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A Century of Cleft Treatment- An Orthodontic Perspective

Received: 27 March 2016     Accepted: 28 March 2016     Published: 19 May 2016
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Abstract

Orofacial clefting is the most common congenital deformity. Its treatment is a long drawn process with various challenges. However, successful completion of treatment is highly satisfying not just to the patient but also the team of specialists involved with it. The following article provides an overview of the evolution of cleft treatment over the past century. It briefly describes the changing views of the orthodontic specialty towards the diagnosis and treatment of this deformity over the past century. Its gradual process from the rudimentary treatment protocols of the early 20th century to the holistic approach followed currently.

Published in Science Journal of Clinical Medicine (Volume 5, Issue 4-1)

This article belongs to the Special Issue Clinical Conspectus on Cleft Deformities

DOI 10.11648/j.sjcm.s.2016050401.19
Page(s) 49-58
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2016. Published by Science Publishing Group

Keywords

Cleft Orthodontics, Orofacial clefts, cleft advances, Cleft lip/ palate

References
[1] Wig KW, Mercado AM. Overview of orthodontic care for children with cleft lip and palate, 1915-2015.Am J OrthodDentofacialOrthop 2015;148:543-56.
[2] Eby JD. Maximum improvements in congenital orofacial clefts. Am J Orthod 1956; 42:867-72.
[3] Kiskadden WS, Tholen EF. Primary and secondary repair of cleft lip. Int J Orthod Oral SurgRadiogr 1932; 18:863-73.
[4] Davis AL. Cleft lip and palatal surgical correction. Am J Orthod Oral Surg 1932; 18:282-90.
[5] Millard DR Jr. Uranoplasty by maxillary compression, Cleft craft: the evolution of its surgery. Volume III: alveolar and palatal deformities. Boston: Little, Brown and Company; 1980. p. 223-30.
[6] Drachter R. The cleft palate and their surgical treatment. Dtsch Z Chir 1914; 131:1-89.
[7] Ivy RH. Review of recent literature on cleft lip and palate surgery. Am J Orthod Oral Surg 1937; 23:844-9.
[8] Webster RC .Title matter. Cleft Palate J 1964; 1:1-16.
[9] Salzmann JA. Northwestern University Cleft Lip and Palate Institute. Am J Orthod Oral Surg 1953; 39:487-8.
[10] Graber TM. Thecongenital cleft palate deformity. J Am DentAssoc 1954; 48:375-95.
[11] Pruzansky S. Presurgicalorthopaedics and bone grafting for infants with cleft lip and palate: a dissent. Cleft Palate J 1964; 1:164-82.
[12] Jolleys A, Robertson NRE. A study of the effects of early bone grafting in complete clefts of the lip and palate—five year study. Br J PlastSurg 1972;25:229-37.
[13] Rosenstein SW. A new concept in the early orthopaedic treatment of cleft lip and palate. Am J Orthod Oral Surg 1969; 56:529-30.
[14] Rosenstein SW, Monroe CW, Kernahan DA, Jacobson BN, Griffith BH, Bauer BS. The case for early bone grafting. J Oral Surg 1982; 70:297-330.
[15] Burston WR. The early treatment of cleft palate conditions. Dent Prac 1953;9:41-52.
[16] McNeil CK. Oral and facial deformity. London, United Kingdom: Sir Isaac Pitman & Sons; 1954.
[17] Ross RB, Johnston MC. The effects of early orthodontic treatment on facial growth in cleft lip and palate. Cleft Palate J 1967;4: 157-64
[18] Horowitz SL, Berkowitz S, Broadway ES, Gorlin R, Hixon EH, Pruzansky S, Ross RB. Cleft lip and cleft palate: research relevant to clinical management in dentistry. An NIDR state of the art report. Subcommittee on Dentistry. Am J Orthod 1973;63:398-406.
[19] Vig K, Mercado A. The orthodontist’s role in a cleft palate-craniofacial team. In: Graber LW, Vanarsdall RL, Vig KW, editors. Orthodontics: current principles and techniques. 5th ed. Philadelphia: Elsevier Mosby; 2012. p. 965-89.
[20] Cooper HK, Harding RL, Krogman WM, Mazaheri DS, Millard RT. Cleft palate and cleft lip: a team approach to clinical management and rehabilitation of the patient. Philadelphia: W. B. Saunders; 1979.
[21] Johnson N, Sandy JR. Prenatal diagnosis of cleft lip and palate. Cleft Palate Craniofac J 2003;40:186-9.
[22] Mulliken JB, Benacerraf BR. Prenatal diagnosis of cleft lip: what the sonologist needs to tell the surgeon. J Ultrasound Med 2001;20:1159-64.
[23] Mercado AM, Vig KW. Orthodontic principles in cleft lip and palate care. In: Losee JE, Kirschner RE, editors. Comprehensive cleft care. New York: McGraw-Hill, Medical Publishing Division; 2009. p. 721-47.
[24] Grayson BH, Santiago PE, Brecht LE, Cutting CB. Presurgicalnasoalveolar molding in infants with cleft lip and palate. Cleft Palate Craniofac J 1999;36:486-98.
[25] Grayson BH, Maull D. Nasoalveolar molding for infants born with clefts of the lip, alveolus, and palate. ClinPlastSurg 2004; 31: 149-58.
[26] Levy-Bercowski D, Abreu A, DeLeon E, Looney S, Stockstill J, Weiler M, et al. Complications and solutions in presurgicalnasoalveolar molding therapy. Cleft Palate Craniofac J 2009;46:521-8.
[27] Van der Heijden P, Dijkstra PU, Stellingsma C, van der Laan BF, Korsten-Meijer AG, Goorhuis-Brouwer SM. Limited evidence for the effect of presurgical nasoalveolar molding in unilateral cleft on nasal symmetry: a call for unified research. Plast Reconstr Surg 2013;131:62e-71e.
[28] Smith DM, Macisaac ZM, Losee JE. Discussion: limited evidence for the effect of presurgicalnasoalveolar molding in unilateral cleft on nasal symmetry: a call for unified research. PlastReconstrSurg 2013;131:72e-4e.
[29] Grayson BH. Discussion: limited evidence for the effect of presurgicalnasoalveolar molding in unilateral cleft on nasal symmetry: a call for unified research. PlastReconstrSurg 2013;131:75e-6e.
[30] Grayson BH, Garfinkel JS. Early cleft management: the case for nasoalveolar molding (Point/Counterpoint). Am J OrthodDentofacialOrthop2014;145:134-40.
[31] Hathaway RR, Long RE Jr. Early cleft management: in search of evidence (Point/Counterpoint). Am J OrthodDentofacialOrthop 2014;145:135-42.
[32] Boyne PJ, Sands NR. Secondary bone grafting of residual alveolar and palatal clefts. J Oral Surg 1972;30:87-92.
[33] Bergland O, Semb G, Abyholm FE. Elimination of the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment. Cleft Palate J 1986;23:175-205.
[34] Ranta R. A review of tooth formation in children with cleft lip/palate. Am J OrthodDentofacialOrthop 1986;90:11-8.
[35] Delaire J, Verdon P, Kenesi MC. Extraoral traction forces with forehead-chin-supporting for the treatment of maxillary deformities as a result of cleft lip and cleft palate. FortschrKieferorthop1973;34:225-37.
[36] So LL. Effects of reverse headgear treatment on sagittal correction in girls born with unilateral cleft lip and palate—skeletal and dental changes. Am J OrthodDentofacialOrthop 1996;109:140-7.
[37] De Clerck HJ, Cornelis MA, Cevidanes LH, Heymann GC, Tulloch CJ. Orthopedic traction of the maxilla with miniplates: a new perspective for treatment of midface deficiency. J Oral Max- illofacSurg 2009; 67:2123-9.
[38] Baek SH, Kim KW, Choi JY. New treatment modality for maxillary hypoplasia in cleft patients: protraction face mask with miniplate anchorage. Angle Orthod 2010;80:783-91.
[39] Ward JA, Vig KW, Firestone AR, Mercado A, da Fonseca M, Johnston W. Oral health-related quality of life in children with oro-facial clefts. Cleft Palate Craniofac J 2013;50:174-81.
[40] Pena W, Vargervik K, Sharma A, Oberoi S. The role of endosseous implants in the management of alveolar clefts. Pediatr Dent 2009; 37:329-33.
[41] Wermker K, Jung S, Joos U, Kleinheinz J. Dental implants in cleft lip, alveolus, and palate patients: a systematic review. Int J Oral Maxillofac Implants 2014;29:384-90.
[42] Oosterkamp BC, Dijkstra PU, Remmelink HJ, van Oort RP, Sandham A. Orthodontic space closure versus prosthetic replacement of missing upper lateral incisors in patients with bilateral cleft lip and palate. Cleft Palate Craniofac J 2010;47:591-6.
[43] Hamada Y, Kondoh T, Noguchi K, Iino M, Isono H, Ishii H, et al. Application of limited cone beam computed tomography to clinical assessment of alveolar bone grafting: a preliminary report. Cleft Palate Craniofac J 2005;42:128-37.
[44] Wortche R, Hassfeld S, Lux CJ, Mussig E, Hensley FW, Krempien R, et al. Clinical application of cone beam digital volume tomography in children with cleft lip and palate. DentomaxillofacRadiol 2006; 35:88-94.
[45] Oberoi S, Chigurupati R, Gill P, Hoffman WY, Vargervik K. Volu- metric assessment of secondary alveolar bone grafting using cone beam computed tomography. Cleft Palate Craniofac J 2009;46:503-11.
[46] Abdelkarim AA. Appropriate use of ionizing radiation in orthodontic practice and research. Am J OrthodDentofacialOrthop 2015; 147:166-8.
[47] Kuijpers-JagtmanAM, Kuijpers MAR, Schols JGJH, Maal TJJ, Breuning KH, van Vlijmen OJC. The use of cone-beam computed tomography for orthodontic purposes. SeminOrthod 2013;19:196-203.
[48] Van Vlijmen OJC, Kuijpers MAR, Berg e SJ, Schols JG, Maal TJ, Breuning H, et al. Evidence supporting the use of cone-beam computed tomography in orthodontics. J Am Dent Assoc 2012; 143:241-52.
[49] SEDENTEXCT project. Radiation protection no. 172: cone beam CT for dental and maxillofacial radiology. Evidence based guidelines 2012. Available at: http://www.sedentexct.edu/content/guideline s-cbct-dental-and-maxillofacial-radiology.
[50] McCarthy JG, Schreiber JS, Karp NS, Thorne CH, Grayson BH. Lengthening the human mandible by gradual distraction. Plast Re- constrSurg 1992;89:1-8.
[51] McCarthy JG. The role of distraction osteogenesis in the reconstruction of the mandible in unilateral craniofacial microsomia. ClinPlastSurg1994;21:625-31.
[52] McCarthy JG, Staffenberg DA, Wood RJ, Cutting CB, Grayson BH, Thorne CH. Introduction of an intraoral bone-lengthening device. PlastReconstrSurg 1995;96:978-81.
[53] Figueroa AA, Polley JW. Management of severe cleft maxillary deficiency with distraction osteogenesis: procedure and results. Am J OrthodDentofacialOrthop 1999;115:1-12.
[54] Minami K, Mori Y, Tae-Geon K, Shimizu H, Ohtani M, Yura Y. Maxillary distraction osteogenesis in cleft lip and palate patients with skeletal anchorage. Cleft Palate Craniofac J 2007;44:137-41.
[55] Kumar A, Gabbay JS, Nikjoo R, Heller JB, O’Hara CM, Sisodia M, et al. Improved outcomes in cleft patients with severe maxillary deficiency after Le Fort I internal distraction. PlastReconstrSurg 2006;117:1499-509.
[56] Dolanmaz D, Karaman AI, Durmus E, Malkoc S. Management of alveolar clefts using dento-osseous transport distraction osteogenesis. Angle Orthod 2003;73:723-9.
[57] Zemann W, Pichelmayer M. Maxillary segmental distraction in children with unilateral clefts of lip, palate, and alveolus. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 2011; 111:688-92.
[58] Rachmiel A, Emodi O, Aizenbud D. Three-dimensional reconstruction of large secondary alveolar cleft by two-stage distraction. Cleft Palate Craniofac J 2014;51:36-42.
[59] Bohman P, Yamashita DD, Baek SH, Yen SL. Stabilization of an edentulous premaxilla for an alveolar bone graft: case report. Cleft Palate Craniofac J 2004;41:214-7.
[60] Proff P, Bayerlein T, Gedrange T. Special features of planning and application of orthodontic miniscrews in cleft patients. J Cranio- maxillofacSurg 2006;34(Suppl 2):73-6.
[61] Vachiramon A, Urata M, Kyung HM, Yamashita DD, Yen SL. Clinical applications of orthodontic microimplant anchorage in craniofacial patients. Cleft Palate Craniofac J 2009;46:136-46.
[62] Yen SL. Protocols for late maxillary protraction in cleft lip and palate patients at Children’s Hospital, Los Angeles. SeminOrthod 2011;17:138-48.
[63] Rachmiel A, Emodi O, Gutmacher Z, Blumenfeld I, Aizenbud D. Oral and dental restoration of wide alveolar cleft using distraction osteogenesis and temporary anchorage devices. J CraniomaxillofacSurg 2013;41:728-34.
[64] Gautam P, Zhao L, Patel P. Biomechanical response of the maxillofacial skeleton to transpalatal orthopedic force in a unilateral palatal cleft. Angle Orthod. 2011;(81)3:507–515.
[65] Shet KV, Shetty KN, Rai R, Mahale AD. Stress distribution and displacement of craniofacial structures following force application in treatment of an operated bilateral facial cleft. Turkish J Orthod. 2015;27:148–157
[66] Shaw WC, Asher-McDade C, Brattstro€m V, Dahl E, McWilliam J, Mølsted K, et al. A six-center international study of treatment outcome in patients with clefts of the lip and palate: part 1. Principles and study design. Cleft Palate Craniofac J 1992;29:393-7.
[67] MølstedK,Asher-McDadeC,BrattstromV,DahlE,Mars M, McWilliam J, et al. A six-center international study of treatment outcome in patients with clefts of the lip and palate: part 2. Craniofacial form and soft tissue profile. Cleft Palate Craniofac J 1992;29:398-404.
[68] Mars M, Asher-McDade C, Brattstrom V, Dahl E, McWilliam J, Mølsted K, et al. A six-center international study of treatment outcome in patients with clefts of the lip and palate: part 3. Dental arch relationships. Cleft Palate Craniofac J 1992; 29:405-8.
[69] Asher-McDade C, Brattstrom V, Dahl E, McWilliam J, Mølsted K, Plint DA, et al. A six-center international study of treatment outcome in patients with clefts of the lip and palate: part 4. Assessment of nasolabial appearance. Cleft Palate Craniofac J 1992; 29: 409-12.
[70] Shaw WC, Dahl E, Asher-McDade C, Brattstrom V, Mars M, McWilliam J, et al. A six-center international study of treatment outcome in patients with clefts of the lip and palate: part 5. General discussion and conclusions. Cleft Palate Craniofac J 1992;29:413-8.
[71] Prahl C, Kuijpers-Jagtman AM, Van’t Hof MA, Prahl-Andersen B. A randomised prospective clinical trial into the effect of infant orthopedics on maxillary arch dimensions in unilateral cleft lip and palate(Dutchcleft). Eur J Oral Sci 2001;109:297-305.
[72] Prahl C, Kuijpers-Jagtman AM, Van’t Hof MA, Prahl-Andersen B. Infant orthopedics in UCLP: effect on feeding, weight, and length. A randomized clinical trial (Dutchcleft). Cleft Palate Craniofac J 2005;42:171-7.
[73] Long RE Jr, Hathaway RR, Daskalogiannakis J, Mercado AM, Russell KA, Cohen MA, et al. The Americleft study: an intercenter study of treatment outcomes for patients with unilateral cleft lip and palate. Part 1—principles and study design. Cleft Palate Craniofac J 2011;48:239-43.
[74] Hathaway RR, Daskalogiannakis J, Mercado AM, Russell KA, Long RE Jr, Cohen MA, et al. The Americleft study: an intercenter study of treatment outcomes for patients with unilateral cleft lip and palate. Part 2—dental arch relationships. Cleft Palate Craniofac J 2011;48:244-51.
[75] Mars M, Plint DA, Houston WJ, Bergland O, Semb G. The Golson yardstick: a new system of assessing dental arch relationships in children with unilateral clefts of the lip and palate. Cleft Palate J 1987;24:314-22.
[76] Daskalogiannakis J, Mercado AM, Russell KA, Hathaway RR, Dugas GS, Long RE Jr, et al. The Americleft study: an intercenter study of treatment outcomes for patients with unilateral cleft lip and palate. Part 3—analysis of craniofacial form. Cleft Palate Craniofac J 2011;48:252-8.
[77] Mercado AM, Russell KA, Hathaway RR, Daskalogiannakis J, Sadek H, Long RE Jr, et al. The Americleft study: an intercenter study of treatment outcomes for patients with unilateral cleft lip and palate. Part 4—nasolabial esthetics. Cleft Palate Craniofac J 2011;48:259-64.
[78] Asher-McDade C, Roberts C, Shaw WC, Gallagher C. Development of a method for rating nasolabial appearance in patients with clefts of the lip and palate. Cleft Palate Craniofac J 1991;28:385-90.
[79] Russell KA, Long RE Jr, Hathaway RR, Daskalogiannakis J, Mercado AM, Cohen MA, et al. The Americleft study: an intercenter study of treatment outcomes for patients with unilateral cleft lip and palate. Part 5—general discussion and conclusions. Cleft Pal- ate Craniofac J 2011;48:265-70.
[80] Peanchitlertkajorn S, Russell K, Daskalogiannakis J, Lamichane M, Mercado A, Hathaway RR, et al. An expansion of the Americleft in- tercenter comparison of dental arch relationships to include a center using NAM 6 GPP as part of its primary protocol [abstract 13]. Fort Worth, Tex: ACPA 67th Annual Meeting; 2010, March 16-20.
[81] Peanchitlertkajorn S, Daskalogiannakis J, Lamichane M, Mercado A, Hathaway RR, Russell K, et al. A multicenter retrospective study of patients with CUCLP from 5 North-American centers [abstract 191]. San Juan, Puerto Rico: ACPA 68th Annual Meeting; 2011, April 5-9.
[82] Mercado AM, Peanchitlertkajorn S, Daskalogiannakis J, Hathaway R, Lamichane M, Russell K, et al. An expansion of the Americleftintercenter comparison of nasolabial appearance out- comes to include a center using NAM as part of its primary proto- col [abstract 15]. San Juan; Puerto Rico: ACPA 68th Annual Meeting; 2011, April 5-9.
[83] Russell K, Long RE Jr, Daskalogiannakis J, Mercado A, Hathaway R, Semb G, et al. A multicenter study using the SWAG scale to compare secondary alveolar bone graft outcomes for patients with cleft lip and palate. Cleft Palate Craniofac J 2015 [Epub ahead of print].
[84] Mercado AM, Russell KA, Daskalogiannakis J, Hathaway RR, Semb G, Ozawa T, et al. The Americleft project: a proposed expanded nasolabial appearance yardstick for 5- to 7-year-old patients with complete unilateral cleft lip and palate (CUCLP). Cleft Palate Craniofac J 2015 [Epub ahead of print].
[85] Sitzman TJ, Mara CA, Long RE Jr, Daskalogiannakis J, Russell KA, Mercado AM, et al. The Americleft project: burden of care from secondary surgery. PlastReconstrSurg Glob Open 2015;3:e442 [Epub ahead of print].
[86] Chapman KL, Baylis A, Trost-Cardamone J, Cordero KN, Dixon A, Dobbelsteyn C, et al. The Americleft speech project: a training and reliability study. Cleft Palate Craniofac J 2014 [Epub ahead of print].
[87] McCarthy JG. Development of craniofacial orthodontics as a sub- specialty at New York University Medical Center. SeminOrthod 2009; 15:221-4.
[88] Santiago PE, Grayson BH. Introduction. SeminOrthod 2009; 15: 219-20.
Cite This Article
  • APA Style

    Anurag Mahale, Vishnu Ben Latif, Varun Menon P., Heena Shaikh, Ancy Koshy, et al. (2016). A Century of Cleft Treatment- An Orthodontic Perspective. Science Journal of Clinical Medicine, 5(4-1), 49-58. https://doi.org/10.11648/j.sjcm.s.2016050401.19

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    ACS Style

    Anurag Mahale; Vishnu Ben Latif; Varun Menon P.; Heena Shaikh; Ancy Koshy, et al. A Century of Cleft Treatment- An Orthodontic Perspective. Sci. J. Clin. Med. 2016, 5(4-1), 49-58. doi: 10.11648/j.sjcm.s.2016050401.19

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    AMA Style

    Anurag Mahale, Vishnu Ben Latif, Varun Menon P., Heena Shaikh, Ancy Koshy, et al. A Century of Cleft Treatment- An Orthodontic Perspective. Sci J Clin Med. 2016;5(4-1):49-58. doi: 10.11648/j.sjcm.s.2016050401.19

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  • @article{10.11648/j.sjcm.s.2016050401.19,
      author = {Anurag Mahale and Vishnu Ben Latif and Varun Menon P. and Heena Shaikh and Ancy Koshy and Bhavik Patel and Abdul Shahariyar},
      title = {A Century of Cleft Treatment- An Orthodontic Perspective},
      journal = {Science Journal of Clinical Medicine},
      volume = {5},
      number = {4-1},
      pages = {49-58},
      doi = {10.11648/j.sjcm.s.2016050401.19},
      url = {https://doi.org/10.11648/j.sjcm.s.2016050401.19},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.sjcm.s.2016050401.19},
      abstract = {Orofacial clefting is the most common congenital deformity. Its treatment is a long drawn process with various challenges. However, successful completion of treatment is highly satisfying not just to the patient but also the team of specialists involved with it. The following article provides an overview of the evolution of cleft treatment over the past century. It briefly describes the changing views of the orthodontic specialty towards the diagnosis and treatment of this deformity over the past century. Its gradual process from the rudimentary treatment protocols of the early 20th century to the holistic approach followed currently.},
     year = {2016}
    }
    

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    T1  - A Century of Cleft Treatment- An Orthodontic Perspective
    AU  - Anurag Mahale
    AU  - Vishnu Ben Latif
    AU  - Varun Menon P.
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    N1  - https://doi.org/10.11648/j.sjcm.s.2016050401.19
    DO  - 10.11648/j.sjcm.s.2016050401.19
    T2  - Science Journal of Clinical Medicine
    JF  - Science Journal of Clinical Medicine
    JO  - Science Journal of Clinical Medicine
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    UR  - https://doi.org/10.11648/j.sjcm.s.2016050401.19
    AB  - Orofacial clefting is the most common congenital deformity. Its treatment is a long drawn process with various challenges. However, successful completion of treatment is highly satisfying not just to the patient but also the team of specialists involved with it. The following article provides an overview of the evolution of cleft treatment over the past century. It briefly describes the changing views of the orthodontic specialty towards the diagnosis and treatment of this deformity over the past century. Its gradual process from the rudimentary treatment protocols of the early 20th century to the holistic approach followed currently.
    VL  - 5
    IS  - 4-1
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Author Information
  • Department of Orthodontics and Dentofacial Orthopaedics, A.J Institute of Dental Sciences, Mangalore, Karnataka, India

  • Department of Orthodontics and Dentofacial Orthopaedics, A.J Institute of Dental Sciences, Mangalore, Karnataka, India

  • Department of Oral and Maxillofacial Surgery, PMS College of Dental Science and Research, Thiruvananthapuram, Kerala, India

  • Department of Orthodontics and Dentofacial Orthopaedics, A.J Institute of Dental Sciences, Mangalore, Karnataka, India

  • Department of Orthodontics and Dentofacial Orthopaedics, A.J Institute of Dental Sciences, Mangalore, Karnataka, India

  • Department of Orthodontics and Dentofacial Orthopaedics, A.J Institute of Dental Sciences, Mangalore, Karnataka, India

  • Department of Orthodontics and Dentofacial Orthopaedics, A.J Institute of Dental Sciences, Mangalore, Karnataka, India

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