Craniomaxillofacial deformities/sleep disorders/cosmetic surgery
Interdisciplinary Management of a Class III Anterior Open Bite Malocclusion in a Patient With Cerebral Palsy

https://doi.org/10.1016/j.joms.2018.07.033Get rights and content

Dentofacial disharmony in patients with cerebral palsy (CP) can lead to low self-esteem and functional limitations. However, medical and behavioral challenges in patients with developmental disorders often prevent dental practitioners from offering the necessary treatment. This report describes the clinical interdisciplinary management of a 20-year-old man with CP, including orthodontic, periodontal, and orthognathic surgery therapy. The patient presented with the chief complaint of having difficulty chewing, was wheelchair dependent, had poor orofacial muscle control, and exhibited a Class III malocclusion with a skeletal anterior open bite. The lower midline was shifted 3 mm to the right, there was severe maxillary spacing, and the patient had gingival overgrowth. A combined orthodontic, periodontal, and orthognathic surgery treatment approach was chosen to meet the patient's interdisciplinary needs. Because of his physical limitations, it was necessary to avoid complicated and prolonged orthodontic treatment mechanics. Interdisciplinary therapy improved the patient's oral function, periodontal health, and facial esthetics and led to a good occlusion, which remained stable 1 year after treatment. Regardless of the treatment challenges, combined orthodontic and surgical therapy in the present patient with CP led to favorable treatment results and improved the patient's self-esteem, confidence in social interactions, and speaking and chewing abilities.

Section snippets

Diagnosis

A 20-year-old man presented to the orthodontic department with his parents with the complaint of having difficulty chewing and the desire to “correct the open bite.” The patient was wheelchair dependent and had spastic diplegia CP. The medical history also disclosed penicillin allergy and a seizure disorder, which was controlled with phenobarbital. A seizure episode had not occurred for many years. The patient had clear and appropriate communication skills and was very motivated to receive

Discussion

Esthetic improvement is the primary motivation of patients seeking orthodontic treatment.24 Patients with handicaps often have low social competency and confidence1 and might be especially motivated to receive orthodontic care. However, medical and behavioral challenges in patients with developmental disorders prevent many orthodontists from offering the necessary treatment.19 In addition, the presence of severe dentofacial disharmony in patients with CP might occasionally necessitate combined

References (28)

  • C. Christine et al.

    Recommendations from the SCPE collaborative group for defining and classifying cerebral palsy

    Dev Med Child Neurol Suppl

    (2007)
  • F.A. Sabuncuoglu et al.

    Orthodontic management of a patient with cerebral palsy: Six years follow-up

    J Contemp Dent Pract

    (2014)
  • C.A. Boyle et al.

    Prevalence of selected developmental disabilities in children 3-10 years of age: The Metropolitan Atlanta Developmental Disabilities Surveillance Program, 1991

    MMWR CDC Surveill Summ

    (1996)
  • X. Lin et al.

    Prevalence and distribution of developmental enamel defects in children with cerebral palsy in Beijing, China

    Int J Paediatr Dent

    (2011)
  • Cited by (2)

    Conflict of Interest Disclosures: None of the authors have a relevant financial relationship(s) with a commercial interest.

    View full text