Indian Dental Academy: will be one of the most relevant and exciting
training center with best faculty and flexible training programs
for dental professionals who wish to advance in their dental
practice,Offers certified courses in Dental
implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic
Dentistry, Periodontics and General Dentistry.
Introduction, definition-tongue thrusting, types,etiology, clinical features, types of swallow, habits contributing to tongue thrusting, buccinator mechanism, case history, diagnosis- informal,formal observation, examination, treatment-muscle exercises, various appliances, mechanism of action of appliances, prevalence, articles, reference.
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.for more details please visit
www.indiandentalacademy.com
Introduction, definition-tongue thrusting, types,etiology, clinical features, types of swallow, habits contributing to tongue thrusting, buccinator mechanism, case history, diagnosis- informal,formal observation, examination, treatment-muscle exercises, various appliances, mechanism of action of appliances, prevalence, articles, reference.
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
Frankles appliance Is a myofunctional appliance
Functional appliance are removable or fixed appliances that aim to utilize eliminate or guide the forces arising from muscle function,tooth eruption and growth inorder to alter skeletal and dental relationship
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
Evolution of orthodontic appliances /certified fixed orthodontic courses by I...Indian dental academy
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.
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.
AGE FACTORS IN ORTHODONTICS
An important consideration in orthodontic diagnosis and treatment planning is the age of the patient. In addition age factors influence the treatment mechanics and prognosis.
There are certain features which are normal to a child, however if present in an adult would constitute malocclusion. These malocclusions need no treatment at that age as they get corrected automatically as the age advances.
The chronological age may sometimes be misleading and may not reflect the exact growth status. Thus skeletal and dental ages of the patient should be ascertained for a more accurate diagnosis.
Functional malocclusion /certified fixed orthodontic courses by Indian dent...Indian dental academy
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
00919248678078
Rme slide /certified fixed orthodontic courses by Indian dental academy Indian dental academy
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
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.for more details please visit
www.indiandentalacademy.com
Frankles appliance Is a myofunctional appliance
Functional appliance are removable or fixed appliances that aim to utilize eliminate or guide the forces arising from muscle function,tooth eruption and growth inorder to alter skeletal and dental relationship
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
Evolution of orthodontic appliances /certified fixed orthodontic courses by I...Indian dental academy
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.
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.
AGE FACTORS IN ORTHODONTICS
An important consideration in orthodontic diagnosis and treatment planning is the age of the patient. In addition age factors influence the treatment mechanics and prognosis.
There are certain features which are normal to a child, however if present in an adult would constitute malocclusion. These malocclusions need no treatment at that age as they get corrected automatically as the age advances.
The chronological age may sometimes be misleading and may not reflect the exact growth status. Thus skeletal and dental ages of the patient should be ascertained for a more accurate diagnosis.
Functional malocclusion /certified fixed orthodontic courses by Indian dent...Indian dental academy
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
00919248678078
Rme slide /certified fixed orthodontic courses by Indian dental academy Indian dental academy
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
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.
Cleft lip and palate /certified fixed orthodontic courses by Indian dental ac...Indian dental academy
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
At the end of this lecture, students should be able to:
Develop an understanding terms Cleft lip & Palate
Develop an understanding of incidence of the condition
Describe the etiology and pathogenesis
Describe classification and dental implications
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.for more details please visit
www.indiandentalacademy.com
Miltidisciplinary approach fo rehabilitation of cleft lip & palate/cosmet...Indian dental academy
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
Cleft lip & Palate /certified fixed orthodontic courses by Indian dental acad...Indian dental academy
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
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.
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.for more details please visit
www.indiandentalacademy.com
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
Orthodontic management of cleft lip and palate /certified fixed orthodontic ...Indian dental academy
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
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
Similar to ClEFT LIP AND PALATE / DENTAL COURSES (20)
Opportunity for Dentists (BDS/MDS )to relocate to United kingdom -Register as a DENTAL HYGIENIST/ DENTAL THERAPIST without Board exams and after approval you can register in GDC as a DH/DT and start working as a DH/DT Immediately and get paid.
You can complete the whole process in 3-4 months.Salary range for DH/DT is around 2500-3500 Pounds per month.
Eligibility / requirements-
1. An International English Language Testing System (IELTS) certificate
at the appropriate level.(Within 2 yrs of application date )
2: A recent primary dental qualification that has been taught and examined in English..(Within 2 yrs of application date )
3: A recent pass in a language test for registration with a regulatory authority in a country where the first language is English.
If you are interested Please contact us for more details.
1ST, 2ND AND 3RD ORDER BENDS IN STANDARD EDGEWISE APPLIANCE SYSTEM /Fixed ort...Indian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals
who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry,
Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
I –Aligners are made with FDA approved transparent thermoplastic materials using 3D scanning, 3D Printing and finally Trays with Pressure vacuum formers.
Dear Doctor,
Indian Dental Academy Now offers comprehensive online Orthodontics course.
Course includes:
1.whiteboard lecture presentations
2.Case Discussions
3.with hundreds of pictures.
4.Demo on Models
5.Demo on Patients
6. subtitles in your own language
12 months unlimited access and support @350 USD only.
For Demo please visit :www.idalectures.com/preview/
For more details visit: www.idalectures.com
Please contact us for any clarifications:
idalectures@gmail.com
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Thanks & Regards
Indian Dental Academy
--
Indian Dental Academy
Leader in continuing dental education
www.indiandentalacademy.com
skype:indiandentalacademy
+919248678078
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...Indian dental academy
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.for more details please visit
www.indiandentalacademy.com
Diagnosis and treatment planning in completely endntulous arches/dental coursesIndian dental academy
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.for more details please visit
www.indiandentalacademy.com
Properties of Denture base materials /rotary endodontic coursesIndian dental academy
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.for more details please visit
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Use of modified tooth forms in complete denture occlusion / dental implant...Indian dental academy
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
4. Habilitation of cleft lip
and palate patient
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.com
6. History
• Hippocrates (400 BC) and Galen (150
AD) mentioned cleft lip, but not cleft
palate.
• For centuries, perforations of palate
were considered secondary to syphilis
• Cleft palate recognized as a congenital
disorder in 1556, by Fanco.
www.indiandentalacademy.com
7. History
• The first successful closure of a soft
palate defect was reported in 1764 by
LeMonnier, a French dentist.
• The first closure of the hard palate was
performed in 1834 by Dieffenbach.
• In the 1930's, Kilner and Wardill
independently developed the "pushback"
procedure.
www.indiandentalacademy.com
8. Embryology
"It is not birth,
marriage, or
death, but
gastrulation, which
is truly the most
important time in
your life."
Lewis Wolpert
(1986)
www.indiandentalacademy.com
11. Etiopathogenesis
• Clefts of lip and palate may be
isolated deformities or may be part
of a syndrome
• Non syndromic clefts are
multifactorial in origin
www.indiandentalacademy.com
13. Some of the more common syndromes
associated with CL/P
• Chromosomal
– Trisomy 13
– Trisomy 18
– Velocardiofacial
syndrome (22q11
deletion)
• Non-Mendelian
– Pierre Robin syndrome
– CHARGE association
– Goldenhar syndrome
• Teratogenic
– Fetal alcohol syndrome
– Fetal phenytoin syndrome
– Fetal valproate syndrome
• Mendelian disorders
– Ectrodactyly-eetodermal
dysplasia-clefting syndrome (AD)
– Gorlin syndrome (AD)
– Oto-palato-digital syndrome (XL)
– Oral-facial-digital syndrome (XL)
– Smith-Lemli-Opitz syndrome
(AR)
– Stickler syndrome (AD)
– Treacher Collins syndrome (AD)
– Van der Woude syndrome (AD)
• Unknown
– de Lange syndrome
– Kabuki syndrome
www.indiandentalacademy.com
14. Incidence
• Best data given by Fogh-anderson 1943,
Jensen et al 1988 denmark, 1.45/1000
live births in 1942 to 1.89/1000 in 1981.
• Racial difference:
American Indians 3.7/ 1000
Japanese 2.7/1000
Maoris & Chinese 2.0/1000
Caucasians 1.7/1000
Blacks 0.4/1000 ( Vanderas 1987)www.indiandentalacademy.com
15. • Cl(P) male : female :: 2 : 1
• Unilateral cleft, right : left :: 1 : 2
• CP alone 1/500 live births, greater in females
• Cleft deformities of all races grouped
50% CL(P)
30 – 35 % CP
15 – 20 % CL alone
Incidence
www.indiandentalacademy.com
16. Complications
• Apart from deficient esthetics, patients
with cleft palate may have the following
complications:
Abnormal midface development,
Velopharyngeal incompetence,
Speech defects, and
Abnormal eustachian tube function.
www.indiandentalacademy.com
17. • Disturbances in function of mastication,
swallowing, speech, respiration & facial
expression
• Abnormal patterns of facial growth
Premaxilla protrusion
Medial position of maxillary segments
Reduced maxillary development
Apparently large mandible
Open gonial angle
Low tongue posture
Anterior open bitewww.indiandentalacademy.com
18. Classification
• Early attempts at classification by
Davies & Ritchie in 1922
Veau in 1931
• Fogh-Anderson in 1942 studied incidence of
CL(P) in Denmark
a. Hare lip including alveolus as far back as incisive
foramen
b. Hare lip & CP
c. Isolated clefts of palate as far forward as incisive
foramen
www.indiandentalacademy.com
19. Kernahan and Stark's classification
of clefts (1958)
Clefts of primary palate only
• Unilateral (right or left)
– Complete
– Incomplete
• Median
– Complete (premaxilla absent)
– Incomplete (premaxilla
rudimentary)
• Bilateral
– Complete
– Incomplete
Clefts of secondary palate
only
– Complete
– Incomplete
– Submucous
Clefts of primary and
secondary palate
• Unilateral (right or left)
– Complete
– Incomplete
• Median
– Complete
– Incomplete
• Bilateral
– Complete
– Incomplete
www.indiandentalacademy.com
23. Cleft lip and palate team
Social
worker
Pediatric
psychiatrist
Geneticist
Prosthodontist
Speech
pathologist
Orthodontist
Otolaryngologist
Pedodontist
Plastic
surgeon
Pediatrician
Team
approach
www.indiandentalacademy.com
24. Role of prosthodontist in
CL(P) management
• Replacement of teeth and other missing
anatomic structures
• Stabilization of cleft maxillary segments
• Retention of tooth position
• Camouflage for inadequate treatment
www.indiandentalacademy.com
25. Management
• Diagnosis
• Parent counselling
• Presurgical orthopedics
• Primary surgery
• Pedodontic and preventive care
• Speech development, assessment, early
intervention and treatment
www.indiandentalacademy.com
26. Management
• Assessment and surgical management of
velopharyngeal incompetance
• Orthodontics
• Secondary surgery of lip, nose, palatal fistulae
• Alveolar bone grafting
• Orthognathic surgery
• Restorative dental treatment
• Management of treatment failures
www.indiandentalacademy.com
28. Diagnosis and examination
• Intrauterine
- Sonographic diagnosis
- Karyotyping
• Post partum
- Clinical
- Radiographic (intra and extraoral,
cineradiography, laminography, pantography)
- Additional aids (speech and sound recording,
measurement of nasal and oral pressures,
psychiatric examination)
www.indiandentalacademy.com
29. Prenatal, perinatal & postnatal
parental counselling
• Requisites
Accurate information should be given by an
expert in the field
Support must be available soon after diagnosis
Parents and members of family given
opportunity to express concern and emotional
response
www.indiandentalacademy.com
30. Prenatal, perinatal & postnatal
parental counselling
Give a clear view of how the baby is likely to
look
Discussion on pregnancy termination based
on accurate information
Promote early adjustment and acceptance of
the baby by the parents and family
Long term dependence on counselor should
be avoided and normalization of family life
should be encouraged
www.indiandentalacademy.com
32. Early feeding management
• The most immediate problem caused by a cleft lip
or palate is likely to be difficulty with feeding.
• Many babies with a cleft lip can breastfeed.
However, some have difficulty in forming a vacuum
in order to suck properly.
• Babies with these problems may need a special
teat and bottle that allows milk to be delivered to
the back of the throat where it can be swallowed.
www.indiandentalacademy.com
33. Early feeding management
• A more upright feeding position controls nasal
regurgitation
• In infants with failure to thrive because of cardiac
problems, laryngospasm, gastric tube feeding is
adviced.
• Under these conditions small prosthesis to obturate
cleft is indicated to encourage oral feeding,
presently considered largely unhelpful.
• Babies who find it difficult to feed may gain weight
slowly at first, but have usually catch up by the time
they are six months old.
www.indiandentalacademy.com
34. Pre surgical orthopedics
• Principal aim is
to realign the
bony elements
of the cleft to
provide a more
normal base for
surgery
Bulb held by bonnet straps
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36. Primary surgery
Clefts of primary palate
• Timing of surgery
Arbitrary criteria :
1. The child must be free of any systemic or
local disease
2. Child must have a minimum weight of 7 lb
3. The child must be in a weight gaining phase
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45. • Position of
obtained maxillary
segments is not
lasting as dental
crossbite is
incidental as long
as bone continuity
in the upper arch is
not established
10 years 16 years
• Children with bilateral cleft ,
premaxilla is prominent at this age.
• Lateral incisors may be in the cleft
and must be preserved
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46. • Parents must be instructed in preventive
dental practices
• Fistulae of palate or labial sulcus may be
present
• For palatal fistulae simple Hawley type
prosthesis may be delivered for speech
improvement
• Repositioning of cleft segments seldom
necessary before permanent incisors erupt
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48. • Treatment should be designed to secure
optimal vertical height of maxilla, position
of teeth and arch form
• Lateral incisors are most commonly
missing
• Supernumerary teeth may be present
adjacent to cleft, their prognosis is
determined & extracted
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49. • Premolar teeth when
absent complicates
development of an
adequate upper arch
• Appliances used to
reposition maxillary
segments
• Speech and hearing
evaluation
• Secondary revision of
lip, nose, palate
considered
Use of quad helix for
arch expansion
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51. • Orthodontic treatment initiated to achieve
– Normal positioning of maxillary segments
– Adequate vertical development of maxilla
– Alignment of teeth for efficient occlusion
– Esthetics
– Positioning of teeth to permit conservative
prosthodontic replacement of missing teeth
• Orthodontist and prosthodontist must be in
consultation in later part of treatment
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52. • When canine final positioning has been
attained, permanent stabilization of the arch
by establishing bone continuity considered
• Bone grafting accomplished safely at 14 – 16
years
– Inlay grafts
– Onlay grafts
– Combination
• Prosthdontic replacement of missing teeth
can be carried out
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53. • Removable dentures given to maintain space
and esthetics
• Fixed prosthesis, implants planned in late
adolescence
• Final cosmetic revision of lip and nose may be
planned in late adolescence
• Considerations given for orthognathic
surgery to improve esthetics by correcting
skeletal malrelationship
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58. • Some patients may not have received
optimum treatment and may require
removable prosthesis to camouflage
collapsed segments and reduced vertical
development of maxilla
• Use of pharyngeal obturator to aid speech
• Edentulous cleft patient represents a
failure in habilitation
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60. Indications of prosthesis
• In unoperated patients
– Wide cleft with deficient soft palate
– Wide cleft of hard palate
– Neuromuscular deficiency of soft palate and
pharynx
– Delayed surgery
– Expansion prosthesis to improve spatial
relationships
– Combined prosthesis and orthodontic appliance
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61. • In operated patients
– An incompetant paltopharyngeal mechanism
– Surgical failures
• Contraindications for prosthesis
– Surgical repair is feasible
– Mentally retarded patient
– Uncooperative child and parents
– Rampant caries
– Lack of prosthodontic training or skill
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62. Premaxilla Positioning Appliance
• In the case of a complete
bilateral cleft lip, the
premaxilla and prolabium
are protrusive and rotated
upward.
• This makes surgical repair
difficult because the clefts
may be wide and there
would be excessive tension
along the suture lines of
the surgically corrected lip.
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63. Premaxilla Positioning
Appliance
• The premaxilla
positioning appliance
(Reisberg et al., 1988;
Figueroa et al., 1996)
is a nonsurgical
technique that
retracts and rotates
the malposed segment
to a more favorable
position for lip repair.
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64. Nasal Conformer
• Surgical repair of a cleft lip can result in a
flattened contour of the nasal alar cartilage.
• Aside from the cosmetic deformity this presents,
it can also contribute to nasal airway obstruction.
• Often the patient must have a corrective surgical
procedure at a later age.
• Grayson et al. (1999) has described the use of a
nasal orthopedic molding appliance to minimize or
avoid this problem.
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65. Articulation Development
Prosthesis
• Repair of a cleft palate is performed by 1 year of age
in order to minimize speech articulation abnormalities
(Dorf and Curtin, 1982).
• However, in some cases surgical repair must be
deferred. This may be due to an excessively wide
cleft or a compromising medical condition that
precludes surgery at that time.
• An articulation development prosthesis (Dorf et al.,
1985) is used to prosthetically create a normal palate
for speech development until the surgical repair can
be performed. www.indiandentalacademy.com
66. • This resin plate covers the gum pads and palate
area but does not extend into the cleft. This
design permits appositional growth at the cleft
margins.
• The prosthesis is retained with denture adhesive
and is worn continuously except for cleaning
several times a day.
• The prosthesis will not impede the eruption of
teeth, and if any teeth are already present, it can
be designed to circumvent them.
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67. Palatal Obturator
• Even after cleft palate surgery residual oronasal
communication may occur on the palate or in the
alveolar ridge or labial vestibule.
• It usually does not cause a problem for feeding, but
speech may be affected.
• A palatal obturator covers the opening and contributes
to normal speech production.
• It eliminates hypernasality and assists speech therapy
for correction of compensatory articulations.
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68. Palatal Obturator
• The prosthesis consists of a resin palatal plate with
retention clasps of stainless steel orthodontic wire.
• If any teeth are congenitally missing, they can be
attached to the plate to improve articulation and
appearance.
• This prosthesis is often used as an interim measure
until the residual communication can be surgically
closed.
• If the oronasal opening cannot be surgically repaired,
the palatal obturator may serve as a definitive
treatment.
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71. Palatopharyngeal Obturator/
speech bulb
• Velopharyngeal insufficiency occurs when a cleft palate
is unrepaired or when a surgically repaired soft palate
is too short to make contact with the pharyngeal walls
during function.
• There is excessive nasal airflow and inadequate oral
pressure for normal speech.
• There may also be nasal regurgitation during feeding.
• A palatopharyngeal obturator provides velopharyngeal
closure and contributes to normal function.
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72. Palatopharyngeal Obturator/
speech bulb
• The palatal portion of this resin plate covers the hard
palate and is attached to several teeth with wire
clasps. This serves to retain and stabilize the
prosthesis.
• The velar portion extends into the pharyngeal area at
the level of the palatal plane and seals the nasal cavity
from the oropharynx during function.
• This prosthesis is most often used as an interim device
until corrective surgery can be performed.
• It may serve as the definitive therapy when no further
surgery is planned.
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74. Palatal Lift
• Velopharyngeal incompetency occurs when the
surgically repaired soft palate is of adequate
length but of inadequate mobility to elevate to
achieve velopharyngeal closure.
• A palatal lift prosthesis covers the hard palate and
extends posteriorly to engage the soft palate and
physically elevate and extend it to the proper
position to achieve closure
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75. • This prosthesis is most effective when the soft palate has
little muscle tone and offers little resistance to elevation.
• Adequate retention must be achieved at the palatal
portion by clasping multiple teeth.
• A pharyngoplasty or pharyngeal flap surgical procedure
may correct this problem.
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81. Tooth Replacement /
Restorative treatment
• Congenitally missing anterior teeth are common in cleft
patients.
• The lateral incisors are missing most often, but cuspids
and central incisors may also be affected.
• If not missing, these teeth may be malformed and
malposed.
• The bone support of teeth adjacent to the cleft is
usually compromised. In bilateral clefts, the bone
quality of the premaxilla is poor, which jeopardizes the
central incisors.
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82. • Edentulous spaces in which
teeth are congenitally
missing can be closed
orthodontically or
surgically during an
orthognathic procedure.
• Then tooth replacement is
not necessary.
• Most commonly, the cuspid
is moved to the position at
which the lateral incisor
would be and the premolar
is moved to the cuspid
position.
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83. • When edentulous cleft site is not closed
orthodontically or surgically, some type of
prosthetic treatment is required
• Options for tooth replacement
include
– a fixed or
– removable partial denture or
– a dental implant
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84. Removable prosthesis
• A removable partial denture is most
often used as a temporary form of
tooth replacement.
• Although it can provide good esthetics,
portions of the prosthesis must rest on
soft tissues of the palate and can cause
irritation.
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85. Removable prosthesis
• There may be movement of the prosthesis
during function.
• The fact that it is removable accentuates
its artificial character, which is a common
objection from patients.
• It is used only as a definitive means of
tooth replacement, where multiple teeth are
missing and the edentulous space is too long
to be spanned by a fixed restoration.
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87. Fixed prosthesis
• A fixed partial denture
attaches to teeth on each
side of the edentulous
space to provide a more
natural tooth replacement.
• If the abutment teeth
need no other restoration,
then a resin bonded fixed
partial denture can be
used.
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88. • Alternatively, a
conventional fixed partial
denture can be used.
• Like the resin-bonded
prosthesis, function and
esthetics are excellent.
Long-term success is
more predictable.
• In patients where bone
grafting has not been
done a fixed removable
Andrews type of
restoration may be used
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89. Dental implants
• If adequate volume of bone exists in
the edentulous space, tooth
replacement can be achieved using
dental implants.
• A titanium alloy analog of a tooth root is
surgically placed in the bone at the site
of the missing tooth.
• This can be placed in natural bone or at
a bone-grafted site.
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90. • This restores the
dental arch to the
most natural state,
provides excellent
function and
appearance, and does
not require the
involvement of
adjacent natural teeth.
• Major limitation :
finding adequate bone
of good quality
particularly in the line
of cleft, bone grafting
improves success
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92. The Future of Prosthetics
• There are currently many exciting areas of
research that will impact on prosthetic
habilitation.
• In utero corrective surgery, the use of bone
morphogenic protein, and tissue and genetic
engineering will eventually play a significant
role in the care of the cleft/craniofacial
patient in general and on prosthodontics and
prosthetics in particular.
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95. References
• Management of cleft lip and palate. Watson,
Sell and Grunwell
• Maxillofacial rehabilitation. Beumer, Curtis &
Fritell
• Maxillofacial prosthetics. Chalian VA, Drane
JB, Standish SM
• Cleft lip and palate. Grabb, Rosenstein and
Bzoch
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96. References
• Doddamani S, Patil RA, Nerli S. Multidisciplinary
approach for improving esthetics in cleft palate
and alveolus patient: A clinical report. JIPS
2005; 5: 39 – 42
• Reisberg DJ. Dental and Prosthodontic Care for
Patients With Cleft or Craniofacial Conditions.
The Cleft Palate-Craniofacial Journal: Vol. 37,
No. 6, pp. 534–537.
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97. References
• Abadi BJ, Johnson JD.
The prosthodontic management of cleft palate
patients.
J Prosthet Dent. 1982 Sep;48(3):297-302.
• Mazaheri M. Prosthodontics in cleft palate
treatment and research. J Prosthet Dent 1964;
14: 1146
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98. References
• Immekus JE, Armany M. a fixed removable
partial denture for cleft palate patients. J
Prosthet Dent 1975; 34: 286
• Arcuri MR. Implant supported prosthesis for
treatment of adults with cleft palate. J
Prosthet Dent 1994; 71: 375
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99. References
• Aram A, Subtelny JD. Velopharyngeal function
and cleft palate prosthesis. J Prosthet Dent
1959; 9: 149
• Dalston RM. Prosthodontic management of the
cleft palte patient: A speech pathologist’s view. J
Prosthet Dent 1977; 37: 190
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100. Thank you
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