Interdisciplinary treatment of an adolescent with unilateral cleft lip and palate.

AIM: The present case report describes the importance of interdisciplinary approach and gives an understanding on management of an adolescent with unilateral cleft lip and palate. BACKGROUND: Failure of fusion between medial nasal process and maxillary process or between the palatal process leads to the formation of clefts. Clefts are result of genetic or environmental factors or a combination of both. Common dental problems associated with clefts includes anterior and posterior crossbites, hypodontia, malformation and abnormal eruption pattern. CASE REPORT: A girl, aged 15 years reported with a chief complaint of unesthetic appearance of her maxillary anterior teeth. She had unilateral cleft lip and palate and had received cheiloplasty and palatoplasty when she was in young age and rhinoplasty when she was 14 years of age. At pretreatment evaluation, she had concave profile with maxillary arch constriction and oroantral fistula and mesially tipped maxillary left canine. CONCLUSION: This patient's treatment was unconventional, but it was successful in significantly improving her masticatory function and smile, along with favorable dental and facial results. Generalized esthetics and function were significantly improved in this patient without orthognathic surgery, and treatment results were stable 3 years after the appliance removal. Clinical considerations, sequencing of treatment phases as shown in this case report can be utilized while treating an adolescent with cleft lip and palate. CLINICAL SIGNIFICANCE: If the skeletal discrepancy is mild and esthetic concerns are minimal, dental compensation by orthodontic treatment alone might be recommended. The cephalometric analysis and prediction tracings provide further information for deciding whether a patient can be treated by orthodontics alone, or by orthodontics and an orthognathic surgical procedure. A change in axial inclination of the teeth can camouflage the skeletal relationship adequately. However, one should be cautious in a growing patient, because he or she might outgrow the dental correction so that ultimately skeletal surgery would be indicated.

Esthetic dentistry in patients with bilaterally missing maxillary lateral incisors: a multidisciplinary case report.

Congenitally missing maxillary lateral incisors pose a difficult esthetic and treatment planning problem for clinicians. Age, location, space limitations, alveolar ridge deficiencies, uneven gingival margins, occlusion and periodontal factors often necessitate an interdisciplinary approach. Over the last several decades, dentistry has focused various treatment modalities for replacement of missing teeth. Treatment plans for patients with missing maxillary lateral incisors have traditionally included either space closure or space reopening. To remove healthy tooth structure of adjacent teeth to replace a tooth, for some patients and dentists, is a very aggressive treatment option which eliminates the option of three unit bridges. Removable partial dentures are also not preferred for its bulkiness and reduced esthetics. Presently, the single implant supported crown is a predictable method of tooth replacement in adolescents. The aim of this case report is to provide a conservative method for the management of bilateral missing lateral incisor.

Biomechanical and clinical considerations in correcting skeletal class II malocclusion with Forsus™.

AIM: The present case report describes the importance of understanding of biomechanical and clinical considerations in application of Forsus appliance in correction of class II skeletal malocclusion. BACKGROUND: Angle's class II malocclusion is one of the most prevailing that may be either skeletal or dental presenting with different clinical manifestations. There are number of appliances to treat such a malocclusion in a growing child. Fixed functional appliances are indicated for class II corrections in patients who report late with minimal residual growth left. CASE DESCRIPTION: A case of class II skeletal and dental malocclusion treated with preadjusted edgewise appliance supplemented with Forsus Fatigue Resistant Device (FRD) (3M Unitek Corp, California, USA) is reported. CONCLUSION: Forsus device is an effective alternative in treating moderate skeletal class II malocclusion. The Forsus FRD (3M Unitek Corp, California, USA) can be used instead of class II elastics in mild cases and in place of Herbst appliance in severe cases. Alteration of force vector by modifying the archwire as shown in this case report while applying Forsus and incorporation of 10 degree labial root torque in lower archwire will minimize the effects on dentition. Engaging modules or tubing on to the pushrod and leaving 1 to 2 mm clearance between distal end of the upper tube and L-pin as shown in this case report will significantly improve the patient compliance. CLINICAL SIGNIFICANCE: Much emphasis should be given to biomechanical considerations which were discussed in this article while treating patients with Forsus to prevent the unwanted effects. Clinical considerations and certain modifications advised in this case report should be utilized while treating class II skeletal malocclusions with Forsus appliance to eliminate the patient cooperation factor and make treatment time estimates much more accurate.