Korean J Orthod.  2018 Mar;48(2):113-124. 10.4041/kjod.2018.48.2.113.

Orthodontic and orthopedic treatment for a growing patient with Tessier number 0 cleft

• Baek SH
• Park YH
• Chung JH
• Kim S
• Choi JY

• KMID: 2406820
• DOI: http://doi.org/10.4041/kjod.2018.48.2.113

Abstract

The purpose of this case report was to introduce the concept of orthodontic and orthopedic treatment for a growing patient with Tessier number 0 cleft. A 5-year-old boy patient with Tessier number 0 cleft presented congenitally missing maxillary central incisors (MXCI), a bony defect at the premaxilla, a constricted maxillary arch, an anterior openbite, and maxillary hypoplasia. His treatment was divided into three stages: management of the bony defect at the premaxilla and the congenitally missing MXCIs using a fan-type expansion plate, iliac bone grafting, and eruption guidance of the maxillary lateral incisors into the graft area for substitution of MXCIs; management of the maxillary hypoplasia using sequential facemask therapy with conventional and skeletal anchorage; and management of the remaining occlusal problems using fixed orthodontic treatment. The total treatment duration was 15 years and 10 months. Class I canine and Class II molar relationships and normal overbite and overjet were achieved at the end of treatment. Although the long-term use of facemask therapy resulted in significant protraction of the retrusive maxilla, the patient exhibited Class III profile because of continued mandibular growth. However, the treatment result was well maintained after 2 years of retention. The findings from this case suggest that interdisciplinary and customized approaches are mandatory for successful management of maxillary hypoplasia, bony defect, and dental problems in Tessier number 0 cleft. Moreover, considering the potential of orthognathic surgery or distraction osteogenesis, meticulous monitoring of mandibular growth until growth completion is important.

Keyword

Tessier number 0 cleft; Orthodontic treatment; Orthopedic treatment; Growing patient

MeSH Terms

Bone Transplantation
Child, Preschool
Humans
Incisor
Male
Maxilla
Molar
Open Bite
Orthognathic Surgery
Orthopedics*
Osteogenesis, Distraction
Overbite
Transplants

Figure

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  Figure 1 Original condition of Tessier number 0 cleft before cheiloplasty. A, Facial photographs obtained just before cheiloplasty at 7 months of age. B. Computed tomography images obtained at 3 months of age.

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  Figure 2 Facial and intraoral photographs obtained at the initial visit (5 years and 0 month of age).

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  Figure 3 Lateral and postero-anterior cephalograms and a panoramic radiograph obtained at the initial visit (5 years and 0 month of age).

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  Figure 4 Maxillary expansion and iliac bone grafting (IBG). A, Intraoral photographs obtained before and after maxillary expansion using a fan-type expansion plate (left, 5 years and 0 month of age; right, 7 years and 2 months of age). B, Panoramic radiograph obtained after IBG.

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  Figure 5 Facial and intraoral photographs obtained during orthopedic treatment using a conventional facemask with tooth-borne anchorage (labiolingual arch; 8 years and 5 months of age).

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  Figure 6 Intraoral photographs obtained after bonding of a fixed orthodontic appliance in the maxillary arch (12 years and 1 month of age).

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  Figure 7 Intraoral photographs obtained after bonding of a fixed orthodontic appliance in the mandibular arch (19 years and 2 months of age).

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  Figure 8 Facial and intraoral photographs obtained after debonding (21 years and 0 month of age).

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  Figure 9 Lateral cephalogram, postero-anterior cephalogram, and a panoramic radiograph obtained after debonding (21 years and 0 month of age).

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  Figure 10 Facial and intraoral photographs obtained after 2 years of retention (23 years and 0 month of age).

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  Figure 11 Lateral cephalogram obtained after 2 years of retention (23 years and 0 month of age, left) and superimposition of the lateral cephalograms obtained after debonding and that obtained after 2 years of retention (right). Solid line, debonding; dotted line, 2 years of retention.

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  Figure 12 Sequential lateral cephalograms and their superimpositions. A, Sequential lateral cephalograms obtained during various stages of treatment. B, Superimposition of cephalograms to depict changes between each stage. Initial, Initial visit; stage 1, 3 months after iliac bone grafting; stage 2, mid-term use of a facemask with miniplate anchorage; stage 3, debonding.

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