Orthodontic Management of Cleft Lip and Palate Patients

Abstract

Patients with a cleft palate and or lip often require complex long-term orthodontic treatment, often in combination with a number of other specialists including maxillofacial surgery in order to produce a good facial appearance, with an esthetic, functional and stable occlusion. This chapter will specifically introduce the role of the orthodontic consultant in the management of the cleft lip and palate patient at multiple stages of their dental development and growth. The orthodontic burden of care for these patients is high and the duration of treatment will depend on the diagnosis and pattern of jaw growth and need for orthognathic surgery.

The Impact of Pre-surgical Orthopedics Appliances (PSOAs) in Bilateral Cleft Lip and Palate (BCLP) Patients

“…26 This appliance was also carried out by consultant orthodontist in treating cleft patients to decompensate the labial segments, align and coordinate the dental arches for a stable occlusal outcome. 27 To date, current active device used is the Presurgical Nasoalveolar Molding (PNAM). 28 The major benefit of this device was to increase the columella skin and the prolabium length prior to surgery, therefore produce adequate skin to reconstruct the central lip length.…”

Comparison of Different Maxillary Advancement Protocols in Patients With Unilateral Cleft Lip and Palate: A Finite Element Analysis

“…Finite element analysis is a computer-aided simulation frequently used especially in engineering and health elds [17]. With these simulations, an in nite number of variables are transformed into a predictable nite number of elements.…”

“…In this way, the data obtained can be converted into predictable results in terms of treatment mechanics [18]. Different methods such as modelling with medical images, anatomical modelling and segmentation have been proposed to obtain the nite element model to be analysed [17]. In the modelling method which is frequently used in medical images, the tissues such as bone and dental structures should be well-separated and their mechanical properties should be wellde ned to the program; because when the effects of the force are examined in the software, the threedimensional image will react according to the mechanical properties and boundary values [17].…”

Multidisciplinary Rehabilitation of an Adult with a Cleft Lip and Palate: An Illustration of a Dental Substitution Approach for the Management of Unilateral Agenesis of Central and Lateral Incisors

“…Notably, there is a plethora of variables to consider when deciding between prosthodontic replacements vs space closure in cases of tooth agenesis. 22,27,28 Some of those variables include the overjet, overbite, canine relationship, dental midlines, tooth shape and color, and the burden of care. 22,27 If the approach is to perform a prosthetic replacement, the space is adjusted accordingly and maintained during active orthodontic treatment with the use of a pontic attached to the archwires.…”