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Periodontal considerations and guidelines for therapy.

This article presents a format of sequential periodontal therapy for the achievement of long-term periodontal health. The author discusses various periodontal considerations that are essential for successful precision restorative dentistry.

Alveoloplasty↗

Primary palatoplasty.

Clefts of the secondary palate, either isolated or accompanying a cleft lip, are characterized by a defect in the palate of varying extent and by abnormal insertion of the levator veli palatini muscles. Repair of the palate should be carried out in one stage, shortly before or after 1 year of age, and should include intravelar veloplasty. The technique of von Langenbeck palatoplasty with intravelar veloplasty has been described. This technique should provide velopharyngeal competency in 80 to 90 per cent of patients with clefts of the secondary palate.

Airway Obstruction↗

Correction of residual deformities of the lip and nose in repaired clefts of the primary palate (lip and alveolus).

Residual deformities of the lip and nose in individuals with repaired unilateral and bilateral clefts may very in severity depending on the state of the original defect, the care taken in the initial surgical procedure, the pattern of the patient's facial growth, and the effectiveness of interceptive orthodontic techniques. Because each patient has a unique combination of deformities, their surgical reconstruction usually requires the modification and combination of several surgical techniques. In this article, a summary of various reconstructive techniques is presented, beginning with an evaluation of secondary cleft defects.

Alveoloplasty↗

Orthodontic-surgical interaction in the management of cleft lip and palate.

The orthodontist's role in the cleft palate team requires close collaboration with the surgeons and other team members. The rationale of timing and sequencing of orthodontic treatment have been discussed in the various time frames, which for convenience have been considered as follows: (1) neonatal or infant maxillary orthopedics; (2) orthodontic considerations in the primary dentition; (3) mixed dentition orthodontics to include presurgical recommendations before an alveolar bone graft and its rationale for use in selected patients; and (4) orthognathic surgery combining an orthodontic and surgical approach to the correction of dental and skeletal components of malocclusion in the permanent dentition. Speech considerations and the communicative skills of the patient with a cleft are important aspects in planning orthognathic surgery for this group of patients. Also, subsequent nose and lip revisions for cosmetic improvement must not be underestimated in the enhancement of the final result following correction of the skeletal and dental discrepancies. Provided the timing and sequencing of appropriate treatment modalities are planned in a closely coordinated, problem-oriented approach by the team members, cleft patients should currently have optimal functional and esthetic results.

Adolescent↗