DR KABERI MAJUMDER BDS, MDS (ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS)
VISITING ASSISTANT PROFESSOR , SGT UNIVERSITY , INDIACONSULTANT , M P SHAH HOSPITAL, NAIROBI, KENYA
CLEFT INTERDISCIPLINARY TEAM
1 Post natal general health check up
pediatrician 10 Dentofacial orthopedics orthodontist
2 Post natal councelling( feeding and swallowing issues)
Counceller/orthodontist/Pedodontist genetist+ psychiatrist
11 Maxillary distraction orthodontist
3 Presurgical orthopedics (NAM) Orthodontist/ pedodontist
12 Adjunctive orthodontics orthodontist
4 Lip/nose repair + GPP Maxillofacial/ plastic surgeon
13 ABG Maxillofacial/ plastic surgeon
5 Palate repair Maxillofacial/plastic surgeon +
14 Comprehensive orthodontics
orthodontist
6 Airway breathing issues /ear tube
ENT surgeon 15 surgical orthodontics + OG Orthodontist + maxillofacial/plastic surgeon
7 Speech therapy Speech pathologist
16 Preprosthetic orthodontics + prosthetic treatment
Orthodontist +prosthodontist
8 Phrayngeal flap ENT surgeon/otolaryngologist
17 Rhinoplasty/ chelioplasty surgeon
18. Oral physiotherapy Physiotherapist9 dental treatment pedodontist
PRESURGICAL INFANT ORTHOPAEDICS
ALVEOLAR MOLDING ( AM)NASO ALVEOLAR
MOLDING ( NAM)UCLP
BCLP
Typical broad flat & cleft nose AFTER NAM
Severe BCLP ---infant orthopedic expansion
& premaxillary retraction
PALATE REPAIR in a neglected cleft case
5yr old comp palate 3 months post op
DECIDUOUS DENTITION (4 to 6 yrs)
Every 6 months periodic review.
1. Functional shift2. space loss3. oral habit
Habit breaker in UCLP patient
Arnold expander
Protraction spring & space maintainer
RETENTION
Palatal arch with acrylic extension
Mixed Dentition 1.Early interceptive orthopedics
2. Adjunctive orthodontics to prepare for
alveolar bone grafting & to support sulcular deepening
1. . incisor derotation and alignment
guidance of eruption with space management
a. Transverse expansion
b. Anterior protractionc. Premaxillary intrusiond. Premaxillary medial
repositioning
CORRECTION OF POSTERIOR CROSSBITE / lateral shift of mandible
Transverse Expansion
1
PREMAXILA PROTRACTION
CORRECTION OF ANTERIOR CROSSBITE / Anterior shift of
mandible
Maxillary Protraction
2
Maxillary protraction using face mask Chin cup to retract mandible
PREMAXILLARY INTRUSION
After
before
1. ORTHOPEDIC tooth/tissue borne distraction
2.ORTHODONTIC --segmental alignment & intrusion
3. SURGICAL lifting with ABG
Laterally displaced premaxilla
1. medial orthopedic repositioning
2. orthodonticSurgical repositioning
Management of the Prominent Premaxilla
PREMAXILLARY SET BACK
Retention
Fixed palatal arch
Hawleys’s with pontic
FR- III
Rigid retention with springs
Palatal arch with thick rectangular s.s 16*22 wire
Surgical/ ABG splint
Management of Severe Cleft and Syndromic Midface Hypoplasia BY
Distraction osteogenesis
RIGID EXTERNAL DISTRACTOR(RED)
Intraoral maxillary distraction
Midpalataldistractor
Anteroposterior distractor
RETENTION- LIFE LONG/21 yrs age
What to do with fistula? ABG/IDO?
Case -1Category - 2
Permanent dentition stage
Age – 12/F
Pre treatment – facial photo
Pre treatment -- INTRA ORAL
PRE TREATMENT RECORDS Lateral cephalogram
panorex
QUADHELIX EXPANSION
Conventional preprostheticorthodontics
2 IN 1 RETAINER CUM PARTIAL DENTURE
Post treatment records
Record Keeping
(before & after every phase of treatment)
Photograhic records- 2D
PATIENT -2CATEGORY -2
12/F
phase I Orthopedic TreatmentFacemask and slow expander
Time taken – 10 months
Pre treatment end of orthopedic treatmentCOMPARISON
COMPARISON Expansion by By slow expander
END OF PHASE 1 MID -TREATMENT RECORDS
Start of phase II adjunctive orthodontic treatment
MID TREATMENT RECORD
1.Archwire expansion2.alignment & derotation of
incisors3.Space created to align LI
ALVEOLAR BONE GRAFTING ( ABG)
ILLIAC CREST BONE GRAFT
Start Of Conventional PreprostheticOrthodontics
CI extracted it was in cleft line. All deci extracted
LI alignment continued
Post Tt record withcompleted LI alignment
OJ - POSITIVE
Post treatment record
2 in 1 hawley’s retainer and partial denture
Pre treatment end of orthopedic (I) end of orthodontic(II)
PATIENT – 3CATEGORY - 2
Mixed dentition stage (8/M)
Maxillary protraction with facemask
PATIENT – 4CATEGORY - 0
Mixed dentition stage (9/M)
UCL AND ALVEOLAS
One yr old Two yrs post op
POST ORATIVE
Pre treatment(mixed dentition stage)
PRE TREATMENTINTRA ORAL
MISSING LI( 22)
LIFE STARTS WITH CLEFT, IT DOESN’T FINISH WITH IT.
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