DR KABERI MAJUMDER BDS, MDS orthodontics in... DR KABERI MAJUMDER BDS, MDS (ORTHODONTICS AND DENTOFACIAL

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  • DR KABERI MAJUMDER BDS, MDS (ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS)

    VISITING ASSISTANT PROFESSOR , SGT UNIVERSITY , INDIA CONSULTANT , M P SHAH HOSPITAL, NAIROBI, KENYA

  • CLEFT INTERDISCIPLINARY TEAM

    1 Post natal general health check up

    pediatrician 10 Dentofacial orthopedics orthodontist

    2 Post natal councelling ( feeding and swallowing issues)

    Counceller/ orthodontist/Ped odontist genetist+ psychiatrist

    11 Maxillary distraction orthodontist

    3 Presurgical orthopedics (NAM) Orthodontist/ pedodontist

    12 Adjunctive orthodontics orthodontist

    4 Lip/nose repair + GPP Maxillofacial/ plastic surgeon

    13 ABG Maxillofacial/ plastic surgeon

    5 Palate repair Maxillofacial/pl astic surgeon +

    14 Comprehensive orthodontics

    orthodontist

    6 Airway breathing issues /ear tube

    ENT surgeon 15 surgical orthodontics + OG Orthodontist + maxillofacial/ plastic surgeon

    7 Speech therapy Speech pathologist

    16 Preprosthetic orthodontics + prosthetic treatment

    Orthodontist + prosthodontist

    8 Phrayngeal flap ENT surgeon/otolary ngologist

    17 Rhinoplasty/ chelioplasty surgeon

    18. Oral physiotherapy Physiotherapist 9 dental treatment pedodontist

  • PRESURGICAL INFANT ORTHOPAEDICS

    ALVEOLAR MOLDING ( AM) NASO ALVEOLAR

    MOLDING ( NAM)UCLP

    BCLP

  • Typical broad flat & cleft nose AFTER NAM

  • Severe BCLP ---infant orthopedic expansion & premaxillary retraction

  • PALATE REPAIR in a neglected cleft case

    5yr old comp palate 3 months post op

  • DECIDUOUS DENTITION (4 to 6 yrs)

    Every 6 months periodic review.

    1. Functional shift 2. space loss 3. oral habit

    Habit breaker in UCLP patient

    Arnold expander

    Protraction spring & space maintainer

  • RETENTION

    Palatal arch with acrylic extension

  • Mixed Dentition 1.Early interceptive orthopedics

    2. Adjunctive orthodontics to prepare for alveolar bone grafting & to support sulcular deepening

    1. . incisor derotation and alignment

    guidance of eruption with space management

    a. Transverse expansion b. Anterior protraction c. Premaxillary intrusion d. Premaxillary medial

    repositioning

  • CORRECTION OF POSTERIOR CROSSBITE / lateral shift of mandible

    Transverse Expansion

    1

  • PREMAXILA PROTRACTION

  • CORRECTION OF ANTERIOR CROSSBITE / Anterior shift of

    mandible

    Maxillary Protraction

    2

  • Maxillary protraction using face mask Chin cup to retract mandible

  • PREMAXILLARY INTRUSION

  • After

    before

    1. ORTHOPEDIC tooth/tissue borne distraction

    2.ORTHODONTIC --segmental alignment & intrusion

    3. SURGICAL lifting with ABG

  • Laterally displaced premaxilla

    1. medial orthopedic repositioning

    2. orthodonticSurgical repositioning

  • Management of the Prominent Premaxilla

    PREMAXILLARY SET BACK

  • Retention

    Fixed palatal arch

    Hawleys’s with pontic

    FR- III

    Rigid retention with springs

    Palatal arch with thick rectangular s.s 16*22 wire

    Surgical/ ABG splint

  • Management of Severe Cleft and Syndromic Midface Hypoplasia BY

    Distraction osteogenesis

  • RIGID EXTERNAL DISTRACTOR(RED)

  • Intraoral maxillary distraction

  • Midpalatal distractor

    Anteroposterior distractor

  • RETENTION

  • RETENTION- LIFE LONG/21 yrs age

  • What to do with fistula? ABG/IDO?

  • Case -1 Category - 2

    Permanent dentition stage

    Age – 12/F

  • Pre treatment – facial photo

  • Pre treatment -- INTRA ORAL

  • PRE TREATMENT RECORDS Lateral cephalogram

    panorex

  • QUADHELIX EXPANSION

  • Conventional preprosthetic orthodontics

  • Post treatment

  • 2 IN 1 RETAINER CUM PARTIAL DENTURE

  • Post treatment records

  • Record Keeping

    (before & after every phase of treatment)

  • Photograhic records- 2D

  • PATIENT -2 CATEGORY -2

    12/F

  • cephalometrics

  • phase I Orthopedic Treatment Facemask and slow expander

    Time taken – 10 months

  • Pre treatment end of orthopedic treatment COMPARISON

  • COMPARISON Expansion by By slow expander

  • END OF PHASE 1 MID -TREATMENT RECORDS

  • Start of phase II adjunctive orthodontic treatment

  • MID TREATMENT RECORD

  • 1.Archwire expansion 2.alignment & derotation of

    incisors 3.Space created to align LI

  • ALVEOLAR BONE GRAFTING ( ABG)

    ILLIAC CREST BONE GRAFT

  • Start Of Conventional Preprosthetic Orthodontics

    CI extracted it was in cleft line. All deci extracted

  • LI alignment continued

  • Post Tt record with completed LI alignment

    OJ - POSITIVE

  • Post treatment record

  • 2 in 1 hawley’s retainer and partial denture

  • Pre treatment end of orthopedic (I) end of orthodontic(II)

  • PATIENT – 3 CATEGORY - 2

    Mixed dentition stage (8/M)

  • Pre treatment

  • Pre treatment

  • Maxillary protraction with facemask

  • PATIENT – 4 CATEGORY - 0

    Mixed dentition stage (9/M)

  • UCL AND ALVEOLAS

    One yr old Two yrs post op

    P O S T O R A T I V E

  • Pre treatment(mixed dentition stage)

  • PRE TREATMENT INTRA ORAL

    MISSING LI( 22)

  • LIFE STARTS WITH CLEFT, IT DOESN’T FINISH WITH IT.

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