The greatest of attention should be taken of all children’s teeth but this is especially important in the case of a cleft lip and palate child. It is the role of the orthodontist on the cleft team responsible for your child to monitor the growth and assist the development of his/her teeth. The first teeth and later the permanent teeth are very important for the success of the orthodontist’s work.
The aim of orthodontic treatment is, where possible, to align all the teeth and close all residual spaces without the use of bridges or dentures.
Dental records from which later treatment of your child is planned are created from about 2½ years. X-rays, impressions and photographs may be taken at this stage. The first full orthodontic assessment occurs at around 6½ to 7 years. Any supernumerary teeth which interfere with the proper development or eruption of second teeth are removed at this stage by a maxillo-facial surgeon. For some children simple orthodontic treatment involving braces to straighten the teeth can now begin and no further treatment may be necessary.
In most cases, however, expansion of the maxilla and bone grafting of the alveolus (tooth bearing portion of the upper jaw) is necessary, with the expansion beginning at about 9 to 10 years of age. The purpose of the expansion is to bring the child’s teeth into correct relationship to each other. When this has been deemed successful, the maxillo-facial surgeon then places a bone graft (from the top of the hip bone) to replace the missing bony tissue. The expanded position of the dental arch is maintained for 6 to 12 months by which time the graft should have taken successfully. The procedure should be completed by the age of 10 to 11 years. Full orthodontic alignment can start with the use of fixed braces when all the permanent teeth have erupted (usually by the age of 13 years).
In a significant number of cases an osteotomy to correct a misalignment of the dental arches is necessary and this surgery is carried out at about 18 years of age. In the majority of cases this surgery gives very good results.
Orthodontic treatment prior to lip repair is rarely required but may be used where the premaxilla is extremely prominent and lip repair is difficult.