Potential and limits of achieving neutral occlusion in patients with clefts of lip, alveolus and palate.
BACKGROUND
Therapy of cleft patients aims to control bone growth and tooth development so as to ensure a secure occlusion with good function. This paper aims to uncover the potential and limits of achieving neutral occlusion in patients with clefts of lip, alveolus and palate. Two treatment approaches are presented and compared with respect to the best long-term results.


METHODS
The first method implies occlusal rehabilitation using maximum intermaxillary orthodontic fixation with the Jasper Jumper. Thus, orthodontic dental-alveolar compensation of the anomaly is obtained. The second method represents orthognathic surgery to achieve ideal intermaxillary relations and a neutral occlusion. Two patients are described - one each for both treatment regimens.


CONCLUSIONS
The methods presented are meant to illustrate possible options for sagittal jaw development/movement in patient management. Orthodontic treatment has to rely on cooperation with maxillofacial surgery to achieve a neutral occlusion. Optimal management is ensured by a combination of both orthodontic and maxillofacial therapy. The orthodontic and surgical techniques for managing unilateral or bilateral clefts are continuously being further developed.


CONCLUSIONS
Although orthodontic treatment can achieve good neutral occlusion in some patients, there are limitations and surgical measures may become necessary.
Gedrange
Tomas
T
Department of Orthodontics, Preventive and Pediatric Dentistry, E.-M.-Arndt University, Greifswald, Germany. gedrange@uni-greifswald.de
Krey
Karl-Friedrich
KF
Hierl
Thomas
T
Proff
Peter
P
Dannhauer
Karl-Heinz
KH
Hemprich
Alexander
A
D000293:Adolescent; D000539:Alveolar Process / Q000002:abnormalities / Q000601:surgery*; D002648:Child; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000000981:diagnostic imaging / Q000601:surgery*; D003768:Dental Occlusion, Centric; D006801:Humans; D008310:Malocclusion / Q000000981:diagnostic imaging / Q000628:therapy*; D008334:Mandible / Q000000981:diagnostic imaging / Q000473:pathology; D009967:Orthodontic Appliances; D019857:Osteogenesis, Distraction / Q000295:instrumentation / Q000379:methods*; D011859:Radiography