAC) consists of carrying out primary surgeries (cheiloplasty and palatoplasty) during the first months of life, followed by a new evaluation at the age of 6 years to verify the need of secondary surgeries. 2 The bone graft in the cleft area, for which the donor area is the iliac crest, belongs to the protocol of treat- ment of individuals with clefts that affect the alveolar ridge. Ideally it is performed before the eruption of permanent canines, being called secondary alveolar bone graft. When the patient seeks treatment in adult- hood, it usually ends up being rehabilitated with pros- thesis. As a consequence of these surgeries, the formation of numerous scars and fibrous tissue in the anterior region may cause some sequelae, such as orofacial growth alterations, 3 shallow vestibule with lack of attached gingiva, and mobility of gingival margin. 4 The main oral manifestations at the cleft area are dental alterations of number, shape, structure, and po- sition. The maxillary lateral incisor is the tooth most frequently affected. 5 Mucogingival alterations are also inherent to the cleft, represented by the presence of a shallow vestibule that may be worsened by the several plastic surgeries required in these subjects, reduced marginal bone height, narrow width of keratinized gin- giva and frequently gingival recession of teeth adjacent to the cleft. 2 Gingival recessions are characterized by apical po- sitioning of the gingival margin in relation to the ce- mentoenamel junction, with consequent exposure of root surface to the oral environment. The main clinical implications are unpleasant esthetics and in some cases tooth sensitivity and/or root caries. 6 The treatment protocol of cleft lip and palate defends the accomplishment of secondary bone graft in the cleft area to allow tooth eruption into the area, stabilize and increase the bone support for tooth and cleft area, a Professor, Prosthodontics, Bauru Dental School, University of São Paulo (FOB/USP); Periodontist, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Bauru, São Paulo, Brazil. b Student, Training Course in Periodontics, Hospital for Rehabilitation of Craniofacial Anomalies. c Professor, Periodontics, Bauru Dental School. d Professor, Prosthodontics, Bauru Dental School. Received for publication Jul 11, 2008; returned for revision Aug 6, 2009; accepted for publication Aug 11, 2009. 1079-2104/$ - see front matter © 2010 Published by Mosby, Inc. doi:10.1016/j.tripleo.2009.08.020 37