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Cleft Palate Craniofac J. 2019 Mar 13:1055665619833865. doi: 10.1177/1055665619833865. [Epub ahead of print]

A Pristine Approach for the Prominent Premaxilla in Bilateral Cleft Lip and Palate (BCLP) Cases.

Author information

1
1 Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India.

Abstract

OBJECTIVE::

The neonate premaxilla in bilateral cleft lip and palate is often protruding and displaced laterally. Surgeons prefer the premaxilla to be repositioned and centralized to allow a tension-free primary lip repair. This report describes the fabrication of a premaxillary bonnet appliance with silicone material and its successful use in 2 cases of bilateral cleft lip and palate (BCLP).

PATIENTS, PARTICIPANTS::

Two male BCLP patients of ages 34 days and 10 days, respectively.

INTERVENTIONS::

Nonsurgical repositioning of the premaxillary segment using silicone cup-bonnet appliance.

RESULTS::

The duration of active treatment by silicone appliance was 36 days in case 1 and 75 days in case 2. The retention period was 2 months and 3 months, respectively. The appliance made of room temperature vulcanizing (RTV) silicone is flexible and softer in comparison to the rigid conventional acrylic appliance and is therefore almost atraumatic. A gentler appliance resulted in enhanced compliance and acceptance by the neonates. There was a noticeable change in the position of the discernible asymmetric premaxilla. Analysis of frontal facial photographs revealed an angular change in the position of the premaxilla (C) by 12° in case 1 and 6° in case 2 in reference to the midfacial plane.

CONCLUSION::

This silicone appliance provides enhanced compliance and improved retention compared to acrylic appliance since it is a more gentle, flexible, and less traumatic alternative to a rigid acrylic appliance. Further, the RTV silicone appliance can be 3-dimensionally printed for better accuracy following intraoral scanning and thus eliminating the need for impression making in cleft newborns.

KEYWORDS:

infant orthopedics; maxilla; nonsyndromic clefting; orthodontics

PMID:
30866673
DOI:
10.1177/1055665619833865

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