ORTHODONTIC AND ORTHOPEDIC REHABILITATION OF PATIENTS WITH CLEFT OF UPPER LIP, ALVEOLAR SURGERY, HARD AND SOFT PALATE
Authors: Makarova O.M. , Semenyaka M.V. , Balya G.M. , Kuroyedova V.D. 
Published: January 2019

The problem of children’s rehabilitation with cleft palate is multi edged and complex. The ultimate goal of rehabilitation measures is to restore the anatomical integrity of the tissues of the hard and soft palate, the function of the articulatory and mastication systems, create conditions for correct speech and maximum aesthetic rehabilitation.
Orofacial cleft leads to the appearance of functional changes in breathing, sucking, chewing and swallowing. In the process of development of masticatory system, the formation of complex dentoalveolar anomalies in parallel with a significant decrease in masticatory efficiency, weakens the process of sound production, which leads to the formation of stable speech disorders. Such children from childhood form a sense of inferiority, they have reduced social adaptation due to the presence of a cosmetic defect and speech disorders.
Optimization of orthodontic and orthopedic rehabilitation of patients with non-incision of the upper lip, alveolar process, hard and soft palate is actual clinical problem of modern dentistry.
Typical orthodontic pathology in such patients is the development of the upper jaw with a significant narrowing of the upper dentition (due to cicatricial changes) and, as a result, the formation of a prognosis, often deep, bite. Possibilities for orthodontic treatment of such patients are significantly limited due to postoperative cicatricial changes, skeletal malformation of the upper jaw, partial upper teeth adentia, small alveolar bone volume, low dentoalveolar compensation capacity, high tendency to relapse, therefore, the completion of orthodontic treatment often requires a double denture.
We propose to use milled caps and present a clinical case of their application.
The stages of manufacturing milled cap are the following: making prints and the manufacture of models; superposition of the facial arch to determine the position of the upper jaw; determination of the central position of the lower jaw (by facial features, with functional tests and subsequent check of the state of the chewing muscles by EMG and the position of the joints with the help of CCPT), plastering the models in the articulator, 3D scanning and digitizing models and digital modeling of the cap with ZIRKONZAHN Scan.
To make the cap, Multistratum flexible was used, which is a biocompatible elastic composite material with a low plaque build-up and high aesthetic characteristics, designed for the manufacture of cynoanatomical structures. Caps are recommended to be used day and night, even during meals. Caps are removed only for daily hygiene procedures.
Thus, the milled cap allows solving practical problems in non-stunted patients with non-incision of the upper lip, alveolar process, hard and soft palate such as: to provide multiple occlusions without contacts and protected occlusion with stable position of the lower jaw; restore the full function of chewing; ensure maximum retention while maintaining the width of the upper dentition; significantly improve the aesthetics of the smile (the appearance of "white aesthetics") and the face (raising the height of the bite, improving the profile, the step of the lips, reducing the second chin, rotation of the lower jaw clockwise); create optimal conditions for further permanent prosthetics, since digital models can be used as reference points for future permanent non-removable structures.
So, removable milled caps are the modern optimal method of temporary long-term prosthetics, which greatly improve the functional and aesthetic status of the patient.