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This one is about: Gumline Collapse


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Gum Line Collapse

Question:

I understand that the gum line collapses - one side behind the other. I think it occurs after the lip repair from the tightening across it. Is there any way to prevent it or is it something that always happens as a result of the lip repair?  A lesser of 2 evils kinda thing? They are repairing my son's lip and gum at the same time does that make it better/worse? What kind of questions should I ask about this?  No one has mentioned this possible complication and I would like to be informed of all the possibilities.

Answer:

Typically the smaller part of the top jaw "collapses" (it is also likely that the other side simply grows more since it is less restrained) behind the larger side (in unilateral CA children, both "sides" typically "collapse" behind the front middle piece in bilateral CA persons) due to the scarring from the lip AND palate repair surgeries. Scar tissue is very dense and tends to contract some but primarily causes a restraint on growing tissues, so the "Lesser of 2 evils" concept is a valid one here. It does NOT ALWAYS happen, and depends on patient differences, size of cleft, type of procedure, surgeon's expertise, etc. The "same time" lip and gum (alveolus) repair (graft or "periosteoplasty") is intended to help prevent this and can in some instances but does NOT ALWAYS prevent this and has been criticized in the past for resulting in MORE scarring at an early age and so potentially even MORE restraint - maybe just of a different type. Quite controversial with some teams adamantly opposed to and others adamantly pushing. NO CONCLUSIVE "proof" yet one way or the other - Hope this helps.

Kirt Simmons DDS PhD  simmons@ortvx1.dent.unc.edu
Orthodontial Consultant - Wide Smiles


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