PMC4413499_01
Pre-treatment facial and intraoral clinical presentation
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F1
A 21-year-old male with a right-sided complete cleft of primary and secondary palate who had primary surgery in childhood at another hospital was referred to our craniofacial centre for management of his facial skeletal deformities [Figure 1]. Overall the maxilla was severely collapsed in all three-dimensional planes [Figure 1].
Upper row: clinical photographs of post distraction showing lateral, facial and intraoral views. Lower row: pre-operative and postoperative lateral cephalograms
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F2
During the phase of activation, an anterior open bite developed due to anti-clockwise rotation of the maxillary segment [Figure 2].
Intra oral views after placement and loading of temporary anchorage devices
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F3
TADs were loaded immediately, and elastomeric chains were engaged from the mini screw to the pre molars and first molar teeth for intrusion [Figure 3].
Upper row-open bite reduction following 10 weeks of loading temporary anchorage device lower row-final aesthetic completion of treatment
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F4
The continuous force bilaterally intruded the posterior teeth within a span of 10 weeks thus reducing the divergence of the occlusal plane, and a positive overbite was achieved. [Figure 4]. The palatal fistula was closed using a tongue flap.