Orthodontics in A Cleft Patient Healthy Life Arch Expansion and Alignment

History

• Age: 16 (b.2007)

• K/C/O Unilateral Left Clap

• Past Surgeries: Cheiloplasty, Palatoplasty and SABG

• Recently did a Rhinoplasty and Lip Revision

• She has Now Reported for Dental Rehab

Cheiloplasty

Palatoplasty

Pre-OP Facial

Profile Acceptable

Pre-OP Smile

Pre-OP Intraoral

• Retained deciduous teeth: 51, 52, 61

• Ectopic eruption of 11, 21 lower anterior crowding

Pre-OP Lateral Views

Pre-OP Occlusal View

• Retained 55, 65

• Rotated 14, 15

• Missing: 14, 12, 13, 22, 23 constricted maxillary arch

Pre-OP Views

OPG Findings and Clinical Co-relation

1. Impacted inverted odontome between roots of 21, 23.

2. Retained deciduous 51, 52, 53, 55, 65.

3. Ectopic eruption of 14 with a 90-degree rotation.

4. 90-degree rotation of 24.

Hypodontia

1. Missing max. 2nd premolars

2. Missing 12, 11, 22

Problem List

• Retained deciduous teeth

• Hypodontia missing permanent incisors and premolars

• Constricted maxillary arch

• The presence of odontome might hinder the movement of 21, 23

Treatment Goals

• Maxillary arch expansion

• Alignment

• Prosthetic rehabilitation

Treatment Plan

• Extraction of retained deciduous 51, 52, 61, 62

• Retain 55, and 65 as placeholders

• Extraction of lingually placed 43

• Posterior bite plane, raise the bite and enable arch expansion

• Posterior arch expansion – Quad Helix

• Alignment

Posterior Bite Plan Inserted

Bite Raised By 4mm

Quad Helix Inserted

3 Months Intra OP

Treatment Ongoing

Further Treatment Plan

• Alignment

• +/- AMD

• Prosthetic Rehab