Management Of Cleft Lip And Palate

Group 4Nur Fatin, Masyitah, Amalina,

Syafiqah, Hanif

A multidisciplinary team approachInvolving: Surgeon Paediatrician/paediatric dentist Orthodontist Speech pathologist Psychologist Cleft coordinator Genetic counselor Audiologist CLAPAM

Dental Team:1.Orthodontist– Concern on the alignment of teeth

2.Paediatric dentist– Concern on the well being of deciduous and

permanent teeth and gingiva

3.Prosthodontist– Replace missing teeth

4.Oral and maxillofacial surgeon– Carry out the surgery procedure

Paediatric Dental Care

1.Infant-toddler2.Primary dentition3.Mixed dentition4.Young permanent dentition

STAGE MANAGEMENTInfant-toddler -Prenatal oral health counseling for parents

-Monitor dental and oral environment, fluoride status, oral habits, OH, diet-Infant oral evaluation: arch form, displacement of arch segment, presence of natal or neonatal teeth

Primary dentition -GOAL: prevention and caries control-Review 3-4x/year-Topical fluoride-Restorative care

Mixed dentition -Prevention against caries, temporary replacement of missing teeth-Eruption of permanent lat. Incisors and maxillary molars-retarded-Ectopic eruption into cleft defect-Parental role-active supervision-ABG (9-11 years old) allow canine eruption-Pre grafting orthodontics-Closure of fistula

STAGE MANAGEMENT Permanent dentition - Care for malformed teeth and replacing missing

teeth-Continuous caries prevention: fluorides, OH, fissure sealants, diet management-Periodontal disease- cleft lip and palate patient predispose to periodontal destruction of teeth adjacent to cleft referral to periodontist-Presurgical orthodontics-Orthognathic surgery (>17 years old) Premaxilla osteotomyLe Fort I maxillary advancement osteotomy+/- mandibular setback (BSSO)

Orthodontics Management

Aims of treatment:• Improved appearances• Improved speech• Improved self image• Functional and stable occlusion

Feeding plate

Alveolar bone graft

Thank you