PMC4269306_01
Occlusal radiograph. You can see the cleft through the palate compromising alveolar ridge and hard palate.
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fig1
At orthopantomography and occlusal radiograph (Figure 1), a cleft is observed with a 1.2 agenesis as well as the presence of supernumerary located on the mesial 2.3.
Type hyrax disjunction device. Intraoral image of disjunctor. You can observe that the exodontia of 1.5 has already been performed, but not the others yet (lateral incisor 1.2 and supernumerary teeth). Behind the device you can see the mucous scar of the cleft.
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fig2
A Hyrax disjunctor (Figure 2) is installed with slow maxillary expansion up to 13 mm.
PMC4269306_02
Dental cast at the beginning (a) and at the end (b) of the treatment. You can see the dental crowding in the maxilla, with the presence of 1.5 on the hard palate. Negative discrepancy was solved through extractions and slow maxillary expansion.
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fig3
Intraoral images at the beginning (a) and at the end (b) of the treatment. Canines were remodeled as lateral incisors with composite.
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fig4
Extraoral images at the beginning (a) and at the end (b) of the treatment. No major changes were made after orthodontic treatment. The scar of the upper lip is slightly perceived.
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fig5
There was no major extraoral change after the treatment (Figure 5).
Smile picture after a two-year followup. There is a harmonic smile and the aesthetic remodeled canines look naturally as lateral incisors.
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fig6
Tongue position remains correct after treatment and speech issues are better after pharyngeal surgery (Figure 6).