Orthodontic treatment of a bilateral cleft lip and palate patient with bilateral tooth transpositions and congenitally missing teeth

Treatment of patients with a cleft lip and palate can be challenging. A boy, 15 years 11 months old, with a bilateral cleft lip and palate and a convex profile, transposed teeth and congenitally missing teeth was treated by orthodontic treatment. 3 year posttreatment records showed excellent results with good occlusion, facial balance and harmony, and long-term stability.     

Orthodontic treatment of a congenitally missing maxillary lateral incisor

Clinicians agree that, regardless of gender or race, tooth agenesis has become more prominent in recent societies. The congenital absence of one or more maxillary lateral incisors poses a challenge to effective treatment planning for the restorative dentist. However, the one-sided orthodontic approach of just moving canines mesially to eliminate restorative procedures leads to compromise. Adult patients presenting with malocclusions, missing lateral incisors, or anterior crowding but who fail to get proper orthodontic treatment, requesting instead esthetic solutions that do not establish a stable occlusion, proper alignment, and proper axial inclination of the teeth will have compromised esthetic and periodontal results. An evaluation of anterior smile esthetics must include both static and dynamic evaluations of frontal and profile views to optimize both dental and facial appearance. This article presents how orthodontics is combined with other specialties in treating a congenitally missing lateral incisor. One case is used to illustrate how orthodontic treatment is progressed in collaboration with other specialists. CLINICAL SIGNIFICANCE: Patients with missing teeth, crowding, midline deviation, unesthetic gingival contours, or other restorative needs may require the interaction between various specialists. For the successful treatment of orthodontic-restorative patients, an interdisciplinary team effort is vital.     

单侧完全性唇腭裂术后反的矫治

唇腭裂患者术后常存在较严重的错畸形，其矫治是比较复杂和困难的。本研究的目的，在于通过对３２名单侧完全性唇腭裂术后反患者正畸治疗的临床观察，探讨该类患者正畸治疗的特点。得出以下结果：①为获得良好的牙弓形态及牙颌关系常需齿槽骨植骨；②扩弓治疗时间较长且多需不对称扩弓，扩弓效果需长时间保持；③方丝弓矫治器治疗结束后，患者侧貌的改善主要局限在牙齿－齿槽区；④３４．３％的患者需要作正颌外科治疗。研究结果提示，为获得更理想的侧貌改善，应对唇腭裂患者早期应用前方牵引治疗。     

Orthodontic space opening in patients with congenitally missing lateral incisors

OBJECTIVE: To determine the best time to begin orthodontic treatment for patients scheduled for implants to replace congenitally missing upper lateral incisors. The aim of timing is to maximize the amount of bone available for implant insertion and to improve incisors inclination. MATERIALS AND METHODS: Seventy-three plaster casts of 14 patients with 26 missing lateral incisors were cross sectioned in the center of the planned insertion of the implant, and the implant profile was projected into the area at three different times: T1--beginning of orthodontic treatment, T2-- end of orthodontic treatment, and T3--implant insertion. Deficiency of alveolar ridge volume needed for implantation was determined by Leica Quin analySIS software. RESULTS: An increase of ridge-volume deficiency from 0.26 mm(2) at T1 to 3.77 mm(2) at T3 was found. During orthodontic treatment the incisors protruded about 9.4 degrees (differing from the O1-NA standard of 7.5 degrees ). To ensure optimal esthetic and functional implantation results, time management concerning orthodontic treatment has to be done carefully. CONCLUSIONS: To avoid a high degree of alveolar bone atrophy and the risk of relapse and retreatment, orthodontic treatment involving tooth movement should not be initiated before the age of 13 years. Furthermore, it is important to maintain anchorage of the upper incisors because high incisor proclination causes extra-axial stress on the implant. An interdisciplinary approach is essential to provide the best treatment outcome.     

单侧完全性唇腭裂术后反He的矫治

唇腭裂患者术后常存在严重的错Ｈｅ畸形，其矫治是比较复杂和困难的。本研究的目的，在于通过对３２名单侧完全性唇腭裂术后反Ｈｅ患者治疗的临床观察，探讨该类患者正畸治疗的特点。     

Orthodontic treatment and demand of a cleft lip and palate patient.

Most orthodontists would agree the treatment plan followed in this case was a severe compromise; many oral surgeons will find it completely unacceptable. However, during the relatively short treatment time--a total of 12 months--the anterior crossbite was corrected and the patient got the front teeth she wanted. Demand or perceived need of the patient should always be the prime objective of any kind of treatment in order to have patient's cooperation. The patient and her parents are now very grateful and ready for the prosthodontic procedures. Although this case was not treated according to the need perceived by the specialists, the result is by all means acceptable and satisfactory to both parties.     

Orthodontic treatment of children with cleft lip and cleft palate

Orthodontic treatment of children with cleft palates continues through the periods of the three dentitions: temporary, mixed, and adult. Using examples, this paper deals with the different difficulties that can be encountered during treatment of this malformation. Orthodontic interception at the time of the temporary dentition corrects the heart of the problem, the transverse insufficiency, but also addresses moderate maxillary retrusion. Cooperation with a speech therapist at this stage is essential. In the mixed dentition, orthodontists correct incisal malalignment and, depending upon the severity of the deformity, consider surgical intervention. In the adult dentition, a variety of decisions must be made: whether to open or close the spaces left by absent lateral incisors; whether to accept an orthodontic compromise or to elect surgical advancement of the maxilla; and, if surgery is deemed appropriate, whether to embark on an early distraction procedure or to rely on a classical osteotomy.     

Combined surgical/orthodontic treatment and autotransplantation of a premolar in a patient with unilateral cleft lip and palate.

OBJECTIVE: The treatment of a patient with a complete unilateral left cleft lip and palate, agenesis of the left upper second premolar, and a severely malformed left upper lateral incisor is reported. Treatment included placement of an autologous bone graft from the left iliac crest into the alveolar cleft at 8 years of age and transplantation of a lower premolar into the reconstructed alveolar process at 10 years of age. During the succeeding orthodontic treatment, the dental arches were aligned and corrected toward a Class I molar occlusion. One year after the end of treatment, the status of the transplanted premolar was good.     

Clinical management of the congenitally missing maxillary lateral incisor and mandibular second premolar: a clinical perspective

The decision to close maintain, or open space at the agenesis sites of the maxillary lateral incisor and mandibular second premolar is generally based on several factors, including the class of malocclusion, skeletal pattern (divergence), esthetics, function, and periodontics. Replacement of congenitally missing maxillary lateral incisors, the second most commonly missing teeth, can involve (1) canine replacement, (2) tooth-supported restoration, and (3) implants. This paper contrary to the opinion of other authors, favors replacement of the congenitally missing lateral incisors in one of several ways, versus orthodontic space closure.     

Multidisciplinary treatment approach with one piece implants for congenitally missing maxillary lateral incisors: a case report

Congenitally missing lateral incisors are a common clinical occurrence. Dental Implants have become a primary treatment option for replacement of these teeth. Many times in prosthodontic treatment planning a multidisciplinary approach is needed for a comprehensive out come. Prosthodontic treatment planning is needed prior to the patient's consultation and following treatment acceptance; the prosthodontist may need to coordinate treatment needs with other specialists, including an orthodontist and an implant surgeon. This article describes multidisciplinary management of a case presenting with spaced maxillary anteriors due to the congenitally missing lateral incisors. Treatment consisted of initial orthodontic space management to obtain adequate space for missing lateral incisors. Single piece, narrow diameter implants were placed in edentulous spaces on both sides. Aesthetic crown lengthening procedure was performed with all anterior teeth along with tissues surrounding the implants. Metal-ceramic crowns were given as definitive restorations, resulting into an acceptable aesthetic outcome.     

Diagnostic protocol in cases of congenitally missing maxillary lateral incisors

Patients with congenitally missing maxillary lateral incisors may seek treatment from an orthodontist for several reasons; unpleasant smile, dental arch disharmony, and midline deviations are among the most frequent complaints. Orthodontists and prosthodontists have raised important questions about the esthetics, occlusion, periodontal health, and psychological conditions noted in these patients. The decision to open lateral incisor spaces for prosthetics or close spaces by mesial movement of the canines requires a careful diagnosis and comprehensive multidisciplinary treatment planning. The purpose of this article is to present a diagnostic protocol to assist in the decision-making process, while analyzing patients with absent maxillary lateral incisors. The basis for a sound diagnosis and an effective treatment plan resides in careful consideration of the facial and dental characteristics of each patient. All information gathered during the clinical examination should be added to data obtained with other diagnostic tools, such as cephalometric analysis and orthodontic waxups, to achieve the treatment option that best suits the patient's expectations.