Long-term stability after multidisciplinary treatment involving maxillary distraction osteogenesis, and sagittal split ramus osteotomy for unilateral cleft lip and palate with severe occlusal collapse and gingival recession: A case report
Kokai Satoshi, Fukuyama Eiji, Omura Susumu, Kimizuka Sachiko, Yonemitsu Ikuo, Fujita Koichi, Ono Takashi,
소속 상세정보
( Kokai Satoshi ) - Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences Department of Orthodontic Science
( Fukuyama Eiji ) - Private practice
( Omura Susumu ) - Yokohama City University Medical Center Department of Oral and Maxillofacial Surgery
( Kimizuka Sachiko ) - Kitasato University School of Medicine Department of Plastic and Aesthetic Surgery
( Yonemitsu Ikuo ) - Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences Department of Orthodontic Science
( Fujita Koichi ) - Yokohama City University Medical Center Department of Oral and Maxillofacial Surgery
( Ono Takashi ) - Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences Department of Orthodontic Science
Abstract
In this report, we describe a case involving a 34-year-old woman who showed good treatment outcomes with long-term stability after multidisciplinary treatment for unilateral cleft lip and palate (CLP), maxillary hypoplasia, severe maxillary arch constriction, severe occlusal collapse, and gingival recession. A comprehensive treatment approach was developed with maximum consideration of strong scar constriction and gingival recession; it included minimum maxillary arch expansion, maxillary advancement by distraction osteogenesis using an internal distraction device, and mandibular setback using sagittal split ramus osteotomy. Her post-treatment records demonstrated a balanced facial profile and occlusion with improved facial symmetry. The patient's profile was dramatically improved, with reduced upper lip retrusion and lower lip protrusion as a result of the maxillary advancement and mandibular setback, respectively. Although gingival recession showed a slight increase, tooth mobility was within the normal physiological range. No tooth hyperesthesia was observed after treatment. There was negligible osseous relapse, and the occlusion remained stable after 5 years of post-treatment retention. Our findings suggest that such multidisciplinary approaches for the treatment of CLP with gingival recession and occlusal collapse help in improving occlusion and facial esthetics without the need for prostheses such as dental implants or bridges; in addition, the results show long-term post-treatment stability.
키워드
Cleft lip and palate; Orthodontic treatment planning; Distraction osteogenesis; Gingival recession
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