Different dental treatment options for bilateral cleft lip and palate may result in similar aesthetic appearance, but they produce definite differences in jaw function. People with clefts of the lip and palate often have dental anomalies as well. The number, shape, and position of teeth can be affected. In particular, the permanent lateral incisor is frequently absent or misshapen.
A study in the Cleft Palate-Craniofacial Journal examines two primary treatments for bilateral cleft lip and palate: orthodontic space closure and prosthetic replacement, primarily with resin-bonded bridges (November 2010, Vol. 47:6, pp. 591-596). The treatment methods were evaluated on the basis of aesthetics and mandibular function. The study included 27 adult patients in the Netherlands with bilateral cleft lip and palate.
In deciding on a treatment, dentists consider the skeletal pattern, tooth size and arch length, and size and color of adjacent teeth. Prosthetic replacement is often preferred to maintain symmetry when incisors are missing or spaced apart and to ensure adequate space for the tongue. Orthodontic space closure is a less costly procedure that can be performed before the end of a patient's growth. Also, it does not involve adjacent healthy teeth as prosthetic replacement does.
In the Cleft Palate-Craniofacial Journal study, which was conducted at the University of Groningen, the patients and a professional panel were asked to rate the aesthetics of the two procedures. Although approaching the subject from different points of view, the two groups did not find a significant aesthetic difference between orthodontic space closure and prosthetic replacement.
The method of treatment did make a difference, however, in the functioning of the jaw. A questionnaire was used to evaluate the patients' ratings of specific functions. In this evaluation, prosthetic replacements were found to result in significantly more impairment of the jaw, the researchers concluded.
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