Reconstruction of Premaxilla With Alveolar Distraction Osteogenesis in a Patient With Complete Cleft Lip and Palate: A Case Report

Abstract

This case report presents an early clinical evaluation of a patient with bilateral cleft lip and palate (CLP) treated with ArchWise Distraction Osteogenesis Technique and Appliance. A 16-year-old patient with a bilateral CLP had a chief complaint of missing upper anterior teeth and poor aesthetics. The patient had class III skeletal and dental relationships, maxillary hypoplasia, maxillary posterior arch constriction, premaxillary deficiency, multiple missing teeth due to an alveolar cleft, and a concave profile. Treatment plan consisted of maxillary expansion with quad helix appliance, leveling and aligning of the arches with fixed orthodontic appliances, and archwise distraction osteogenesis. Osteotomies were performed to mobilize the posterior segments. Activation of the distractors was continued until the lateral segments had contacted each other, and then sagittal distraction was performed in order to correct the sagittal discrepancy. Patient was referred to the oral surgeon and prosthodontist for the final restorations. A very large gap was successfully repaired using this protocol while maintaining the ideal arch form and generating new bone behind the distracted segments.

Aesthetic Concepts and Interdisciplinary Approach in a Patient With Bilateral Cleft Lip and Palate and Missing Premaxilla: A Case Report

“…Treatment options include the use of telescopic crowns cemented to natural teeth in case of removable partial dentures (Kurtulmus et al, 2007;Acharya and Brecht, 2014) and overdentures, to camouflage large defects with major bone and soft tissue deficiencies (Abreu et al, 2015). A more recently published technique is the interdental alveolar distraction to correct large cleft defects, reducing the cleft area and making possible the final restoration without the risk of bone grafting large alveolar deformities (Liou et al, 2000;Shahab et al, 2019). Implant-supported fixed prosthesis (Van Nhan, 2018) and conventional fixed dental prosthesis are also considered good options for these types of patients depending the severity of the case (Bidra, 2012).…”

“…Soft tissue coverage of a graft is essential to improve the chance of success of the procedure, and tissue deficiency creates a high risk of infection (Witsenburg, 1985). Any surgical intervention usually must be combined with presurgical orthodontic treatment, and in many cases, final prosthodontic rehabilitation is necessary to assure the best functional and aesthetic results (Levy-Bercowski et al, 2011;Bidra, 2012;Abreu et al, 2015;Shahab et al, 2019).…”

Reconstruction of Oronasal Fistula with Tongue Flap: A Cleft Palate Report

“…As an alternative to bone graft surgery, the osteogenic distraction technique can be used to improve alveolar bone. This procedure facilitates mucous coverage and new bone formation, reducing the size of the cleft palate [ 13 ]. The osteogenic distraction protocol offers several advantages, one of them is the lack of need for a second intervention site since there is no graft, this technique also allows for an expansion of the dental arch, making it suitable for crowding cases whilst simultaneously improving the morphology of the nasal septum and maxilla.…”

Multidisciplinary action in a patient with cleft lip and palate: esthetic-functional dentofacial treatment for more than two decades

“…Orthodontic intervention is performed at different multidisciplinary treatment stages; a pre-surgical orthodontic approach is required in the early stages [9][10][11], and then the postsurgical orthodontic treatment is continued. At this point, it can be determined whether the patient's malocclusion can be treated with conventional orthodontic treatment, or whether another orthognathic procedure such as maxillary advancement will be necessary [1].…”