Oral Health and Dental Management

Alexandria protocol for complete rehabilitation of cleft palate patients: The Egyptian experience

2^nd International Conference and Exhibition on Dental & Oral Health

April 21-23, 2014 Crown Plaza Dubai, UAE

Ahmed Mohamed Medra

Accepted Abstracts: Oral Health Dent Manag

Abstract:

Aim: The objective of this work is to review the outcome of a comprehensive protocol for total rehabilitation; functionally and esthetically, of patients with post-cleft palate defects ( uni-lateral and bilateral) in the age group 6 years to 18years. Study Design: Fifty patients (24 females, 26 males) with post-cleft palate defects, with a history of complete cleft lip, alveolus and palate, ( 20 patients with bilateral and 30 patients with unilateral) who were treated in our center for (chelio-plasty and palato-plasty). The study was conducted during the period between Jan. 2005 and Dec. 2010 years. Materials and Methods: Our Protocol consists of five phases: Phase I : Orthodontic Preparation, Phase II: Alveolar Reconstruction, Phase III: Maxillary & /Or Midface distraction, Phase IV: Chelio-Septo-Rhinoplasty and Phase V: Dental Rehabilitation The materials Included two groups: 1. First group, 20 patients with history of complete bilateral cleft lip, alveolus, and palate. 2. Second group, 30 patients with a history of unilateral complete cleft lip, alveolus, and palate of the patients treated during the period between 2005 and 2010; 50 alveolar cleft (18 females, 32 males) have been documented. Ages of the patients rangedbetween 6 and 18 years; the mean age was 8. 5years. All the patients were operated upon for cleft of primary palate (lip and alveolus) at the age of 3-6 months and palatoplasty for secondary palate at the age of 12 to 18 months in other centers, allpatienhad, dentalproblems, skeletal malocclusion( class III due to maxillary deficiency), unilateral/or bilateral alveolar defects, oro-nasal fistulas, mal-repaired lips as well as nasal deformities. Protocol of Treatment: Phase I: Orthodontic Preparation: 1. Realignment of teeth, maxillary expansion was performed in all patients before the operation. 2. In severe maxillary arch constriction; surgically assisted rapid maxillary expansion was done (16 patients). Phase II: Alveolar Reconstruction: By one of two techniques: 1. Alveolar Bone Grafts: This is done for patients before and during age of mixed dentitions, ( between 6 and 11 years), a;Early secondary alveolar bone graft; before the eruption of lateral incisor, when the root is 1/3 to 2/3 rds formed, (age 5-8 years). b; Classical secondary alveolar bone graft, when the root of canine is 1/3 to 2/3 rds formed; (age 8-11 years). 2. Trans Alveolar Transport Distraction, (TATD): Construction of Tran-alevolarTransportDistractor ;A custom made tooth-born distractor was manufactured for unilateral defect and two for bilateral defects. Patients Criteria: The age of patients were more than 11 years and with one or more of the followings: ? Wide alveolar cleft ? Full eruption of permanent dentitions ? Soft Tissue deficiency ? Failure of previous bone grafting ? Absent premaxilla. ? Rudimentary premaxilla