A Follow-Up Study of Cleft Lip and Palate Patients Treated with Orthodontics, Secondary Bone Grafting, and Prosthetic Rehabilitation

Abstract

The purpose of this study was to evaluate the significance of secondary bone grafting in cleft palate treatment. The investigation included a clinical, a biometrical, and a radiographic follow-up of the occlusion, the craniofacial morphology and the function of the masticatory system. The total material of secondary bone grafting cases during the period of 1958–68 consisted of 125 patients. For the final examination, 93 of them were present. The treatment plan was: (1) orthodontic treatment, (2) bone grafting, (3) retention treatment, (4) prosthetic reconstruction of lost teeth. 58 bridges were inserted. The mean age of the patients at the time of bone grafting was 20 years and the mean lag between the bone grafting procedure and the final check-up was 7 1/2 years. Besides bone grafting, 43 palatopharyngeal flap-operations were carried out. At the final check-up, none of the patients wear any obturator. Besides these operations 7 osteotomies of the lower jaw were carried out. The frequence of crossbites was reduced from 94 to 31%. Open bites were present in 6 cases while the remaining cases exhibited normal overjet and overbite. A slight degree of relapse after the orthodontic expansion treatment was noted; thus, in 12 cases, one or two teeth relapsed to crossbite occlusion. The jaw function was fairly normal in all cases studied. The chewing ability was reduced in 9 cases, though the average number of tooth contact-pairs increased, from 5.9 prior to orthodontic treatment to 11.4 at the final examination. The cephalometric part of the investigation indicated that the average patient had a more retrognathic type of face with steeper mandibular and nasal planes than are reported for non-clefts. The bone grafting procedure was successful in 96% of the cases, as evaluated from radiographs. The reorganisation of the average bone graft was completed within 3 to 6 months. This clinical and radiographic investigation revealed that bone grafting of the alveolar process and the palate did normalise and stabilize the maxilla in practically all instances. Thus the method used had prevented relapse after orthodontic treatment in the great majority of cases and the definitive prosthetic rehabilitation could be carried out using the same principles as in non-cleft cases.