Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies - USP (HRAC-USP) - Part 2: Pediatric Dentistry and Orthodontics

José Alberto De Souza Freitas,Simone Soares,João Henrique Nogueira Pinto,Lucimara Teixeira Neves,Renato Yassutaka Faria Yaedú,Daniela Gamba Garib,Rita De Cássia Moura Carvalho Lauris,Ana Lúcia Pompéia Fraga De Almeida,Marchini Oliveira,Ivy Kiemle Trindade-Suedam

doi:10.1590/s1678-77572012000200024

José Alberto De Souza Freitas, Simone Soares + Show 8 more

Open Access

https://doi.org/10.1590/s1678-77572012000200024

Copy DOI

Abstract

The aim of this article is to present the pediatric dentistry and orthodontic treatment protocol of rehabilitation of cleft lip and palate patients performed at the Hospital for Rehabilitation of Craniofacial Anomalies - University of São Paulo (HRAC-USP). Pediatric dentistry provides oral health information and should be able to follow the child with cleft lip and palate since the first months of life until establishment of the mixed dentition, craniofacial growth and dentition development. Orthodontic intervention starts in the mixed dentition, at 8-9 years of age, for preparing the maxillary arch for secondary bone graft procedure (SBGP). At this stage, rapid maxillary expansion is performed and a fixed palatal retainer is delivered before SBGP. When the permanent dentition is completed, comprehensive orthodontic treatment is initiated aiming tooth alignment and space closure. Maxillary permanent canines are commonly moved mesially in order to substitute absent maxillary lateral incisors. Patients with complete cleft lip and palate and poor midface growth will require orthognatic surgery for reaching adequate anteroposterior interarch relationship and good facial esthetics.

Highlights

Cleft lip and palate are the most prevalent malformations in mankind and are considered a relevant public health problem by the World Health Organization[47]
This paper describes the treatment protocol of pediatric dentistry and orthodontic in individuals with cleft lip and palate
Impressions of the mandibular arch are only obtained in the complete deciduous dentition. Knowledge on these aspects is important for the rehabilitative treatment to be performed at this stage, which comprises the onset of orthodontic intervention and accomplishment of secondary surgeries, including alveolar bone graft

Summary

INTRODUCTION

Cleft lip and palate are the most prevalent malformations in mankind and are considered a relevant public health problem by the World Health Organization[47]. Individuals with cleft lip and palate may present alterations in the deciduous dentition at the cleft area, especially affecting the maxillary lateral incisor[16,25]. The oral cavity of the newborn may present gingival and palatal cysts of the newborn, natal and neonatal teeth at the region of complete unilateral and bilateral cleft lip and palate, which may be lateral incisors of the normal series or supernumerary teeth[1,25] These WHHWK SUHVHQW VXSHU¿FLDO LPSODQWDWLRQ DQG H[FHVVLYH mobility, their extraction is indicated because of the risk of aspiration, due to the communication between the oral and nasal cavities in this type of cleft[7]. Impressions of the mandibular arch are only obtained in the complete deciduous dentition Knowledge on these aspects is important for the rehabilitative treatment to be performed at this stage, which comprises the onset of orthodontic intervention and accomplishment of secondary surgeries, including alveolar bone graft. Individuals with cleft lip (affecting only the lip and alveolar ridge) and individuals with cleft palate (affecting only the palate) do not SUHVHQW GH¿FLHQFLHV LQ DQWHURSRVWHULRU PD[LOODU\ growth after plastic surgeries[44,46]

Transverse deficiency of the maxillary dental arch

The anterior crossbite in individuals with occlusal

Findings

FINAL CONSIDERATIONS