For Parents > Stages and Treatment
Stages and Treatment
- Prenatal: No treatment.
- Neonatal: Some clinicians have used lip adhesions, a presurgical orthopedic appliance, or a head bonnet with elastics to initiate palatal molding. These forces will ventroflex a protuding premaxilla in a complete bilateral cleft lip and palate. In some instances, depending upon the presurgical appliance utilitized, the premaxilla may be bodily retracted rather than ventroflexed. Caution should be utilized. Early alveolar bone surgeries, such as primary bone grafting and gingivoperiosteoplasty, have been shown to be harmful, causing midfacial growth retardation and a bad position (anterior crossbite) of the upper front teeth, which is very difficult to correct.
- Infant: When the primary teeth begin to erupt, the parents are advised as to the immediate expectation of minor irregularities of the dentition, particularly an incisor or supernumerary tooth erupting in the palate. There is no long-term consequence leaving these ectopic teeth in place. The long-term facial/palatal treatment is outlined in general terms, in a positive manner, by showing records of completed cases.
- Ages 4-6 years: First phase orthodontics is to align the palatal segments and their teeth placed in good occlusion.
- Ages 7-10 years:
- The second phase of orthodontic appliance therapy usually occurs in the early mixed dentition.
- Generally the malpositioned and rotated incisor teeth are aligned and placed into a reasonably good relationship, and the posterior segments are expanded (if not done earlier) to an approprate relationship with the lower dental arch. When this is completed, an alveolar bone graft is usually placed and any oronasal fistula closed. A fixed palatal retainer is always required if the braces are removed since the alveolar bone graft is rarely able to maintain the corrected arch form.
- Teenage:
- When the permanant teeth erupt, a final extensive orthodontic treatment phase begins.
- Final finishing may require surgical and/or orthopedic (bone repositioning with an appliance) correction of the maxilla or the use of distraction osteogenesis to improve jaw relationship. A dental prosthesis is usually required to replace missing teeth and to stabilize the corrected maxillary arch form (orthodontic/prosthetic retention).
- These procedures require close cooperation between orthodontist, surgeon, pedodontist, prosthodontist, or general dentist.