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The orthodontic management of patients with cleft lip and palate: from birth to the late mixed dentition

British Dental Journal volume 234, pages 873–880 (2023)Cite this article

Abstract

This is the first of two papers outlining the orthodontic management of patients with cleft lip and palate. This paper will review orthodontic input into children with cleft lip and palate from birth to the late mixed dentition before definitive orthodontics. It will emphasise the importance of timing in alveolar bone grafting, the role of the general dental practitioner and the impact of timing on definitive orthodontic outcome.

Key points

  • To understand the orthodontic management of patients with cleft lip and palate.

  • To understand the importance of the multidisciplinary team within decision-making.

  • Dental health is imperative for good orthodontic outcomes.

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References

  1. Shaw W C, Williams A C, Sandy J R, Devlin H B. Minimum standards for the management of cleft lip and palate: efforts to close the audit loop. Royal College of Surgeons of England. Ann R Coll Surg Engl 1996; 78: 110-114.

  2. Ranta R. A review of tooth formation in children with cleft lip/palate. Am J Orthod Dentofacial Orthop 1986; 90: 11-18.

  3. Baek S-H, Moon H-S, Yang W-S. Cleft type and Angle's classification of malocclusion in Korean cleft patients. Eur J Orthod 2002; 24: 647-653.

  4. Semb G, Brattström V, Mølsted K, Prahl-Andersen B, Shaw W C. The Eurocleft study: intercenter study of treatment outcome in patients with complete cleft lip and palate. Part 1: introduction and treatment experience. Cleft Palate Craniofac J 2005; 42: 64-68.

  5. Tsichlaki A, Chin S Y, Pandis N, Fleming P S. How long does treatment with fixed orthodontic appliances last? A systematic review. Am J Orthod Dentofacial Orthop 2016; 149: 308-318.

  6. Prahl-Andersen B. Dental treatment of predental and infant patients with clefts and craniofacial anomalies Cleft Palate Craniofac J 2000; 37: 528-532.

  7. McNeil C K. Congenital cleft palate; a case of congenital cleft palate that required the fitting of a special appliance. Br Dent J 1948; 84: 137-141.

  8. Bongaarts C A, Kuijpers-Jagtman A M, van't Hof M A, Prahl-Andersen B. The effect of infant orthopedics on the occlusion of the deciduous dentition in children with complete unilateral cleft lip and palate (Dutchcleft). Cleft Palate Craniofac J 2004; 41: 633-641.

  9. Meazzini M C, Capasso E, Morabito A, Garattini G, Brusati R. Comparison of growth results in patients with unilateral cleft lip and palate after early secondary gingivoalveoloplasty and secondary bone grafting: 20 years follow up. Scand J Plast Reconstr Surg Hand Surg 2008; 42: 290-295.

  10. Bongaarts C A, van't Hof M A, Prahl-Andersen B, Dirks I V, Kuijpers-Jagtman A M. Infant orthopedics has no effect on maxillary arch dimensions in the deciduous dentition of children with complete unilateral cleft lip and palate (Dutchcleft) Cleft Palate Craniofac J 2006; 43: 665-672.

  11. Bongaarts C A, Prahl-Andersen B, Bronkhorst E M et al. Infant orthopedics and facial growth in complete unilateral cleft lip and palate until six years of age (Dutchcleft). Cleft Palate Craniofac J 2009; 46: 654-663.

  12. Noverraz R L, Disse M A, Ongkosuwito E M, Kuijpers-Jagtman A M, Prahl C. Transverse dental arch relationship at 9 and 12 years in children with unilateral cleft lip and palate treated with infant orthopedics: a randomized clinical trial (DUTCHCLEFT). Clin Oral Investig 2015; 19: 2255-2265.

  13. Bartzela T, Katsaros C, Shaw W C et al. A longitudinal three-centre study of dental arch relationship in patients with bilateral cleft lip and palate. Cleft Palate Craniofac J 2010; 47: 167-174.

  14. Greyson B H, Cutting C, Wood R. Preoperative columella lengthening in bilateral cleft lip and palate. Plast Reconstr Surg 1993; 92: 1422-1423.

  15. Singer E, Daskalogiannakis J, Russell K A et al. Burden of Care of Various Infant Orthopedic Protocols for Improvement of Nasolabial Esthetics in Patients With CUCLP. Cleft Palate Craniofac J 2018; 55: 1236-1243.

  16. Van der Heijden P, Dijkstra P U, Stellingsma C, van der Laan B F, Korsten-Meijer A G, Goorhuis-Brouwer S M. Limited evidence for the effect of presurgical nasoalveolar molding in unilateral cleft on nasal symmetry: a call for unified research. Plast Reconstr Surg 2013; 131: 62-71.

  17. Padovano W M, Skolnick G B, Naidoo S D, Snyder-Warwick A K, Patel K B. Long-Term Effects of Nasoalveolar Molding in Patients With Unilateral Cleft Lip and Palate: A Systematic Review and Meta-Analysis. Cleft Palate Craniofac J 2022; 59: 462-474.

  18. Massie J P, Bruckman K, Rifkin W J et al. The Effect of Nasoalveolar Molding on Nasal Airway Anatomy: A 9-Year Follow-up of Patients with Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2018; 55: 596-601.

  19. Boyne P J, Sands N R. Secondary bone grafting of residual alveolar and palatal clefts. J Oral Surg 1972; 30: 87-92.

  20. Boyne P J, Sands N R. Combined orthodontic-surgical management of residual palato-alveolar cleft defects. Am J Orthod 1976; 70: 20-37.

  21. Semb G. Alveolar bone grafting. Front Oral Biol 2012; 16: 124-136.

  22. Precious D S. A new reliable method for alveolar bone grafting at about 6 years of age. J Oral Maxillofac Surg 2009; 67: 2045-2053.

  23. Mundra L S, Lowe K M, Khechoyan D Y. Alveolar Bone Graft Timing in Patients With Cleft Lip & Palate. J Craniofac Surg 2022; 33: 206-210.

  24. Bergland O, Semb G, Abyholm F E. Elimination of the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment. Cleft Palate J 1986; 23: 175-205.

  25. Schultze-Mosgau S, Nkenke E, Schlegel A K, Hirschfelder U, Wiltfang J. Analysis of bone resorption after secondary alveolar cleft bone grafts before and after canine eruption in connection with orthodontic gap closure or prosthodontic treatment. J Oral Maxillofac Surg 2003; 61: 1245-1248.

  26. Ozawa T, Omura S, Fukuyama E, Matsui Y, Torikai K, Fujita K. Factors influencing secondary alveolar bone grafting in cleft lip and palate patients: prospective analysis using CT image analyzer. Cleft Palate Craniofac J 2007; 44: 286-291.

  27. Feichtinger M, Mossböck R, Kärcher H. Assessment of bone resorption after secondary alveolar bone grafting using three-dimensional computed tomography: a three-year study. Cleft Palate Craniofac J 2007; 44: 142-148.

  28. Dissaux C, Bodin F, Grollemund B et al. Evaluation of success of alveolar cleft bone graft performed at 5 years versus 10 years of age. J Craniomaxillofac Surg 2016; 44: 21-26.

  29. Doucet J-C, Russell K A, Daskalogiannakis J et al. Facial Growth of Patients With Complete Unilateral Cleft Lip and Palate Treated With Alveolar Bone Grafting at 6 Years. Cleft Palate Craniofac J 2019; 56: 619-627.

  30. Ruppel J K, Long R E Jr, Oliver D R et al. The Americleft Project: A Comparison of Short- and Longer-Term Secondary Alveolar Bone Graft Outcomes in Two Centres Using the Standardized Way to Assess Grafts Scale. Cleft Palate Craniofac J 2016; 53: 508-515.

  31. Pinheiro F H, Drummond R J, Frota C M, Bartzela T N, Dos Santos P B. Comparison of early and conventional autogenous secondary alveolar bone graft in children with cleft lip and palate: A systematic review. Orthod Craniofac Res 2020; 23: 385-397.

  32. Enemark H, Sindet-Paedersen S, Bundgaard M. Long-term results after secondary bone grafting of alveolar clefts. J Oral Maxillofac Surg 1987; 45: 913-919.

  33. Semb G. Effect of alveolar bone grafting on maxillary growth in unilateral cleft lip and palate patients. Cleft Palate J 1988; 25: 288-295.

  34. Levitt T, Long R E Jr, Trotman C A. Maxillary growth in patients with clefts following secondary alveolar bone grafting. Cleft Palate Craniofac J 1999; 36: 398-406.

  35. Shaw W C, Semb G, Nelson P et al. The Eurocleft project 1996-2000: overview. J Craniomaxillofac Surg 2001; 29: 131-142.

  36. Murthy A S, Lehman J A. Evaluation of alveolar bone grafting: a survey of ACPA teams. Cleft Palate Craniofac J 2005; 42: 99-101.

  37. Revington P J, McNamara C, Mukarram S, Perera E, Shah H V, Deacon S A. Alveolar bone grafting: results of a national outcome study. Ann R Coll Surg Engl 2010; 92: 643-646.

  38. Paterson M, Rae J, Paterson P, Gilgrass T, Devlin M, McIntyre G. Secondary Alveolar Bone Grafting (CLEFTSiS) 2007-2010. Cleft Palate Craniofac J 2016; 53: 141-146.

  39. Abyholm F E, Bergland O, Semb G. Secondary bone grafting of alveolar clefts. A surgical/orthodontic treatment enabling a non-prosthodontic rehabilitation in cleft lip and palate patients. Scand J Plast Reconstr Surg 1981; 15: 127-140.

  40. Turvey T A, Vig K, Moriarty J, Hoke J. Delayed bone grafting in the cleft maxilla and palate: a retrospective multidisciplinary analysis. Am J Orthod 1984; 86: 244-256.

  41. Lilja J, Möller M, Friede H, Lauritzen C, Petterson L E, Johanson B. Bone grafting at the stage of mixed dentition in cleft lip and palate patients. Scand J Plast Reconstr Surg Hand Surg 1987; 21: 73-79.

  42. Paulin G, Astrand P, Rosenquist J B, Bartholdson L. Intermediate bone grafting of alveolar clefts. J Craniomaxillofac Surg 1988; 16: 2-7.

  43. Enemark H, Jensen J, Bosch C. Mandibular bone graft material for reconstruction of alveolar cleft defects: long-term results. Cleft Palate Craniofac J 2001; 38: 155-163.

  44. Trindade I K, Mazzottini R, Silva Filho O G, Trindade I E, Deboni M C. Long-term radiographic assessment of secondary alveolar bone grafting outcomes in patients with alveolar clefts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 100: 271-277.

  45. El Deeb M, Messer L B, Lehnert M W, Hebda T W, Waite D E. Canine eruption into grafted bone in maxillary alveolar cleft defects. Cleft Palate J 1982; 19: 9-16.

  46. Jia Y L, Fu M K, Ma L. Long-term outcome of secondary alveolar bone grafting in patients with various types of cleft. Br J Oral Maxillofac Surg 2006; 44: 308-312.

  47. Ellwood R P, O'Mullane D M. Association between dental enamel opacities and dental caries in a north Wales population. Caries Res 1994; 28: 383-387.

  48. Malanczuk T, Opitz C, Retzlaff R. Structural changes of dental enamel in both dentitions of cleft lip and palate patients. J Orofac Orthop 1999; 60: 259-268.

  49. Samman N, Cheung L K, Tideman H. A comparison of alveolar bone grafting with and without simultaneous maxillary osteotomies in cleft palate patients. Int J Oral Maxillofac Surg 1994; 23: 65-70.

  50. Vellone V, Cirignaco G, Cavarretta B, Cascone P. Canine Eruption After Secondary Alveolar Bone Graft in Unilateral Cleft Lip and Palate Patients. J Craniofac Surg 2017; 28: 1206-1210.

  51. Freitas J A, Garib D G, Oliveira M et al. Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies-USP (HRAC-USP)-part 2: paediatric dentistry and orthodontics. J Appl Oral Sci 2012; 20: 268-281.

  52. Allareddy V, Bruun R, MacLaine J, Markiewicz M R, Ruiz R, Miller M A. Orthodontic Preparation for Secondary Alveolar Bone Grafting in Patients with Complete Cleft Lip and Palate. Oral Maxillofac Surg Clin North Am 2020; 32: 205-217.

  53. Parsaei Y, Uribe F, Steinbacher D. Orthodontics for Unilateral and Bilateral Cleft Deformities. Oral Maxillofac Surg Clin North Am 2020; 32: 297-307.

  54. Liao Y-F, Huang C-S. Presurgical and postsurgical orthodontics are associated with superior secondary alveolar bone grafting outcomes. J Craniomaxillofac Surg 2015; 43: 717-723.

  55. Chang L, Wang Y, Liu H. Evaluation of the timing of orthodontic arch expansion and graft in cleft lip and palate. Hua Xi Kou Qiang Yi Xue Za Zhi 2016; 34: 205-209.

  56. Long R E Jr, Spangler B E, Yow M. Cleft width and secondary alveolar bone graft success. Cleft Palate Craniofac J 1995; 32: 420-427.

  57. Vuity D, Biddlestone J, Paterson P, Russell C, Devlin M, Gillgrass T. The Glasgow Anterior Stabilisation (GAS) appliance: A novel orthodontic appliance for pre-maxillary stabilisation in bilateral cleft lip and palate. J Plast Reconstr Aesthet Surg 2017; 70: 540-542.

  58. Sindet-Paedersen S, Enemark H. Reconstruction of alveolar clefts with mandibular or iliac crest bone grafts: a comparative study. J Oral Maxillofac Surg 1990; 48: 554-560.

  59. Amanat N, Langdon J D. Secondary alveolar bone grafting in clefts of the lip and palate. J Craniomaxillofac Surg 1991; 19: 7-14.

  60. Kalaaji A, Lilja J, Friede H, Elander A. Bone grafting in the mixed and permanent dentition in cleft lip and palatepatients: long-term results and the role of the surgeon's experience. J Craniomaxillofac Surg 1996; 24: 29-35.

  61. Dado D V, Rosenstein S W, Alder M E, Kernahan D A. Long-term assessment of early alveolar bone grafts using three-dimensional computer-assisted tomography: a pilot study. Plast Reconstr Surg 1997; 99: 1840-1845.

  62. Jabbari F, Skoog V, Reiser E, Hakelius M, Nowinski D. Optimization of dental status improves long-term outcome after alveolar bone grafting in unilateral cleft lip and palate. Cleft Palate Craniofac J 2015; 52: 210-218.

  63. Meyer S, Mølsted K. Long-term outcome of secondary alveolar bone grafting in cleft lip and palate patients: a 10-year follow-up cohort study. J Plast Surg Hand Surg 2013; 47: 503-508.

  64. Jabbari F, Wiklander L, Reiser E, Thor A, Hakelius M, Nowinski D. Secondary Alveolar Bone Grafting in Patients Born With Unilateral Cleft Lip and Palate: A 20-Year Follow-up. Cleft Palate Craniofac J 2018; 55: 173-179.

  65. Park H-M, Han D-H, Baek S-H. Comparison of tooth development stage of the maxillary anterior teeth before and after secondary alveolar bone graft: Unilateral cleft lip and alveolus vs unilateral cleft lip and palate. Angle Orthod 2014; 84: 989-994.

  66. Vandersluis Y R, Fisher D M, Stevens K, Tompson B D, Lou W, Suri S. Comparison of dental outcomes in patients with nonsyndromic complete unilateral cleft lip and palate who receive secondary alveolar bone grafting before or after emergence of the permanent maxillary canine. Am J Orthod Dentofacial Orthop 2020; 157: 668-679.

  67. Solis A, Figueroa A A, Cohen M, Polley J W, Evans C A. Maxillary dental development in complete unilateral alveolar clefts. Cleft Palate Craniofac J 1998; 35: 320-328.

  68. Russell K A, McLeod C E. Canine eruption in patients with complete cleft lip and palate. Cleft Palate Craniofac J 2008; 45: 73-80.

  69. Tortora C, Meazzini M C, Garattini G, Brusati R. Prevalence of abnormalities in dental structure, position, and eruption pattern in a population of unilateral and bilateral cleft lip and palate patients. Cleft Palate Craniofac J 2008; 45: 154-162.

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  1. Cleft Surgical Service for Scotland & Glasgow Dental Hospital and School, Glasgow, United Kingdom

    Toby Gillgrass

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Gillgrass, T. The orthodontic management of patients with cleft lip and palate: from birth to the late mixed dentition. Br Dent J 234, 873–880 (2023). https://doi.org/10.1038/s41415-023-5955-x

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