Orthopaeddontics in Cleft Treatment

Abstract

Orthopaeddontics offers a comprehensive treatment paradigm tailored to paediatric patients aged 5 to 11 years with cleft anomalies, focussing on early correction of dento-alveolar and orthognathial deformities alongside structured psychological support. The intensive pre- surgical preparational treatment phase, conducted during this very active growth period, lays the foundation for subsequent surgical interventions, particularly secondary osteofusion, in children with the CLA and CLAP deformities. The primary objective is to achieve optimal gothic arch formation, ideal maxillary-mandibular occlusal relationship and attain balanced facial aesthetics while mitigating orthognathial deformities. Following surgery, orthopeaddontic maintenance continues into the pre-adolescent years, typically until the age of 12 years, ensuring sustained treatment efficacy before transitioning to standard orthodontic care. Central to this approach is a non-extraction treatment philosophy targeting both primary and permanent dentition, aimed at aligning teeth to achieve the most ideal arch or horse-shoe- shaped alveolus arch for all of the two (uCLA/uCLAP) or three arch segments (bCLA/bCLAP) within a balanced maxillary-mandibular occlusal relationship with an ideal facial balance. Various orthopaeddontic techniques are employed to address abnormal dimensional appearances, complimented by a psychologically sensitive approach to support paediatric patients and their families. During the orthopaeddontic treatment the treating expert needs to liaise with the parents to support the cleft child with a gentle, psychologically meaningful approach to warrant essential ultimate outcome with lifelong positive aesthetic appearance and functionality and to secure an easier acceptance of their odyssey as a person with a cleft deformity. A result of the utilization of this growth phase, related to the midfacial development and function, needs to be comparable with the expected development of a non-cleft child at a similar age. Ultimately, successful orthopeaddontic intervention during the critical growth phase should yield marked improvements in speech, facial aesthetic and a functional occlusion, potentially reducing the need for future orthodontic treatments and minimizing treatment duration.