PMC8487844_01
Persistent oronasal communication.
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The patient presented with a cleft lip and palate, a condition for which he underwent the first surgery in China, but with persistent oronasal communication (Figure 1).
Initial photographic documentation.
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At the clinical and radiological (panoramic radiograph and lateral cephalogram of the skull) examination, the patient also presented an ectopic tooth 21, an ectopic and conoid tooth 22 positioned at the level of the left unilateral cleft, and upper and lower crowding with a very deep curve of Spee (Figures 2-4).
Initial dental casts.
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At the clinical and radiological (panoramic radiograph and lateral cephalogram of the skull) examination, the patient also presented an ectopic tooth 21, an ectopic and conoid tooth 22 positioned at the level of the left unilateral cleft, and upper and lower crowding with a very deep curve of Spee (Figures 2-4).
Initial panoramic radiograph and lateral cephalogram of the skull.
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At the clinical and radiological (panoramic radiograph and lateral cephalogram of the skull) examination, the patient also presented an ectopic tooth 21, an ectopic and conoid tooth 22 positioned at the level of the left unilateral cleft, and upper and lower crowding with a very deep curve of Spee (Figures 2-4).
Cone-beam computed tomography.
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As the presence of strong bone dehiscence, the orthodontic team decided to require a cone-beam computed tomography (CBCT) to a better definition of the bone condition (Figure 5).
Tooth 21 recovery in the dental arch.
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After 3 months of treatment, the archwire is replaced with a 0.19 x 0.25 NiTi archwire, a bracket is applied on tooth 21, and an accessory 0.16 NiTi archwire was applied for extruding and distorting the tooth (Figure 6).
Tooth 22 extraction.
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The maxillofacial surgeon then proceeded with tooth 22 extraction (Figure 7) and bone graft surgery (Figure 8).
Panoramic radiograph after graft surgery.
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The maxillofacial surgeon then proceeded with tooth 22 extraction (Figure 7) and bone graft surgery (Figure 8).
Temporary prosthetic tooth supported by orthodontic palatal miniscrews.
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Once the achievement of these objectives, the team decided to prosthetically rehabilitate the avulsed tooth 22 with the application of a temporary prosthetic tooth supported by orthodontic miniscrews applied on the patient palate using the Easy Driver system (Figure 9).
Final photographic documentation.
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Figures 10-12 showed the therapeutic result obtained.
Final stone models.
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Figures 10-12 showed the therapeutic result obtained.
Final panoramic radiograph and lateral cephalogram of the skull.
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Figures 10-12 showed the therapeutic result obtained.