Challenges in Orthodontics and Pediatric Dentistry in the Management of Patients With Cleft Lip and Palate

Abstract

Challenges in orthodontic management for patients with cleft lip and palate (CLP) center on facial growth deficiencies and oral health. Patients with complete CLP exhibit maxillary arch constriction from an early age, typically more severe in the canine region than in the molar region. Transverse management centers on the maxillary arch and types of expansion. The ability to provide targeted anterior expansion while simultaneously addressing posterior crossbites is crucial for correcting arch constriction in patients with cleft lip and palate. Maxillary constrictions are usually addressed immediately prior to the secondary alveolar bone graft procedure. The instability of maxillary expansion in CLP patients is one reason why expansion is often performed early. Anteroposterior (sagittal) orthopedic management of maxillary deficiencies in patients with CLP still remains a challenge, with decisions on treatment based on timing, indications, and severity. A protocol is presented with favorable results for complicated cases. Early correction of the hypoplastic maxilla in patients with CLP is notoriously followed by substantial skeletal relapse; consequently, protraction undertaken in the deciduous or early-mixed dentition should be reserved for cases in which marked functional impairment, such as hipoacusia, is present. Conversely, when the same orthopedic stimulus is applied in proximity to the pubertal growth spurt, the skeletal correction tends to be considerably more stable. Challenges in pediatric dentistry persist with poor oral hygiene and caries. Without a foundation for stable dentition, the best of orthodontic treatment planning can be compromised. Despite awareness on importance of oral health as it relates to systemic conditions and the additional factors faced with CLP patients, more follow-up is needed. Prevention and frequent follow-up with the pediatric dentist are key.