Page 1
DR KABERI MAJUMDER BDS, MDS (ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS)
VISITING ASSISTANT PROFESSOR , SGT UNIVERSITY , INDIACONSULTANT , M P SHAH HOSPITAL, NAIROBI, KENYA
Page 4
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
Page 6
PRESURGICAL INFANT ORTHOPAEDICS
ALVEOLAR MOLDING ( AM)NASO ALVEOLAR
MOLDING ( NAM)UCLP
BCLP
Page 7
Typical broad flat & cleft nose AFTER NAM
Page 8
Severe BCLP ---infant orthopedic expansion
& premaxillary retraction
Page 9
PALATE REPAIR in a neglected cleft case
5yr old comp palate 3 months post op
Page 10
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
Page 11
RETENTION
Palatal arch with acrylic extension
Page 12
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
Page 13
CORRECTION OF POSTERIOR CROSSBITE / lateral shift of mandible
Transverse Expansion
1
Page 15
PREMAXILA PROTRACTION
Page 16
CORRECTION OF ANTERIOR CROSSBITE / Anterior shift of
mandible
Maxillary Protraction
2
Page 17
Maxillary protraction using face mask Chin cup to retract mandible
Page 18
PREMAXILLARY INTRUSION
Page 19
After
before
1. ORTHOPEDIC tooth/tissue borne distraction
2.ORTHODONTIC --segmental alignment & intrusion
3. SURGICAL lifting with ABG
Page 20
Laterally displaced premaxilla
1. medial orthopedic repositioning
2. orthodonticSurgical repositioning
Page 21
Management of the Prominent Premaxilla
PREMAXILLARY SET BACK
Page 22
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
Page 23
Management of Severe Cleft and Syndromic Midface Hypoplasia BY
Distraction osteogenesis
Page 24
RIGID EXTERNAL DISTRACTOR(RED)
Page 25
Intraoral maxillary distraction
Page 26
Midpalataldistractor
Anteroposterior distractor
Page 28
RETENTION- LIFE LONG/21 yrs age
Page 29
What to do with fistula? ABG/IDO?
Page 31
Case -1Category - 2
Permanent dentition stage
Age – 12/F
Page 32
Pre treatment – facial photo
Page 33
Pre treatment -- INTRA ORAL
Page 34
PRE TREATMENT RECORDS Lateral cephalogram
panorex
Page 35
QUADHELIX EXPANSION
Page 36
Conventional preprostheticorthodontics
Page 38
2 IN 1 RETAINER CUM PARTIAL DENTURE
Page 39
Post treatment records
Page 40
Record Keeping
(before & after every phase of treatment)
Page 43
Photograhic records- 2D
Page 44
PATIENT -2CATEGORY -2
12/F
Page 46
phase I Orthopedic TreatmentFacemask and slow expander
Time taken – 10 months
Page 47
Pre treatment end of orthopedic treatmentCOMPARISON
Page 48
COMPARISON Expansion by By slow expander
Page 49
END OF PHASE 1 MID -TREATMENT RECORDS
Page 50
Start of phase II adjunctive orthodontic treatment
Page 51
MID TREATMENT RECORD
Page 52
1.Archwire expansion2.alignment & derotation of
incisors3.Space created to align LI
Page 53
ALVEOLAR BONE GRAFTING ( ABG)
ILLIAC CREST BONE GRAFT
Page 54
Start Of Conventional PreprostheticOrthodontics
CI extracted it was in cleft line. All deci extracted
Page 55
LI alignment continued
Page 56
Post Tt record withcompleted LI alignment
OJ - POSITIVE
Page 57
Post treatment record
Page 58
2 in 1 hawley’s retainer and partial denture
Page 59
Pre treatment end of orthopedic (I) end of orthodontic(II)
Page 60
PATIENT – 3CATEGORY - 2
Mixed dentition stage (8/M)
Page 63
Maxillary protraction with facemask
Page 64
PATIENT – 4CATEGORY - 0
Mixed dentition stage (9/M)
Page 65
UCL AND ALVEOLAS
One yr old Two yrs post op
POST ORATIVE
Page 66
Pre treatment(mixed dentition stage)
Page 67
PRE TREATMENTINTRA ORAL
MISSING LI( 22)
Page 70
LIFE STARTS WITH CLEFT, IT DOESN’T FINISH WITH IT.
Thank you for listening