Special Problems with Teeth and Jaws
Because cleft palate affects the form and growth of the upper jaw, the teeth become a special consideration. Development and alignment of the teeth and their relationship to the jaw needs to be addressed during infancy and throughout the child’s growing years.
Age Five to Eight Years
. As the child grows, the bony arch that supports the teeth, the alveolus, may become too narrow or incorrectly shaped. This condition is called collapse of the alveolar arch and requires orthodontic treatment.
A prosthesis called an expansion device is inserted in the mouth which gradually expands the arch. Once the arch is expanded, its shape is maintained as the child grows and develops either with continued use of the expansion device or with a different type of prosthesis which is temporarily inserted into the mouth.
As the permanent cuspid (canine or eye) teeth develop and begin the process of eruption, usullay between seven to nine years of age, it is necessary to correct the bony defect in the alveolar ridge. The surgical procedure used is a bone graft. It involves filling the space between the edges of the alveolus with a small amount of bone taken surgically from the hip.
To prepare the area for bone grafting, the orthodontist applies orthodontic bands and wires(braces) to the teeth; he or she will work with your child until the teeth are properly positioned.
Ages Eight to Twelve Years.
Ages eight to twelve are called the period of mixed dentition because children lose their primary (baby) teeth, and their secondary (permanent) is used to move the teeth into a more normal position. This enables the orthodontist to create a normal arch form and a good positioning of the upper and lower teeth.
If there is underdevelopment of the upper jaw, overdevelopment of the lower jaw or a combination of two, further recommendations for treatment will be made. In about ten percent of all cases, surgical treatment may be necessary to correct skeletal deformities of the upper and/or lower jaws. Treatment is delayed until orthodontic alignment of the teeth is completed, and this surgery is performed no earlier than fourteen to sixteen years of age.
Upper jaw surgery involves incisions in the soft tissues inside the mouth which cover maxilla, allowing the surgeon to advance or move it forward. The new position of the bone is then secured with miniplate fixation. While this type of surgery is not frequently required, it can enhance the function and appearance of the teeth and jaws while speech and nasal breathing.
Surgery on the lower jaw may be necessary to correct the skeletal deformity. It is performed when the jaw appears to be overgrown and must be set back to balance both the upper and lower lower jaws. This setback procedure is called a mandibular osteotomy.
Final Orthodontic Treatment
Final orthodontic treatment focuses on the proper positioning of the teeth in the upper and lower jaws. Absent teeth are corrected with a bridge, a removable partial denture or the newer technique of dental implants. Depending on the particular cleft deformity and your child’s unique problems, any one, or a combination of these techniques, may be recommended.