Aim: To evaluate the changes in maxillary alveolar morphology in unilateral cleft lip palate infants treated with nasoalveolar molding(NAM). Setting and Design: Study was carried out in the orthodontic department associated with a operating cleft unit in a rural region of central India. Ten UCLP (unilateral cleft lip palate) infants less than 6 weeks of age were treated with NAM prior to surgical repair. Materials and Methods:Pre NAM and Post NAM study models of the UCLP infants were analyzed. Critical linear dimensions including inter- canine width, inter-tuberosity width, arch length and midline deviation were recorded at the different stages using a digital vernier caliper and compared. Statistical analysis were performed using SPSS 13.00 statistical software. Results: Results from this study showed that the width of the alveolar cleft showed a significant decrease with NAM. The arch length and width of the arch in the anterior region also showed a reduction with NAM. The intertuberosity width showed a statistically significant increase during treatment. The arch perimeter showed a significant increase with NAM. Conclusion: NAM was effective in reducing the severity of the initial cleft deformity mainly at the anterior portion of the maxillary arch.

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Background: Various methods have been described for the primary surgical reconstruction of the unilateral cleft lip and palate deformity (UCLP) in infants. There have been several attempts at restoring the normal anatomy of the nose at the time of lip repair in the affected individuals with varying degrees of success. Presurgical nasoalveolar molding (PNAM) is a presurgical infant orthopedic procedure that attempts to target the nasal deformity leading to a more esthetic surgical repair. Objective: At our center we aimed to use PNAM to help in providing the surgical team with a better foundation for an easier and more esthetic single stage repair at the level of nose in addition to the lip and alveolus. Method: The infant nasal cartilages are amenable to correction in the first few weeks of life when they retain their plasticity. Three infants with complete unilateral cleft lip palate (CUCLP) were operated upon after a course of PNAM. No nasal stents were use after repair to retain the results. Results: PNAM reduced the extent of the cleft deformity and improved the anatomic relationship between the affected structures. Postoperative recovery was uneventful. Subjective evaluation immediate post surgery and at the time of palate repair reveals adequate nasolabial esthetics. Long term results of PNAM assisted repair are to be ascertained. Conclusions: The use of PNAM enables in reducing the severity of the deformity the surgical team has to tackle thereby enabling in a better and esthetic primary repair

Management of bilateral cleft lip and palate cases is a challenging task, and if the premaxilla is shifted to either side, it poses a problem for the surgeon to operate and also for the orthodontist to do the orthodontic alignment. The aim of this study was to reposition the shifted premaxilla for better retraction with presurgical infant orthopedics, thus reducing the tissue tension and further scarring which have detrimental effects on maxillary growth. The innovative technique with pre-directional (PD) appliance is easy to fabricate and use and works in this direction. Acrylic, springs, permasoft liner, elastics, retentive tapes. Previous approach for the shifted premaxilla was more focused on the surgical correction. In adults, surgery with osteotomy is the only option, with its own limitations and disadvantages, in repositioning the shifted premaxilla. Thus, PD appliance aids to correct the shifted premaxilla in presurgical molding stage. The premaxilla was thus shifted 5.5 mm to the left side, with premaxilla in facial symmetry, with the PD appliance. Presurgical orthopedics with PD appliance is worth in infants with shifted premaxilla in bilateral clefts cases.

Dr. (Mrs.) PV Ha z are y Prof. c II OD D pI. or Ort ho do nti cs he Hel d Pc1 WcH D en ted Co ll ege cl~ dng i (M ), Wardh a M l harc1 sh trdEstheti c ha always bee n a catchwo rd among patients. W ith mo re numb r of adult pati ents des iring orth odontic treatment , sp cial esth eti demands of these pa ti ents pose a gr at hall eng to th e o rth odo nti c co mmunit y. These patients have professio nal and so ial commitment s and ca nnot accept 'visibl e braces' even fo r a sho rt tim . Even a spec ialty lik o rthodo nti cs w hi ch had traditio nall y given more importance to tr ea tment objecti ves th an anything else had to rethink its app roac h toward s such pati ent s. To be able to serve su h pati nt s, th orthodo ntic communit y ca me out w ith th e ultimate esth etic so luti o n -Li ngual orthodonti c (LO). Lingual o rth odonti s, apart from offerin g th e esthetic benefit, also provide several mec hani al advantages. Si nce its inceptio n in ' 1970s great adva nces have bee n made in this modali ty. AI prese nt , the modality of Lingual o rt hodontics is a complete system in itse lf and enco mpasses a curate di ag nosi , treatm ent proto co l, c lini ca l and labo rato ry pro edures. Thi s article review s th e development and pr se nt status of thi s int erestin g and ex iting orthodo nti c approac h. Lin gual orth odo ntics, lingu al brackets, lingual brac k t pia em nt, lingual bo nd ing, pati ent s' res po ns s

NAM helped reduce the severity of the cleft deformity in the BCLP infant and facilitated an easier and esthetic single stage primary surgical repair.

The resultant displacement in position of center of resistance is negligible; hence, there is no need of changing biomechanics during orthodontic treatment for a tooth with three wall infrabony defects. However, it is necessary to further study other infrabony defects like two wall or one wall defect, and their effect on position of CRes.

The cleft alveolus component of the oral cleft deformity is addressed with a separate surgical stage. Several host and operator related factors affect the surgical outcome. When factors that increase the likelihood of secondary alveolar bone graft failure are identified, alterative methods like dentoalveolar distraction (DAD) may be employed. In infants, molding of the alveolar segments is possible and when a synergistic surgical approach is used, the possibility of successful alveolar cleft repair is increased. The authors present two case reports wherein the use of nasoalveolar molding (NAM) and DAD helped to tackle the alveolar cleft deformity.