Abstract
Objective
To determine the prevalence of maxillary third molars developing inferior to the second molars in patients with cleft lip and palate (CLP) and to describe associated clinical and radiographic characteristics.
Design
This retrospective chart review assessed maxillary third molar position using cone-beam computed tomography (CBCT).
Setting
Tertiary cleft and craniofacial center within an academic institution.
Patients/Participants
Patients aged ≥7 years with CLP who underwent CBCT imaging between 2019 and 2025. A total of 104 patients met inclusion criteria (79 unilateral cleft lip and palate (UCLP), 25 bilateral cleft lip and palate (BCLP)).
Interventions
No experimental interventions were performed.
Main Outcome Measure(s)
Prevalence of maxillary third molars positioned inferior to the second molars, defined radiographically by crown position relative to the adjacent second molar. Secondary measures included developmental stage, visibility on 2-dimensional (2D) versus 3-dimensional (3D) imaging, and associated second molar eruption disturbances.
Results
Ectopic third molars were identified in 4 of 104 patients (3.8%), occurring in 3 UCLP and 1 BCLP patient. All ectopic teeth were in early developmental stages (Demirjian A-C), were poorly visible on 2D panoramic reconstructions, and were associated with delayed or failed eruption of the second molar.
Conclusions
Inferior positioning of maxillary third molars is an uncommon but clinically significant eruption disturbance in CLP. When CBCT imaging is obtained for clinical indications in patients with CLP, careful 3D assessment of third molar position may facilitate early identification of ectopic development and help prevent second molar impaction. Further study is needed to optimize timing and indications for early surgical removal.
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