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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

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

VISITING ASSISTANT PROFESSOR , SGT UNIVERSITY , INDIACONSULTANT , 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/Pedodontist 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/plastic 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/otolaryngologist

17 Rhinoplasty/ chelioplasty surgeon

18. Oral physiotherapy Physiotherapist9 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 shift2. space loss3. 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 protractionc. Premaxillary intrusiond. 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

Midpalataldistractor

Anteroposterior distractor

RETENTION

RETENTION- LIFE LONG/21 yrs age

What to do with fistula? ABG/IDO?

Case -1Category - 2

Permanent dentition stage

Age – 12/F

Pre treatment – facial photo

Pre treatment -- INTRA ORAL

PRE TREATMENT RECORDS Lateral cephalogram

panorex

QUADHELIX EXPANSION

Conventional preprostheticorthodontics

Post treatment

2 IN 1 RETAINER CUM PARTIAL DENTURE

Post treatment records

Record Keeping

(before & after every phase of treatment)

Photograhic records- 2D

PATIENT -2CATEGORY -2

12/F

cephalometrics

phase I Orthopedic TreatmentFacemask and slow expander

Time taken – 10 months

Pre treatment end of orthopedic treatmentCOMPARISON

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 expansion2.alignment & derotation of

incisors3.Space created to align LI

ALVEOLAR BONE GRAFTING ( ABG)

ILLIAC CREST BONE GRAFT

Start Of Conventional PreprostheticOrthodontics

CI extracted it was in cleft line. All deci extracted

LI alignment continued

Post Tt record withcompleted 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 – 3CATEGORY - 2

Mixed dentition stage (8/M)

Pre treatment

Pre treatment

Maxillary protraction with facemask

PATIENT – 4CATEGORY - 0

Mixed dentition stage (9/M)

UCL AND ALVEOLAS

One yr old Two yrs post op

POST ORATIVE

Pre treatment(mixed dentition stage)

PRE TREATMENTINTRA ORAL

MISSING LI( 22)

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

Thank you for listening