Objective: This study aimed to assess the scientific evidence on the efficiency of presurgical infant orthopedic appliances in patients with cleft lip and palate to shed light on a specific, contemporary discussion of whether the appliances have long-term advantages with respect to treatment outcomes.Design: A systematic review. Methods: Two literature surveys from the five electronic databases were performed with a 1-month interval. Randomized controlled trials and controlled clinical trials (controls had no presurgical infant orthopedics) that had followup periods of a minimum of 6 years were included in the study. The exceptions to the follow-up limit were studies related to feeding and parent satisfaction.Results: Of the 319 articles retrieved in the literature surveys, 12 were qualified for the final analysis. The level of evidence of these articles ranged from 1b to 4. Eight randomized controlled trials and four controlled clinical trials were available on eight treatment outcomes. The longest follow-up period of the randomized controlled trials was 6 years. No randomized controlled trials were found on active presurgical infant orthopedic appliances and on nasoalveolar molding appliances.Conclusions: Based on the results, presurgical infant orthopedic appliances have no long-term positive effects on seven of the eight studied treatment outcomes in patients with cleft lip and palate. More randomized controlled trials need to be done to have evidence regarding the effects of presurgical infant orthopedics in different surgical protocols. Also, the encouraging results about the effect of nasolaveolar molding appliances on nasal symmetry have to be supported by future randomized controlled trials.

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Objective: To evaluate the relative effects of Class II elastics applied directly with utility arches (UAs) or with the Reciprocal Mini-Chin Cup (RMCC) appliance. Materials and Methods: Thirty patients with Class II division 1 malocclusion were included. Fifteen of them were treated with the RMCC appliance and the other 15 treated with Class II elastics on UAs. Lateral cephalograms of an additional 15 untreated persons having the same characteristics as the treatment groups were used as a control group. Results: The mean control period was 10 months. Class I molar and canine relationships were achieved in a mean treatment time of 4.6 months with the RMCC appliance and in 8.5 months with the elastics on UAs. The amount of overjet reduction was 4.7 mm in the RMCC group (87.87% dental) and 5.2 mm in the UA group (80.76% dental). The molar correction was 4.5 mm in the RMCC group (87.36% dental) and 2.0 mm in the UA group (51.47% dental). The anterior lower facial height increased in both of the treatment groups. Conclusions:The RMCC appliance is a valuable alternative for Class II elastic use in Class II cases in which the upper molars need to be moved to the distal more than the upper incisors.

Lower incisors moved forward and Incisor Mandibular Plane Angle (IMPA°) increased in both treatment groups. Statistically significant differences between the groups were found when comparing pre-treatment and post-treatment arch dimension and position of mandibular molars. Results were better for lingual arches with extraction on one side than with extraction on both sides Conclusions: A lingual arch seems to be an effective tool for maintaining arch length, and was not found to impair mandibular growth.

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Alveolar bone grafting is an essential step in the overall management of patients with cleft lip and palate (CLP). The numerous advantages of this procedure have been reported in the literature. Failure to rehabilitate the alveolar cleft may give rise to a variety of problems. Lack of investing alveolar bone often precludes the correction of anterior tooth irregularities and limits orthodontic treatment and/or prosthodontic rehabilitation. The success of the graft is multifactorial. The periodontal health of the surrounding graft tissues, the experience and ability of the surgeon, the timing of surgery, and orthodontic management of the cleft area before and after grafting are shown to be the most important factors in this issue. In this chapter, current orthodontic approaches in relation with alveolar bone grafting (ABG) in cleft patients will be discussed.