## 1 Introduction  
Cleft lip and/or palate is the most common congenital deformity, with unilateral cleft lip and palate (UCLP) being the commonly recognized asymmetrical form. However, it is important to note that bilateral cleft lip and palate (BCLP) can also exhibit asymmetry, often due to the rotation of the incisive bone [1]. While genetics plays a critical role in the etiology of cleft lip and/or palate, the exact cause is multifactorial [2]. Additionally, differences in the oral microbiome between patients with clefts and those without this congenital deformity have been observed. These differences can lead to microbial imbalances, which in turn can result in challenges related to healing, increased risk of caries, and other conditions that impact overall health [1, 3]. Patients with cleft lip and/or palate require multidisciplinary treatment involving specialists from various disciplines [1]. Most of the treatment focuses on the lip and nose, which are typically the most affected areas [4, 5]. Surgical intervention forms the cornerstone of treatment, while cleft palate care focuses on collaboration among a range of specialists, including pediatricians, plastic surgeons, orthognathic surgeons, dentists, speech therapists, and orthodontists. The success of treatment relies heavily on building trust and fostering cooperation with the patient's family, especially the parents [1, 6]. Among the challenges faced by patients with cleft lip and/or palate, severe malocclusions are a common issue. The predominant malocclusion observed in cleft patients is a crosswhite, which has been reported to affect 75% of individuals with BCLP and 65% of those with UCLP, according to recent research [7]. Another frequently encountered malocclusion is class III, primarily caused by maxillary hypoplasia. Many of these malocclusions may eventually necessitate orthognathic surgery due to underlying maxillary hypoplasia [8]. In an attempt to minimize the need for future orthognathic surgery, trials have been conducted using maxillary traction distractors [9]. It is important to consider whether this phenomenon is caused by maxillary hypoplasia or asymmetric mandibular growth, as both have been identified as genetically based causes [10]. Orthodontic treatment is typically required for several years, usually starting shortly after birth and lasting until adulthood. In the deciduous and mixed dentition stages, removable appliances are primarily employed, whereas full orthodontic treatment involving fixed appliances is planned for permanent dentition [11]. In addition to malocclusions, dental anomalies are another significant issue among cleft patients. These anomalies encompass not only the positioning of teeth, but also their shape, quality, quantity, and eruption timing. Dental anomalies, such as enamel hypoplasia and supernumerary teeth, are commonly observed on the cleft side [12; 13; 14]. The presence of additional tooth buds or the absence of teeth altogether, as well as malformed tooth anatomy, pose a challenge in achieving arch symmetry. This may cause a challenge for experienced dentists to restore arch symmetry, achieve desirable dental outcomes, and create a natural smile. Furthermore, cleft patients have a higher predisposition to dental caries and inadequate oral hygiene, making them potential candidates for future esthetic dentistry and prosthetic treatment [12; 13; 14; 15; 16]. Teeth impaction, especially in the cleft area, is a common problem. The canine tooth is the most frequently impacted in cleft patients [17]. This condition can also be associated with dentigerous cysts, further complicating the treatment [18]. Patients easily notice the asymmetry of their teeth, emphasizing the importance of addressing and restoring symmetry as a key aspect of orthodontic, prosthetic, and restorative treatment [19]. Successful prosthetic restoration requires not only perfect esthetics, but also proper function, often necessitating the use of facebows and articulators [20].