Cleft in orthodontics /certified fixed orthodontic courses by Indian dental academy
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats. Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics, Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call 0091-9248678078
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Cleft in orthodontics /certified fixed orthodontic courses by Indian dental academy
- 1. CLEFT LIP & PALATE IN ORTHODONTICS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandenacademy.com
- 2. Introduction • Surgical repair alone cannot solve the multiple problems encountered with the deformities that result from clefts of the lip and palate. • The Challenge – – creation of an aesthetically acceptable correction of the deficient columella and the deformity of the nasal cartilages – continuity of the vermillion border of the lips. www.indiandenacademy.com
- 3. Modern Pre-surgical orthopaedics • Active and passive appliances • 1950 Mc neil- used acrylic appliance adapted to cleft • 1964-Pruzansky opposed presurgical orthopaedicsbelieved spontaneous repositioning of premaxilla followed lip repair • 1971-Georgiade placed acrylic expansion plate into maxillary segments. 2-3 weeks premaxilla was brought into position www.indiandenacademy.com
- 4. Pre-surgical orthopaedics • 1980- Latham used pin retained variety • Split appliance secured to palatal segments with pins in interosseous position in horizontal processes of maxillary bone • Steel bar from one tuberosity to another • Movable metal arms along each alveolar ridge • 1 inch activation screw placed anteroposteriorly in cleft www.indiandenacademy.com
- 5. Anatomy of UCLP • Nasal floor communicates with oral cavity • Maxilla on cleft side is hypoplastic • Columella is displaced to normal side • Nasal ala on cleft side is laterally, posteriorly, and inferiorly displaced • Lip muscles insert into ala and columella www.indiandenacademy.com
- 6. Objectives of Pre-surgical orthopaedics • To align and approximate the intra alveolar segments • To correct the malpositioned nasal cartilages. • In addition the correction of the position of the philtrum and columella are performed. www.indiandenacademy.com
- 7. The Impression Technique • Primary impression – temporary tray adapting wax over the gumpads • Addition Silicon Impression Material • Custom acrylic trays • Hospital setting • ALGINATE NOT USED www.indiandenacademy.com
- 8. Molding Plate • clear acrylic resin • surgical adhesive tapes that are applied externally • modified at weekly intervals to gradually approximate the alveolar segments and to reduce the size of the intraoral cleft gap • plate also acts as an obturator www.indiandenacademy.com
- 9. Taping • tight apposition of lip segments with micropore tape, results in the orthopaedic benefits of the traditional lip adhesion without the consequent scar • combined with the moulding plate produces controlled movement of the anterior alveolar segments www.indiandenacademy.com
- 10. Nasal Stent • gradual additions of small amounts of acrylic resin, the stent is positioned inside the nose underneath the apex of the alar cartilage on the cleft side • Moulding the shape of the – cartilaginous septum – alar cartilage tip – medial and lateral crus www.indiandenacademy.com
- 15. Molding Plate & Taping www.indiandenacademy.com
- 23. Molding Plate & Taping www.indiandenacademy.com
- 27. Pre – Post Comparisons www.indiandenacademy.com
- 28. Advantages of PNAM • • • • • Helps guide alveolar segments - almost normal position, prior to surgery. Reduction of the cleft gap width facilitates the primary gingivo-periosteal closure of the defect- greater probability that a complete osseous bridge will form when the cleft width is reduced. Reduces the formation of scar tissue and produces more consistent postoperative results. Eliminates the need for secondary 'surgical' columella elongation and the accompanying scars at the lip columella junction. Reduces the number and extent of surgeries that a cleft patient will undergo during a lifetime. www.indiandenacademy.com
- 29. Complications that may occur • Soft tissue breakdown - excessive modification of the appliance - force application exceeds the tissue tolerance • Area of ulceration intraorally or on the nasal lining • If parents fail to apply tape and elastics during the molding, then the appliance will not adequately be retained during the course of treatment, and progress would be lost. • If the appliance is lost or not worn, a cleft gap that had been closed early during molding therapy may widen again as the infant places its tongue into the cleft. www.indiandenacademy.com
- 30. Conclusion • PNAM remains a controversial part of comprehensive care for cleft lip and palate patients – helps to decrease the tension between the tissues – help to bring about better aesthetic results post surgically • Decreased scarring can also contribute to better growth and decrease the dento-alveolar effects of cleft surgeries at a young age. www.indiandenacademy.com
- 31. www.indiandentalacademy.com Leader in continuing dental education www.indiandenacademy.com