Korean J Orthod.  2019 Jan;49(1):59-69. 10.4041/kjod.2019.49.1.59.

Long-term stability after multidisciplinary treatment involving maxillary distraction osteogenesis, and sagittal split ramus osteotomy for unilateral cleft lip and palate with severe occlusal collapse and gingival recession: A case report

Affiliations
  • 1Orthodontic Science, Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan. skokai.orts.paper@gmail.com
  • 2Private Practice, Yokohama, Japan.
  • 3Department of Oral and Maxillofacial Surgery, Yokohama City University Medical Center, Yokohama, Japan.
  • 4Department of Plastic and Aesthetic Surgery, Kitasato University, School of Medicine, Kanagawa, Japan.

Abstract

In this report, we describe a case involving a 34-year-old woman who showed good treatment outcomes with long-term stability after multidisciplinary treatment for unilateral cleft lip and palate (CLP), maxillary hypoplasia, severe maxillary arch constriction, severe occlusal collapse, and gingival recession. A comprehensive treatment approach was developed with maximum consideration of strong scar constriction and gingival recession; it included minimum maxillary arch expansion, maxillary advancement by distraction osteogenesis using an internal distraction device, and mandibular setback using sagittal split ramus osteotomy. Her post-treatment records demonstrated a balanced facial profile and occlusion with improved facial symmetry. The patient's profile was dramatically improved, with reduced upper lip retrusion and lower lip protrusion as a result of the maxillary advancement and mandibular setback, respectively. Although gingival recession showed a slight increase, tooth mobility was within the normal physiological range. No tooth hyperesthesia was observed after treatment. There was negligible osseous relapse, and the occlusion remained stable after 5 years of post-treatment retention. Our findings suggest that such multidisciplinary approaches for the treatment of CLP with gingival recession and occlusal collapse help in improving occlusion and facial esthetics without the need for prostheses such as dental implants or bridges; in addition, the results show long-term post-treatment stability.

Keyword

Cleft lip and palate; Orthodontic treatment planning; Distraction osteogenesis; Gingival recession

MeSH Terms

Adult
Cicatrix
Cleft Lip*
Constriction
Dental Implants
Esthetics
Female
Gingival Recession*
Humans
Hyperesthesia
Lip
Osteogenesis, Distraction*
Osteotomy, Sagittal Split Ramus*
Palatal Expansion Technique
Palate*
Prostheses and Implants
Recurrence
Tooth
Tooth Mobility
Dental Implants
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