Orthodontic problems related to clefts

Whereas the Orthodontist in the cleft palate team will probably see your child at a very early stage, Orthodontic treatment will not start in most cases until the age of mixed dentition.
In children born with cleft palate, in the stage of early dentition (ages 2.5-6 yrs) malocclusion is relatively rare. When it does arise, it is usually a posterior crossbite (the upper back teeth close inside the lower ones) and it is related to the insufficient width of the upper jaw. Since this is a problem that will most probably reoccur in the mixed and permanent dentition, its treatment is deferred until then.
In the age of early mixed dentition ( ages 6-8 yrs) moderate crossbite tendencies (anterior and posterior) may appear. In addition, children with a cleft of the alveolus (the tooth bearing area of the jaw) may present irregularities and rotation of the upper permanent incisors (front teeth). The lateral incisors are either missing or hypoplastic (reduced in size), although extra teeth (supernumerary teeth) are not uncommon. The goals of treatment at this stage are to correct the posterior crossbite by expanding the upper dental arch.
When the age of permanent dentition (age 8+ yrs) has been reached, and provided that the bone grafting procedure has been carried out and that adequate time has been allowed for the permanent canine tooth to erupt through the added bone (see surgery) in the area of the cleft, a stage of comprehensive orthodontic treatment will nearly always be required in order to align and shape the dental arch and to resolve any remaining anterior and posterior crossbites. Since lateral incisors and / or other permanent teeth may be missing, decisions will also have to be made as to whether the spaces from the missing teeth will be closed by moving adjacent teeth or whether they will be maintained for later prosthetic replacement. As a rule, the less prosthetic work in the mouth, the better the long term prognosis.
In five to ten per cent of patients with cleft lip or cleft lip and palate, due to deficient upper jaw growth, surgery will be required to bring the upper jaw forward in order to correct the bite as well as the facial esthetics. If orthodontic treatment has not previously been provided, then it will certainly be required before the surgical procedure to move the upper jaw.