Presurgical orthopaedic treatment of newborns with clefts--functional treatment with long-term effects
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Rosemarie Grabowski1, Helfried Kopp, Franka Stahl
1Department of Orthodontics, University of Rostock, Germany. rosemarie.grabowski@uni-rostock.de
Insights
Presurgical orthopedic treatment for cleft lip, alveolus, and palate guides maxillary growth, achieving near-normal dental arch development and occlusion in young adults. This protocol aids complex rehabilitation by reducing cleft size and promoting physiological development.
Area of Science:
- Orthodontics and Maxillofacial Surgery
- Craniofacial Development
- Pediatric Rehabilitation
Background:
- Cleft lip, alveolus, and palate (CLAP) require complex, multidisciplinary rehabilitation.
- Early intervention is crucial for optimizing craniofacial growth and dental arch development.
- Long-term outcomes of presurgical orthopedic interventions in CLAP patients are essential to evaluate.
Purpose of the Study:
- To present an orthopaedic/orthodontic treatment protocol for complex rehabilitation of CLAP patients.
- To evaluate the long-term results of maxillary development and occlusion in young adults treated with this protocol.
- To assess the efficacy of presurgical orthopaedic treatment in reducing cleft size and guiding growth.
Main Methods:
- A cohort of 43 newborns with unilateral or bilateral CLAP was followed.
- Maxillary dental casts were analyzed before and after presurgical orthopaedic treatment, and at young adult age.
- Occlusion was studied in adults, correlating outcomes with therapeutic interventions.
Main Results:
- Presurgical orthopaedic treatment effectively reduced cleft width by leveraging natural growth processes.
- Upper dental arch development in treated children aged 3-4 years aligned with non-cleft controls.
- Long-term follow-up indicated positive maxillary development and occlusion in young adults.
Conclusions:
- Maxillary growth can be guided toward physiological norms in CLAP patients through early functional orthopaedic therapy (ages 1-12 months).
- A combination of functional orthopaedic therapy and tissue-preserving surgical techniques is key.
- This protocol facilitates complex rehabilitation, improving long-term craniofacial and occlusal outcomes.
Aim:
Presentation of an orthopaedic/orthodontic treatment protocol within the framework of complex rehabilitation of patients with clefts of lip, alveolus and palate. Presurgical orthopaedic treatment aims at reduction of cleft size by guiding growth and functional rehabilitation. Long-term results of maxillary development and occlusion at young adult age are reported.
Patients And Methods:
43 newborns with unilateral (19) or bilateral (24) clefts of lip, alveolus and palate were examined until their deciduous dentition was complete. In 29 patients a late follow-up was performed at age 17.3 years (mean). Maxillary dental casts were evaluated prior to and following presurgical orthopaedic treatment at the time the deciduous dentition was complete and at young adult age (2 to 5 years after termination of orthodontic treatment). Parameters were width of the alveolar and palatal cleft as well as width and length of the dental arch. In the adults occlusion was studied and the occlusal outcome was related to the therapeutical input.
Results:
Presurgical orthopaedic treatment reduced the cleft width by taking advantage of normal growth. At the age of 3 to 4 years the development of the upper dental arch was in line with that of non-cleft children.
Conclusion:
Maxillary growth may be guided in almost physiological terms even in patients with a cleft of lip, alveolus and palate. Prerequisite is functional rehabilitation by means of orthopaedic treatment at age 1 to 12 months in terms of functional orthodontic therapy and a surgical protocol saving tissues with growth potential.
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