Dental procedures for cleft lip and palate patients bring together function and looks

Cleft Palate–Craniofacial Journal — It may look the same, but it doesn’t chew the same. Different dental treatment options for bilateral cleft lip and palate may result in similar esthetic appearance, but they produce definite differences in jaw function. People with clefts of the lip and palate often have dental anomalies as well. The number, shape, and position of teeth can be affected. In particular, the permanent lateral incisor is frequently absent or misshapen.

A study in the November 2010 issue of Cleft Palate–Craniofacial Journal examines two primary treatments for bilateral cleft lip and palate: orthodontic space closure and prosthetic replacement, primarily with resin-bonded bridges. The treatment methods were evaluated on the basis of esthetics and mandibular function. Twenty-seven adult patients in the Netherlands with bilateral cleft lip and palate took part in the study.

In deciding on a treatment, dentists consider the skeletal pattern, tooth size and arch length, and size and color of adjacent teeth. Prosthetic replacement is often preferred to maintain symmetry when incisors are missing or spaced apart and to ensure adequate space for the tongue. Orthodontic space closure is a less costly procedure that can be performed before the end of a patient’s growth. Also, it does not involve adjacent healthy teeth as prosthetic replacement does.

The patients and a professional panel were asked to rate the esthetics of the two procedures. Although approaching the subject from different points of view, the two groups did not find a significant esthetic difference between orthodontic space closure and prosthetic replacement.

The method of treatment did make a difference, however, in the functioning of the jaw. A questionnaire was used to evaluate the patients’ ratings of specific functions. In this evaluation, prosthetic replacements were found to result in significantly more impairment of the jaw.

Full text of the article, “Orthodontic Space Closure Versus Prosthetic Replacement of Missing Upper Lateral Incisors in Patients With Bilateral Cleft Lip and Palate,” Cleft Palate–Craniofacial Journal, Vol. 47 No. 6, November 2010, is available here.

The Cleft Palate–Craniofacial Journal is an international, interdisciplinary journal reporting on clinical and research activities in cleft lip/palate and other craniofacial anomalies, together with research in related laboratory sciences. It is the official publication of the American Cleft Palate–Craniofacial Association (ACPA). For more information, visit http://www.acpa-cpf.org/.