The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats. Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics, Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call 0091-9248678078

1. INDIAN DENTAL ACADEMY
Leader in continuing dental education
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2. L
C
P
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3. Introduction
 Very common congenital deformity of
orofacial structures
 Cleft lip – Cheiloschisis
 Cleft palate – Palatoschisis
 Incidence – 0.59 to 3.63 per 1000 live births
India – 1.7 per 1000 live births
 Boys : girls = 3:2
 Isolated cleft palate more in girls
 Left > right when unilateral
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4. TREATMENT
 Prosthetic era (1565 -1764)
- Ambroise Pare
 Surgical era (1764 – 1940)
- Le Mornier
 Surgery – ortho – prostho era
(1940 – 1970)
 Surgery – ortho – surgery era
(1970 to present)
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5. Aims of treatment
 Long mobile palate, which can
completely close the nasopharynx
and oropharynx.
 Achieve intact well-aligned dental
arch.
Ultimate goal
Attain normal form and function with
least possible damage to growth and
development by surgery
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7. FISHMAN
protocol
e) Bone grafting
for alveolar
defects primary
grafting (< 2 yrs)
f) Orthopedics for
reapproximating
maxillary
segments and
normalizing
oral function.
Stage I
Maxillary
orthopedic
stage
Birth to 18
months
Stage II
Primary
Dentition
18 months to
5yrs
Stage III
Late Primary or
Mixed dentition
6 to 11 yrs
Stage IV
Permanent
dentition
12 to 18 yrs
a)Maxillary
obturator to
prevent feeding
problems,
increasing
burpingand
chocking.
a) Establishing
maintaining
oral health.
a) Orthodontic
treatment 7 to 8
yrs. Started 12
months before
grafting.
*Arch
expansion to
correct posterior
cross bite –
Quad Helix.
*Alignment of
maxillary
incisor.
a) Final tooth
alignment
and
interdigitation
b)“Bulb”
prosthesis to
position
premaxilla in
midline
c)“Bonnet
& Strap”
prosthesis for
retraction of
premaxilla
d) Cheiloplasty
“Rule of Tens”.
b) Palatoplasty
(12 to 14
months) for
normal
speech.
Improves
hearing and
swallowing
c) Early
secondary
bone
grafting. (2
to 4 yrs)
b) Secondary
bone grafting (6
to 15 yrs) for
eruption of
permanent
canine.
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b) Rapid palatal
expansion.
c) Cosmetic
surgery for
nasal bone,
tip and
symmetry.

8. Orthodontic treatment phases
 Presurgical orthopedics (0-3 months)
 Interceptive orthopedics (6-7yrs)
- Transverse expansion, protraction
 Alignment of maxillary incisors
 Secondary alveolar bone grafting (8-11yrs)
 Conventional orthodontics (permanent)
 Dental adjustments (16-17yrs in female
and 18-19yrs in male)
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9. Obturators
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12. Thank you
For more details please visit
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