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This one is about: Reconstructing the Jigsaw After Alveolar Collapse
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RECONSTRUCTING THE JIGSAW AFTER ALVEOLAR COLLAPSE
by Kirt Simmons DDS
Complete alveolar collapse is quite common in children with bilateral cleft palates, due primarily to scar contraction of the palate. The degree of collapse is variable, but it is not uncommon to have the lateral (side) jaw segments nearly touching in the front, with the premaxillary (middle) segment collapsed backward so that the patient has an under bite (front top teeth bite behind the lower teeth). Orthodontic appliances of various types, including removable (retainer-type) appliances, braces and/or cemented thick wire "springs" called "W-Arches" (or Quad Helix Lingual Arches) in the upper jaw can both widen the lateral segments and move the front segment forward.
This is typically performed between the ages of six to nine. Although it can be done when only baby teeth are in the mouth, most clinicians prefer to wait until the permanent molars (big back teeth) and incisors (front teeth) are present. This treatment is usually done prior to bone grafting of the upper jaw.
Once jaw segments have been moved they must be retained, or held, either with a removable retainer, or a fixed wire retainer, or by leaving the expansion appliance in place at least until the bone grafts are healed. Further expansion involving "braces" may again be necessary when all the permanent teeth are in and full braces are applied, typically between age ten to fourteen.
To sum, alveolar collapse is not uncommon among children with bilateral clefts. Orthodontic practices can do much to reestablish or approximate the normal dental arch, and then maintain the integrity of that arch after bone graft surgery. It is often a fairly lengthy, multi-staged process, but in the end the results are very often quite satisfying.
------------------------Kirt Simmons, DDS, provides orthodontic care for cleft patients at the University of North Carolina in Chapel Hill NC and is the Orthodontic Consultant for WIDE SMILES.
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