Patients with cleft lip and/or palate go through a lifelong journey of multidisciplinary care, starting from before birth and extending until adulthood. Presurgical orthopedic (PSO) treatment is one of the earliest stages of this care plan. In this paper we provide a review of the PSO treatment. This review should help general and specialist dentists to better understand the cleft patient care path and to be able to answer patient queries more efficiently. The objectives of this paper were to review the basic principles of PSO treatment, the various types of techniques used in this therapy, and the protocol followed, and to critically evaluate the advantages and disadvantages of some of these techniques. In conclusion, we believe that PSO treatment, specifically nasoalveolar molding, does help to approximate the segments of the cleft maxilla and does reduce the intersegment space in readiness for the surgical closure of cleft sites. However, what we remain unable to prove equivocally at this point is whether the reduction in the dimensions of the cleft presurgically and the manipulation of the nasal complex benefit our patients in the long term.
In the present report, two techniques of space closure; two-step anterior teeth retraction (TSR) and en masse retraction (ER) were used in two adult patients who had bimaxillary protrusion and were treated with four premolar extractions and fixed orthodontic appliance therapy. Both patients had a Class I dental malocclusion and the same chief complaint, which is protrusive lips. Anterior teeth were retracted by two-step retraction; canine sliding followed by retraction of incisors with T-loop archwire in the first patient and by en masse retraction using Beta titanium alloy T-loop archwire in the second case. At the end of treatment, good balance and harmony of lips was achieved with maintenance of Class I relationships. The outcome of treatment was similar in the two patients with similar anchorage control. ER can be an acceptable alternative to the TSR during space closure since it is esthetically more acceptable. However, it requires accurate bending and positioning of the T-loop.
The aim of this study is to assess the prevalence of parafucntional oral habits including breathing disorder, bruxism, thumb-sucking, clenching and some of the related factors among a group of Saudi dental patients ranging from 6 to 16 years of age. The sample of this study comprised 1032 Saudi children (712 boys and 320 girls) collected from the screening clinic, Faculty of Dentistry, King Abdulaziz University. Standardized questionnaire form, information about the presence or absence of different parafunctional oral habits and the participant's oral health knowledge was obtained. Age, sex and number of siblings were collected. Descriptive statistics, t test and Chi square test were used as appropriate. The prevalence of breathing disorders, bruxism, thumb-sucking and clenching habits were 20.2%. 30.2%, 16.7% and 13.6%, respectively. Bruxism was more prevalent in boys (33.1%) than girls (23.7%), while girls had a significantly higher prevalence of thumb-sucking and clenching (p=0.001). The number of siblings had a significant effect on bruxism and thumb-sucking (p=0.04), but not on breathing disorder (p=0.44) or clenching (p=0.22). Oral health knowledge had insignificant effect on breathing disorders, bruxism, thumb-sucking and clenching (p=0.88, 0.71, 0.28 and 0.31, respectively).
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