Abstract
The outcomes of alveolar bone grafting and orthognathic surgeries in patients with cleft lip and/or palate have become reliable in the last two decades. On the other hand, predictable and cost-effective treatments are required worldwide. In orthodontic treatment in The University of Tokyo Hospital, treatment with maxillary expansion followed by prosthodontic management used to be considered first, but recently, treatment with minimum maxillary expansion and minimum prosthodontic management is planned. A nasoalveolar molding plate (NAM) is used for the presurgical orthopedics and alveolar bone grafting is performed in deciduous dentition. The orthodontic treatment is usually commenced in the early mixed dentition using a lingual arch and a sectional arch as basic appliances. The maxillary protraction is often applied while paying attention to the fact that its long-term results are difficult to predict. In the permanent dentition, tooth alignment including maxillary second molars is performed using a multi-bracket appliance. In cases with very poor maxilla-mandibular relationship, orthognathic surgery is unavoidable, and it is recommended even in borderline cases. In patients with cleft palate, extraction of lateral incisors or premolars is often required and a space at the alveolar cleft is mostly closed by the medial movement of the canine. On the contrary, a lateral incisor is frequently aligned with or without crown restoration in patients with cleft lip and alveolus. The retention is continued as long as possible with a fixed lingual wire in the maxillary anterior teeth and a plate-type retainer. In cases with a residual space at the alveolar cleft, an adhesive bridge is often placed recently. The majority of these treatments will become unnecessary when the primary surgeries are improved and the palatal arch form and the maxilla-mandibular relationship become good. Such improvements are desired.
