Dr. Shweta's Dental Clinic

D – 42 Kalkaji, New Delhi–110019
Ph.: +91–11–26414243
+91–9811227991, +91–9810335961

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"ISO 9001 : 2000 Certified Dental Clinic"

Cleft Lip & Palate

The word cleft means a gap or split between two things. A cleft lip is a split in the upper lip. This can happen on one or two sides of the lip, creating a wider opening into the nose. A cleft palate is a split in the roof of the mouth. This leaves a hole between the nose and the mouth. Sometimes a cleft lip and cleft palate occur together in the same person. Cleft lip and cleft palate are very common.

Unilateral incomplete

Unilateral complete

Bilateral complete

Cleft Lip

Incomplete cleft palate

Unilateral complete lip and palate

Bilateral complete lip and palate

Cleft Palate

Cleft lip and cleft palate are birth defects, which means they happen while a baby is developing inside his or her mother. Normally, the mouth and nose of a baby develop between the first 6 and 12 weeks of growth. In some babies, parts of the lips and roof of the mouth don't grow together. Because the lips and the palate develop separately, it's possible to have cleft lip, cleft palate, or both.

Cleft lip is usually repaired by the time a baby is 3 to 6 months old. During surgery on the cleft lip, the doctor closes the gap in the lip and corrects the nostril. A person who has cleft lip repaired as an infant will have a scar on the lip under the nose.

Cleft palate is usually repaired at age 9 to 12 months. During surgery on cleft palate, doctors close the hole between the roof of the mouth and the nose and reconnect the muscles in the soft palate.

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Nasoalveolar Molding (NAM)

Nasoalveolar molding is a nonsurgical method of reshaping the gums, lip and nostrils before cleft lip and palate surgery, lessening the severity of the cleft. Surgery is performed after the molding is complete, approximately three to six months after birth. NAM is used mainly for children with large clefts and has revolutionized cleft repair.

The NAM technique allows the pediatric dentist and surgeon to mold the abnormally formed nasal cartilage into a more optimal relationship prior to surgery. The total treatment time for unilateral cleft cases is 2-3 months.

Stage 1

Stage II

Stage III

Timing of Treatment

Timing is very important. The ideal time to begin NAM is 1-2 weeks after birth. A molding plate is then fabricated and inserted. The infant will wear the molding plate 24 hours a day for approximately 4-6 months. The molding plate causes no pain and is attached with small rubber bands taped to the face.

Adjustments to the molding plate/nasal portion are done weekly, or every other week, depending on the progress. Each adjustment is very small, but it starts to guide the baby's gums, lip, and nasal cavities as they are growing.

At the conclusion of nasoalveolar molding (in unilateral cases, it is approximately four months and in bilateral cases, six months), the nasal cartilages, columella, philtrum, and alveolar segments should be aligned to facilitate the surgical restoration of a child's facial features to normal configurations.

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Bone Grafting

In the past, the treatment of periodontal (gum) disease was considered painful and disfiguring. For many years, the best way to achieve the ultimate goal of therapy (shallow, maintainable pockets) was to do resective surgical procedures that often resulted in the exposure of sensitive root surfaces and the appearance of "long" teeth.

Periodontists at Dr Shweta’s Clinic, are able to restore or regenerate missing bone and attachment around teeth subjected to long-standing periodontal disease.

Guided Tissue Regeneration (GTR) refers to procedures that attempt to regenerate lost periodontal structures (bone, periodontal ligament, and connective tissue attachment) that support our teeth. This is accomplished using biocompatible membranes, often in combination with bone grafts and/or tissue stimulating proteins.

Guided Bone Regeneration (GBR) refers to procedures that attempt to regenerate bone prior to the placement of bridges or, more commonly, implants. This is accomplished using bone grafts and biocompatible membranes that keep out tissue and allow the bone to grow. We have great techniques available to us to replace missing bone. We can increase the height of bone and the width of bone. We can fill in anatomical voids in bone thereby creating new bone and we can fill in all sorts of defects that develop when teeth are lost. We can even use grafting techniques to prevent the loss of bone in circumstances where bone would normally be lost like the extraction of a tooth.

Alveolar bone grafting is done in cleft to bridge the bony gap and to allow teeth to erupt through the graft. Secondary bone graft is done from 7-9 years of age after orthodontic preparation.

Alveolar bone grafting

Iliac crest graft

Successful bone graft

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Nasal Conformer

Stage1

Stage II

Stage III

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Expansion

In cleft patients there is collapse of the dental arches. Expansion can be done with Quad helix or Nitinol expander.

Stage I

Modified expander

Stage-II

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Over Denture

An overdenture is a type of denture that is secured by precision dental attachments. The attachments are placed in tooth roots or dental implants which have been placed specifically for the overdenture attachment. Types of overdentures include bar joint dentures and telescopic dentures.

If you lose most or all of your lower teeth there is nothing to hold a denture down while you chew. An overdenture fastens a denture to the jawbone much in the way natural teeth are anchored. The adjacent teeth may be altered with locking devices or connecting bars to ensure the denture fits properly. These bar joints support the dentures better than individual implants though implants are still required to support the bars. Generally the more implants the stronger the bar and bars on the upper arch always require more implants than bars on the lower arch due to the lesser bone density in the upper jaw.