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

• Kokai S
• Fukuyama E
• Omura S
• Kimizuka S
• Yonemitsu
• Fujita K
• Ono T

• KMID: 2431081
• DOI: http://doi.org/10.4041/kjod.2019.49.1.59

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

Figure

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  Figure 1 Pretreatment facial and intraoral photographs.

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  Figure 2 Pretreatment radiographs. A, Panoramic radiograph; B, lateral cephalogram; C, posteroanterior cephalogram.

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  Figure 3 Intraoral photographs obtained before and after maxillary distraction osteogenesis. A, Before distraction osteogenesis; B, after distraction osteogenesis.

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  Figure 4 Computed tomography images obtained before and after maxillary distraction osteogenesis. A, Before distraction osteogenesis; B, after distraction osteogenesis.

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  Figure 5 Post-treatment facial and intraoral photographs.

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  Figure 6 Post-treatment radiographs. A, Panoramic radiograph; B, lateral cephalogram; C, posteroanterior cephalogram.

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  Figure 7 Post-treatment computed tomography images.

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  Figure 8 Superimposed pretreatment (black line) and post-treatment (red line) cephalometric tracings. For the first molar, the solid line represents the right side and the dotted line represents the left side.

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  Figure 9 Facial and intraoral photographs obtained after a 5-year retention phase.

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  Figure 10 Radiographs obtained after a 5-year retention phase. A, Panoramic radiograph; B, lateral cephalogram; C, posteroanterior cephalogram.

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  Figure 11 Superimposed cephalometric tracing: post-treatment (black line) and post-retention (red line). For the first molar, the solid line represents the right side and the dotted line represents the left side.

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