CLEAR LIP AND PALATE TREATMENTS

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Cleft lip and palate is a genetic disorder seen approximately 10,000/1 in the population. Its incidence is increasing in consanguineous marriages. Although it is called cleft lip and palate, only lip and palate clefts are also seen. Early intervention is very important in the treatment of cleft lip and palate. The place of the orthodontist is very important in these treatments, which are a team effort. Because they both make pre-surgical preparations in infancy and regulate the dental and skeletal structures of individuals with cleft lip and palate until the age of 18 so that the mouth and tooth structure are balanced.

Implants are one of the best treatment methods in today’s dentistry, as they completely replace the existing teeth. Because when it is placed inside the existing jawbone, it completely combines with the bone and becomes a very durable structure. It creates a complete tooth structure with teeth in porcelain or zirconium structure placed on this durable structure. It offers a better solution in terms of function and aesthetics compared to the existing tooth, which is yellowed and worn, and the root surface is inflamed.

INFRASTRUCTURE (0-3 MONTHS) TREATMENTS:

Complete cleft lip and palate treatment:
If the cleft extends from the lip to the palate on one or both sides, the nasal and jawbone structures in this area collapse. If the position of the nose behind is added to these collapsed structures, an aesthetically bad appearance occurs.
Apart from the aesthetic appearance, the baby cannot eat properly. Because liquid and solid food residues escape into these slits and affect the trachea and cause coughing. It can even cause serious health problems by causing food to get into the baby’s windpipe and clog it.
For these reasons, families want their clefts to be closed with surgical treatment immediately. However, performing surgery immediately causes many wrong situations. Because the immediate closure of the clefts means the acceptance of the existing collapsed tissues, creating irreversible facial asymmetries in the future.
For this reason, these structures should be shaped under the control of the orthodontist for the first 2 months. This shaping is called “nasoalveolar shaping”.

Nasoalveolar shaping
In nasolveolar shaping, a nasolveolar shaping appliance is made by taking measurements from the baby. As the feeding appliance fulfills its task and closes all the openings of the palate, it prevents the food from escaping into the trachea during feeding. Other advantages of the appliance are:
Thanks to the nose protrusion, it allows the nose to be corrected and lifted up.
It shapes the upper palate structure and minimizes future jaw disorders.
It shapes the lip structures by means of bands and rubber, and minimizes the scar (scar) and asymmetry problems that may occur on the lip after surgery.
It facilitates the surgeon’s work during surgery.
It corrects the forward protrusion of the premaxilla in the bilateral clefts and ensures that the teeth come out healthier.
The nasolveolar shaping procedure is a difficult process in terms of both time and psychology. Because it is very difficult for the orthodontist and the family to perform these procedures in the most difficult period of the baby (in the baby who constantly cries, vomits, and loses his head). At the same time, it is very important for the family to have the baby wear the appliance constantly and to use the rubbers and bands given by the orthodontist. Otherwise, the treatment fails. At the end of 3 months, when enough shaping is done, the operation is completed successfully. It is very important that the baby comes to regular check-ups every 6 months.
The nasolveolar shaping appliance is different from the feeding plate appliance. While bone structures are shaped and expanded in the nasoalveolar shaping appliance, this is not possible in the feeding plate, and only the patient is allowed to eat.
Cleft palate treatments only:
Only in the cleft palate can food escape into the windpipe of the baby. Although it is recommended to make a nutrition plate in old methods, it is no longer recommended in the current conjuncture. Because nutritional plates are fixed structures, they restrict the development of jaw structures. Instead, the following is recommended by the orthodontist during feeding:
Feeding by placing it on the mother’s chest in an upright position
Taking special long-tipped baby bottles and feeding the baby with them
Avoiding grainy foods
Apart from this, there is nothing to be done or an appliance to be done in cleft palate.

CHILDHOOD (8-10 YEARS) TREATMENTS

In individuals with cleft lip and palate, some of the permanent teeth have erupted at this age. Having these permanent teeth is important for making fixed or removable appliances. Otherwise, the retention of the appliances cannot be ensured.
In this period, the development of the upper jaw, that is, the maxilla, is examined. In individuals with cleft lip and palate, the maxilla may be deviated from normal either in the horizontal direction or in the anteroposterior direction. For this, the following treatments can be applied in the maxilla:
Face mask and maxilla enlargement treatments:
The aim of this treatment is to bring the maxilla forward. The reason why patients are treated at this age is the last age at which the development of the maxilla continues. After these ages, the maxilla completely fuses with the other posterior skull bones and becomes very difficult to move. Another reason is that some of the permanent teeth come out and the face mask provides retention and stability to the intraoral appliance.
In this treatment, there are 2 appliances, a face mask and a hooked hyrax. The intraoral hyrax appliance is fixed to the teeth in the mouth by sticking it with special adhesives. The screw in the middle of this is opened for 2-4 weeks, according to the physician’s decision, and the upper jaw is expanded. Then, elastics are hung on the hooks of the face mask, which is attached to the face from the intraoral hooks of this appliance. These tires pull the maxilla forward, thanks to their flexibility and recovery properties. This allows the maxilla to grow forward.
Although these elastics, which are attached to the mouthpiece from the face mask, initially disturb the child in terms of visual and comfort, the child adapts very quickly (within 1 week) over time. It is very important to wear tires regularly and replace them daily with a new one from the package, as they lose their elasticity within 1 day. After monthly or weekly checks, fixed wires can be switched after adequate correction is achieved. After these procedures, the number of future surgeries of the child with cleft lip and palate may decrease to zero.
After the correction at these ages, the bone cavities are filled by plastic surgeons and the final skeletal result is obtained.
For this reason, skeletal treatment, which starts with nasoalveolar shaping, is concluded with this treatment and repeated surgery gives much better results.

ADOLESCENT (12-14 YEARS) TREATMENTS

In patients with cleft lip and palate, there are either no teeth or severe crowding at the location of the cleft line. At the same time, crowding can be seen in the teeth due to the reflection of jaw disorders on the teeth. For this reason, the teeth should be corrected with fixed devices in order to correct these teeth and restore the aesthetic appearance.

ADMINISTRATION (AGE 18 AND OVER) TREATMENTS

Treatments performed by orthodontists in this period are usually orthognathic surgical preparation treatments after the completion of jaw development. Even if all orthodontic treatment devices are used in the jaws, skeletal problems may still remain. Or, if skeletal treatments are not seen in infancy-childhood, bone structures should be corrected with orthognathic surgery. For orthognathic surgery preparation, all teeth must be arranged and surgical splints must be made showing the amount of jaws being brought forward. These are all procedures performed by the orthodontist. According to surgical splints, surgery is performed and the jaw structures are corrected. After the orthodontic treatment is done for a while after the surgery, the jaw relations are completely corrected.

İkon Diş provides service to its patients with a multidisciplinary approach with its physician staff specialized in different fields of oral and dental health.

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