title: Cleft lip and palate: a variable clinical spectrum
title: medical and dental considerations
titleType: Subtitle
Creators: name: Bartzela, Theodosia
Publisher: name: Charité - Universitätsmedizin Berlin
Year: 2022
Subjects: subject: orthodontic treatment
subject: craniofacial anomalies
subject: orofacial clefts
subject: tooth agenesis
subject: associated malformations
subject: apical root resorption
subject: dental casts
subject: genetics
subject: 600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit

description: Patients with an orofacial cleft (OFC) need complex treatment and require long-term and collective decisions from the multidisciplinary team. These patients may have an associated congenital malformation or syndrome. Some conditions like learning or psychiatric disorders or heart diseases can be diagnosed later in life. Therefore, the team members should examine the patients in different developmental stages to diagnose early an associated condition. Nevertheless, deep phenotyping of the dental and craniofacial affecting structures is only possible after 14 and 18 years of age, respectively, at the end of these structures’ development. Moreover, the genetic basis of OFC is multifactorial and, so far, not well understood. In our study, almost 25% of the examined patients with OFC had a positive family history (Bartzela et al., 2021). Patients with CPO have an associated anomaly or syndrome (66,7%) more often than patients with other cleft types. Skeletal (27,7%) and eye malformations (22,9%) were more common than malformations in other organs or systems. Sex predominance has been registered according to the cleft type. Males were more often observed in CL/P (71,4%) and females (59,7%) in CPO cleft types. Phenotyping CL/P pedigrees make understanding etiopathogenesis even more complicated (Bartzela et al., 2021). The increased prevalence of TA in these patients inside and outside the cleft region of the maxilla but also in the mandible suggests a common genetic pathway between OFC and TA. Patients with OFC require long-lasting, multidisciplinary orthodontic treatment with an MBA. Expansion and symmetry of the collapsed dental arches, followed by a secondary bone graft to correct the interrupted arch continuity, are required before the orthodontic tooth movement in the cleft region. The severe form of EARR related to orthodontic treatment is rare, and the most commonly affected teeth are the central incisors of the cleft side (Bartzela et al., 2020). Severe rotation of the central incisors on the cleft side, pre-existing EARR, atypical root form, specific bone anatomical aspects, oral habits (e.g., lip or tongue posture or dysfunction), and associated medical conditions have been considered as predisposing factors for EARR during the orthodontic treatment (Bartzela et al., 2020). Intercenter studies for evaluating treatment outcomes of patients with CLP can be carried out with e-mail transfer or CDs of images of the dental casts or digital models. The images could be protected by a password, allowing the participant raters from their computers to access and score the dental models. This method facilitates intercenter studies or remote clinical audits. Clinical trials, intercenter studies, and epidemiological data may help evaluate treatment results and identify the role of genetic variation bias and confounding factors on clinical phenotypes. Documentation and meticulous record collection of these patients for the quality assessment of the treatment outcome are mandatory. Early identification of associated syndromes or malformations is of vital importance, especially in life-threatening complications. The type and timing of orthodontic treatment and maxillofacial surgery are critical and often complicated by disrupting dental and craniofacial structures’ development. The team’s goal is to improve function and aesthetic outcomes and ascertain a better quality of life for these patients and their families. Patients’ and parents’ considerations, satisfaction, and psychosocial aspects need research evaluation. Further research is required for clinical recommendations and treatment consensus.