5.4.- Clinical Case 4: G. Q.

34 years old adult patient with severe complete bilateral cleft lip and palate.

Severe Class III esqueletal maloclussion implicating transversal, anteroposterior and vertical dimensions

Very poor general oral conditions



Photographic record: Before /After

Speciaities



5.3.-Clinical Case 3: A. B.

Long – term evolution, comprehensively treated and finished clinical cases

7 years old boy presenting :

  • Complete unilateral right lip and  palate non syndromic cleft sequeales
  • 3 D maxilofacial esqueletal discrepancy  with facial, functional, dental and aestheticimplications.
  • Hipernasality, dislalias, otitis media diagnosis, mixed breathing, atipical deglutionand  lingual interposition habit. 
  • High risk of caries 
  • Adjusted psychosocial development.
  • Comprehensive treatment evolution from 7 – 18 years of age.            

Photographic record 2007 / 2018: Before /After



5.2.- Clinical Case 2: S. C.

Surgical Pin Placement

Virtual Surgical Planning

Orthognatic Surgery – Mandibular advancement with transversal correction

Surgical procedure: Maxillary impactation and Mentoplastia.

2018 – Photographic record

2021 – Final photographic record


Photograpic record: Before / After



5.1.- Clinical Case 1: G. H.

2010

LEFT UNILATERAL COMPLETE LIP – INCOMPLETE PALATE CLEFT SEQUEALE

Kernahan and Stark Y Classification.
Extraoral photography

Squeletal Diagnosis

  • Symmetric patient 
  • Class I profile 
  • Class III maloclusssion
  • Maxillary retrusion and micrognatism
  • No transversal maxillary discrepancy
  • Horizontal growth tendency
  •  Cervical maduration stage  CVS1

Dental Diagnosis

Early mixed  dentition

OB :  -1mm (51, 61), -2mm (52), -3mm (62) 

  • OJ : – 2.0 MMS
  • Anterior crossbite 
  • Posterior bilateral open bite

ST Functional Diagnosis

  • Anterior atypical deglution with lingual protrusión and interposition 
  • Orofacial muscular  imbalance
  • Sigmatism 

Treatment Plan

Phase I

  • Genetic Evaluation 
  • Speech Therapy evaluation  
  • Psychologic support
  • Pediatric Dentistry evaluation . Minimal invassive procedures 
  • Maxillofacial Orthopaedic evaluation and management : Maxillary expansión and protraction / facial mask ,maxillary expansión / Alt Ramec Protocol

Phase II

  • Corrective Orthodontic treatment
  • Orthodontic management to prepare the cleft área for the alveolar bone graft 
  • Mucoexpangraft technique 
  • Periodontal mucogingival management 
  • Alveolar bone graft

Phase III

  • Prostetic Dentistry
  • Orthodontic Retention
Timeline
2010 Extra – intraoral photographic sequence.
2011 Intraoral photographic sequence.
2011 Panoramic radiography
Cephalometric Analysis
Treatment evolution 2010 – 2011 – 2013
Treatment evolution 2015 – 2018 – 2021
Treatment evolution 2010 – 2011 – 2013
Treatment evolution 2010 – 2011 – 2013
2021 – Final records
2021 – Final records
Retention
2021 – x-ray
2021 – Cephalometric Analysis
2021 – Overlap

Prostetic

Photographic record 2010 / 2021: Before /After