

For an adult person considering orthodontics plus dento-facial orthopedics to fix an underbite (7.5mm diff b/w lower and upper jaw) and crossbite, is it possible to use orthopedic devices like palatal expanders when the individual has previously had surgery to repair a cleft palate? Since the cleft palate surgery closed the gap in the roof of the mouth, and the expander is supposed to pull it apart, would that create an issue?

Doctor Answers 5

Adult Orthodontics in Cleft Lip and Palate

Dear Guidance4Me,  Yes, adults with previously repaired cleft palate can be treated with some nonsurgical treatments to address dental malocclusion (under, over, or cross-bite) .  As you likely are aware, facial imbalance such as you describe (7.5 mm) is typical for some people with cleft lip and palate.  

As you research your options, please consider having a consultation with an cleft surgeon who performs orthognathic (jaw correction) surgery.  This will allow you to consider the possible changes from surgical, non-surgical, or even combined treatment plans.  

Most major university medical centers have multidisciplinary cleft programs that could guide you to some potential surgeons in your area.

Sacramento Facial Plastic Surgeon
5.0 out of 5 stars 5 reviews

Cleft palate

The best treatment for an adult in this situation is to have an orthognathic surgery. Most likely the surgeon would need to split the top jaw and position it forward. Bone grafting is needed.   Any other treatment in my opinion is unstable.

Majid Jamali, DMD
New York Oral & Maxillofacial Surgeon
5.0 out of 5 stars 9 reviews

Orthognathic surgery is probably the ideal treatment

As an adult cleft palate patient, I would assume that you went through a series of orthodontics as a child (e.g. rapid palatal expander, palatal arch, alveolar bone graft surgery and orthodontics)? Dentofacial orthopedics is by means to mechanically move the jaw by applying force/vector to the growing jaw. As an adult, there isn't much of growth left, and the most predictable way of correcting the -7.5mm overjet in your Class 3 malocclusion is 1) distraction osteogenesis or 2) orthognathic surgery. Without any photos of your facial profile and radiographs, it would be impossible to add anything further. I would highly recommend you to seek at least three or four opinions before you settle on a treatment! Good luck!

Richard Shin, DDS
Rockville Orthodontist

Dentofacial Orthopaedics

Yes is the simple answer. The more complicated explanation is that there may be mahy different approaches to achieve or address your desired result.  There is a Dr. Martin Chin in the SF area who is very good with this.  You should do multiple consults with multiple teams and see there results.  Have them discuss and show you their failures as well as successes. 

Lawrence Singer, DMD
Washington Cosmetic Dentist
5.0 out of 5 stars 4 reviews

Cleft Lip and smile makeover

You asked a really great question.  Every case is different. Many times I can correct the vertical and anterior-posterior relationship with specialized dental procedures.  Other times, I work with the surgeons to show them where the maxillary or upper jaw should be.  We do take the TMJ joints in consideration.  In other words, it is important to find the correct position for the muscles, teeth, and joints from a functional and esthetic position.

This is the starting point and is done by dentists who have advanced training in this area. In short, there are some non-surgical cases and some that also need surgery.

I hope this helps!

Ronald Konig DDS
Houston Cosmetic Dentist
