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Multidisciplinary approach to functional and esthetic therapy of the patient with bilateral palatal and lip cleft

Background:Orofacial clefts are the most common facial malformations in all populations and ethnic groups. The therapies of those malformations are longitudinal, complex and include multidisciplinary approach of different specialties. Clinical Procedure:Patient was initially referred to theDepartment of Orthodontics, Dental Polyclinic Zagreb. She had a history of surgical treatment at the Department of Maxillofa- cial Surgery, Clinical Hospital Dubrava in Zagreb. Patient had a bilateral palatal and lip cleft which included the cleft of processes alveolaris and premaxilla in upper anterior region. The main complaint of the patient was personal dissatisfaction with the look of her smile and she wanted esthetic and functional correction of the teeth and occlusion. A therapy plan was created which included three phases ; orthodontic, periodontology and prosthodontic phase. Orthodontic therapy lasted for 3 years and the result was beyond expectations. The therapy was conducted with fixed orthodontic appliance in both jaws, combined with intraoral appliance for maxilla expansion, quad helix(SMA). Periodontology therapy was done in two stages. The goal was the removal of excess hyperplastic mucosa and the management of keratinized tissue in the esthetic region. During the first stage, plastic surgery was done to the upper vestibular anterior region along with free gingival graft which was taken from palate region. During the second stage a tunnel technique was done with connective tissue graft in the upper anterior region to make a correction of the bilateral cleft line. After 6 months of healing, the patient was sent to the Department of Prosthodontics where upper frontal teeth were restored with all-ceramic crowns. Outcomes:The clinical outcome of this multidisciplinary approach was a very successful esthetic and functional rehabilitation of the patient, who was very satisfied with the result and the confidence gained in communication with other people.

Lip and palatal cleft, Multidisciplinary approach, Periodontology therapy, Free gingival graft, Tunnel technique, Connective tissue graft

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