CLEFT ORTHODONTICS: A LIFE LONG JOURNEY
CLEFT ORTHODONTICS
Understanding Cleft Orthodontics: Building a Confident Smile
The process of creating a functional and attractive smile for individuals who have cleft lip or palate extends through their entire life. The orthodontist uses their expertise to control the development of teeth and jaw relationships while the surgeon fixes the initial gap in the patient’s mouth.
Think of cleft orthodontics as a highly customized roadmap that begins in infancy and continues into young adulthood.
The Phases of Treatment
Because a cleft affects the bone where teeth grow (the alveolar ridge), teeth may be missing, displaced, or rotated.
Orthodontic care is usually broken down into three main stages:
Infant Management:
Some infants require the “NAM” (Nasoalveolar Molding) appliance to develop their gum and nose structure before their initial surgical procedure.
The Mixed Dentition Phase:
Palatal expansion serves as the primary goal between the ages of 7 and 10. The orthodontist uses an expander to widen the upper jaw which creates space for permanent teeth and prepares the site for a bone graft procedure.
The Adolescent Phase:
The dental treatment begins after the adult teeth arrive because we use complete braces or transparent aligners to position the teeth in their final arrangement.
Common Orthodontic Goals
In a typical cleft case, the orthodontist isn’t just “straightening teeth”; they are correcting complex structural issues:
1. Correcting a Crossbite: Many patients have an upper jaw that sits inside the lower jaw. The dental team uses special equipment to move the upper teeth to their proper position.
2. Closing Gaps: The orthodontic treatment helps to eliminate gaps which exist because of absent lateral incisors and the cleft condition itself.
3. Bite Correction: The functional occlusion of your teeth requires proper assessment because it directly impacts your ability to chew and speak.
A Team Effort
Cleft care is the ultimate “team sport.” Your orthodontist works closely with oral surgeons, speech therapists, and ENT doctors. Orthodontic treatment using braces will not achieve proper jaw alignment, which requires surgeons to consider orthognathic surgery as an option for patients who need to undergo surgery during their late teenage years to achieve symmetrical facial development and proper dental alignment. The treatment plan requires multiple braces and retainer sessions with dental appointments, but the treatment plan aims to achieve a permanent solution which includes a healthy functional smile that increases the patient’s self-confidence.
Treatment road map for cleft lip /palate
| Age/timing | Key milestones |
|---|---|
| 1 week after hospital discharge | First team evaluation |
| 2 weeks of age | Start presurgical infant orthopedic treatment |
| 3-4months of age | Unilateral cleft lip repair |
| 4-6 months of age | Bilateral cleft lip repair |
| Three weeks after lip repair | Start nasal stenting,if indicated |
| 6 months of age | Begin solid food |
| 9 -12 months of age | Cleft palate repair |
| 12 - 24 months of age | First pediatric dental visit, ear tube placement if indicated |
| 18 months of age | First speech evaluation |
| 4 years of age | Common timing of start of speech therapy, if indiacted |
| 4-6 years of age | Cleft lip/ nose revision , speech surgery |
| 5-6 years | First orthodontic evaluation |
| 7-9 years | Early orthodontic treatment, alveolar bone grafting |
| 12 -18 years | Puberty growth period ,ongoing orthodontic treatment |
| 18+ | Final cleft lip /nose repairs , Jaw surgery |