Evolution of maxillary expansion in patients with cleft lip and palate

Abstract

Introduction. The craniofacial orthodontist who is part of the multidisciplinary team evaluating children with cleft lip and palate plays an important role in examining the development of dental occlusion. Early surgical interventions in children with cleft lip and palate frequently cause occlusion disorders with a prevalence of anterior crossbite in 62%. The expansion of the maxilla is important for normalizing the morphology and correct symmetrical tooth eruption. The aim is to evaluate the evolution of maxillary expansion in patients with cleft lip and palate. Material and methods. This study included 20 patients with cleft lip and palate, including 8 girls and 12 boys aged 6-12 years, with a mean age of 9.35 years. Unilateral cleft lip and palate was present in 16 patients, bilateral cleft lip and palate – 2 patients, and clefts of the hard and soft palate – 2 patients. The study models were scanned, and the maxillary dimensions were examined using a 3D Dolphin Imaging program before and after maxillary slow expansion over an average of 12.2 months. Results. Clinical evaluation of patients with cleft lip and palate showed crossbite occlusion. Of these patients, anterior and posterior crossbite occlusion was present in 11 (55%) patients, anterior crossbite occlusion in 3 (15%) patients, unilateral posterior crossbite occlusion in 3 (15%) patients and bilateral in 3 (15%) patients. In the transverse plane, the size of the upper jaw increased statistically significantly (p = 0.002), but in the sagittal plane we found a statistically significant elongation of the upper jaw (p < 0.05) following slow expansion treatment with a removable orthodontic appliance over an average of 12.2 months in patients with cleft lip and palate. Conclusions. Slow maxillary expansion treatment during the mixed dentition period in patients with cleft lip and palate was found to be more effective in the sagittal plane than in the transverse plane.