Clinical Case: Orthodontic Treatment of Adult Patient with Cleft Palate and Class III Malocclusion

Aim: We present a clinical case of a 26 year old patient with surgically corrected left palate, class III malocclusion and severe crowding in the upper jaw. Materials and methods: We diagnosed a severe transverse underdevelopment of the upper jaw, palatal position of 12, 22, 25, posterior cross bite, anterior open bite. The patient's previous orthodontic treatment included extraction of 18, 15, 25, 28 and rapid palatal expansion, but there was still teeth-alveolar discrepancy and the teeth couldn't be aligned. Our treatment plan included: distalization of 17, 16, 26, 27 and expansion in premolar area using the Pendulum appliance, anchoring the new position of the molars by orthodontic mini-screws; distalization of 14, 13, 24 and 23 and introduction of 12 and 22 in the toothed arch. The next step was achieving good occlusal relationships and orthopedic effect by the action of Face mask. Results: Six months approximately were needed for the molar distalization by the M-Pendulum appliance, followed by the placement of mini-screws to anchoring their new distal position. They were engaged as soon as they were applied and the process of sagittal teeth movement and the forthcoming introduction of laterals in the dental arch took about another five months. The patient was motivated by the outcome and continues to cooperate in the second phase of the treatment. Conclusions: Both diagnosis and proper planning are the key of successful orthodontic treatment.