Cleft lip and palate is the most common among craniofacial malformations and causes
several esthetic and functional implications that require rehabilitation. This paper
aims to generally describe the several aspects related to this complex pathology and
the treatment protocol used by the Hospital for Rehabilitation of Craniofacial
Anomalies, University of São Paulo (HRAC-USP) along 40 years of experience in the
treatment of individuals with cleft lip and palate.
The aim of this article is to present the pediatric dentistry and orthodontic
treatment protocol of rehabilitation of cleft lip and palate patients performed at
the Hospital for Rehabilitation of Craniofacial Anomalies - University of São Paulo
(HRAC-USP). Pediatric dentistry provides oral health information and should be able
to follow the child with cleft lip and palate since the first months of life until
establishment of the mixed dentition, craniofacial growth and dentition development.
Orthodontic intervention starts in the mixed dentition, at 8-9 years of age, for
preparing the maxillary arch for secondary bone graft procedure (SBGP). At this
stage, rapid maxillary expansion is performed and a fixed palatal retainer is
delivered before SBGP. When the permanent dentition is completed, comprehensive
orthodontic treatment is initiated aiming tooth alignment and space closure.
Maxillary permanent canines are commonly moved mesially in order to substitute absent
maxillary lateral incisors. Patients with complete cleft lip and palate and poor
midface growth will require orthognatic surgery for reaching adequate anteroposterior
interarch relationship and good facial esthetics.
This paper presents the treatment protocol of maxillofacial surgery in the
rehabilitation process of cleft lip and palate patients adopted at HRAC-USP.
Maxillofacial surgeons are responsible for the accomplishment of two main procedures,
alveolar bone graft surgery and orthognathic surgery. The primary objective of
alveolar bone graft is to provide bone tissue for the cleft site and then allow
orthodontic movements for the establishment of an an adequate occlusion. When
performed before the eruption of the maxillary permanent canine, it presents high
rates of success. Orthognathic surgery aims at correcting maxillomandibular
discrepancies, especially anteroposterior maxillary deficiencies, commonly observed
in cleft lip and palate patients, for the achievement of a functional occlusion
combined with a balanced face.
Gingival recessions are caused by many etiologic factors, which usually act in combination. Thus, all factors causing recession should be analyzed so that planning and treatment of this clinical condition may be established, for achievement of optimal outcomes.
Even though the present results suggest that peri-implant health can be observed in areas with keratinized mucosa width under 2 mm provided an adequate oral hygiene control is performed, longitudinal randomized studies are necessary to analyze the relationship between the width of keratinized mucosa and the health of peri-implant tissues.
The repair of bone defects raises the interest of investigators in several health specialties. Grafting techniques with bone substitutes and laser therapies have been investigated to replace autogenous bone and accelerate the bone healing process.ObjectiveTo evaluate the effect of photobiomodulation therapy (PBMT) associated with guided bone regeneration (GBR) in critical size defects.Material and MethodsThe study was conducted on 80 male rats (Rattus norvegicus albinus, Wistar) submitted to surgical creation of a critical size defect on the calvaria, divided into eight study groups: group C (control - only blood clot); group M (collagen membrane); group PBMT (photobiomodulation therapy); group AB (autogenous bone); group AB+PBMT; group AB+M; group PBMT+M; group AB+PBMT+M. The animals were killed 30 days postoperatively. After tissue processing, bone regeneration was evaluated by histomorphometric analysis and statistical analyses were performed (Tukey test, p<0.05).ResultsAll groups had greater area of newly formed bone compared to group C (9.96±4.49%). The group PBMT+M (achieved the greater quantity of new bone (64.09±7.62%), followed by groups PBMT (47.67±8.66%), M (47.43±15.73%), AB+PBMT (39.15±16.72%) and AB+PBMT+M (35.82±7.68%). After group C, the groups AB (25.10±16.59%) and AB+M (22.72±13.83%) had the smallest quantities of newly formed bone. The area of remaining particles did not have statistically significant difference between groups AB+M (14.93±8.92%) and AB+PBMT+M (14.76±6.58%).ConclusionThe PBMT utilization may be effective for bone repair, when associated with bone regeneration techniques.
Hypodontia is the congenital absence of one or more teeth and may affect permanent
teeth. Several options are indicated to treat hypodontia, including the maintenance
of primary teeth or space redistribution for restorative treatment with partial
adhesive bridges, tooth transplantation, and implants. However, a multidisciplinary
approach is the most important requirement for the ideal treatment of hypodontia.
This paper describes a multidisciplinary treatment plan for congenitally missing
permanent mandibular second premolars involving orthodontics, implantology and
prosthodontic specialties.
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