The role of the orthodontist in the treatment of adolescents with orofacial clefts.
In the orthodontic treatment of patients with clefts the main aim is to maximize the growth and development of the maxillary complex and, at the same time, to improve functional efficiency and facial aesthetics. The commonest malocclusions found in adolescents with lip and palate clefts are: frontal or anterior crossbite; posterior or buccal crossbite which is either unilateral or bilateral; retrusion of the middle third of the face to a greater or a lesser degree; open bite; and finally malformation and displacement of the teeth adjacent to the cleft. Treatment may be divided into: correction of malocclusions in the transverse plane; correction in the antero-posterior plane; vertical corrections; and correction of misplaced individual teeth. Posterior (lateral) crossbite can be corrected by both gradual and rapid (forced) expansion using various removable appliances. Following this, correction of anterior crossbite and restoration of vertical occlusal relationships will be necessary. Finally, misplaced individual teeth will need to be repositioned. Traumatic surgery and consequent scar tissue affects the growth of the maxillary arch and the development of the occlusion. This was demonstrated in a comparative analysis of monozygotic and dizygotic twins discordant for clefts as well as in twin pairs whose clefts were non-identical in type and extent. The adolescents who still have unoperated clefts have special problems.
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D000293:Adolescent; D002971:Cleft Lip / Q000601:surgery; D002972:Cleft Palate / Q000601:surgery; D006801:Humans; D008310:Malocclusion / Q000628:therapy*; D008445:Maxillofacial Development; D014071:Tooth Abnormalities / Q000628:therapy; D014087:Tooth Movement Techniques