Role of Orthodontists in the

management of cleft lip & palate

Role of orthodontists extend from infancy to adulthood and during this period of service,
he actively participated by_
 Facilitating surgical repair of cleft lip and palate by aligning cleft segment
 Removing any interference to normal growth
 Preparing cleft sites for grafting

A. During Infancy (birth – 6 month):

Presurgical orthopedics are used which help_
 To facilitate feeding
 To establish normal tongue posture
 To stimulate palatal growth
 To reduce the chance of ear infection
 To reposition the premaxilla
1. In unilateral cleft:
 Passive treatment involves the use of acrylic plate
 Active treatment involves the use of screws or pins which obtain similar results in
a shorter time
2. In Bilateral cleft:
 Nasoalveolar molding (NAM)
 External traction
 Pin retained appliance

B. During primary dentition period (6month – 6 years):

 In the presence of dental cross bite with mandibular shift If possible execute only
grinding of premature contacts on deciduous teeth at this stage and then wait for
the mixed dentition. Protraction face mask to be used only in:
 Mild maxillary hypoplasia, in the presence of CO/CR shifts.

 In the presence of dental cross bite without mandibular shift, it is advisable not to
perform any palatal expansion due to:
a. Risk of widening of pre-existing oro-nasal communication.
b. High tendency towards relapse (because of palatal scarring).

C. During mixed dentition period (6 years – 12 years):

1. Elimination of cross bite by expansion of anterior or posterior maxilla using
  Rapid palatal expander (RPE)
 Hi-Rax type RPE
 Quad heli expander
 RPE with fan shaped expansion screw
 RPE with double hinge expander
 Removable expanders, which should be avoided in cleft patients as these
patients might need speech therapy
2. Alignment of incisors by correction of
 Rotation
 Ectopic eruption of maxillary incisors
3. Preparation for alveolar bone grafting by expansion of maxilla
4. Correction of mild maxillary hypoplasia using face mask

C. During permanent dentition period (12 years – onwards):

1. Labial inclination of maxillary incisors
2. Lingual inclination of mandibular incisors
3. Preparation to subsequent orthognathic surgery
4. Obtaining good final occlusion