Interdisciplinary Management of a Class III, Anterior Open Bite Malocclusion in a Patient with Cerebral Palsy

Publication date: Available online 16 August 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Dimitrios Michelogiannakis, John Stephen Vorrasi, Elli Anna Kotsailidi, Paul Emile Rossouw

Abstract

Dentofacial disharmony in patients with cerebral palsy (CP) may 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 male with CP, including orthodontic, periodontic 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 (AOB). The lower midline was shifted 3 mm to the right, there was severe maxillary spacing and the patient suffered from gingival overgrowth. A combined orthodontic-periodontic and orthognathic surgery treatment approach was chosen to meet the patient's interdisciplinary needs. Due to 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 one year after treatment. Regardless the treatment challenges, combined orthodontic-surgical therapy in the present patient with CP led to favorable treatment results and improved the patient's self-esteem, confidence in social interactions, as well as speaking and chewing abilities.

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