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VCU School of Dentistry Orthodontic Team

804-828-3042
craniofacial@vcuhealth.org
Orthodontic Scholarships—NOW AVAILABLE
Are you a current patient with cleft lip/palate in good standing with the Center for Craniofacial Care?
If so, you may be eligible to receive FULL PAID orthodontic treatment provided by the VCU Department of Orthodontics as related to your treatment plan.

Contact us for more details!

Orthodontic TeamThe VCU School of Dentistry Department of Orthodontics plays a critical role in providing orthodontic services and comprehensive dental care to patients with craniofacial deformities in central Virginia.

Patients with Cleft Lip and/or Palate
The majority of the patients with craniofacial deformities treated at VCU Orthodontics present with a cleft lip and/or palate, a congenital facial deformity that affects about one out of every 700 to 750 infants born in the United States.1

The VCU Orthodontic clinic also offers treatment to patients with various other craniofacial deformities including but not limited to, craniosynostosis, Pierre Robin syndrome and Ectodermal Dysplasia.

The treatment of cleft lip and palate patients requires a multidisciplinary team approach and usually extends into the adolescent years. 1, 2

Care provided to cleft lip and palate patients is a multistage process that needs to be carefully coordinated between the various medical and dental specialties. The efficient coordination of such therapeutic effort assures a successful outcome of treatment for these patients, allowing them to enjoy a fulfilling life and active participation in society. The American Cleft Palate and Craniofacial Association adopted the criteria necessary to provide quality multidisciplinary oral care to patients with such facial deformities in 1993.  The multidisciplinary approach to care has proven very beneficial to patients over the years, providing better communication and understanding of treatment to patients and their family. 1,3

imageThe Virginia Commonwealth University Medical Center has an active craniofacial team that includes medical and dental specialty providers. Among the specialties represented are: Plastic Surgery, Neurosurgery, Oral and Maxillofacial Surgery, Orthodontics, Pediatric Dentistry, Ophthalmology, Otolaryngology, Speech Pathology, Psychology and Social Work.

Families start to interact with the entire team as early as a few weeks after their baby is born and the first stage of the facial rehabilitation includes the surgical closure of the lip (as early as it is safe to achieve surgically) and then the surgical closure of the palate (typically within the first year). Families meet with providers on the dental team from their very first appointment at the craniofacial team. An orthodontist (Dr. Bhavna Shroff), a pediatric dentist (Dr. Frank Farrington) and an oral and maxillofacial surgeon (Dr. Omar Abubaker) discuss with the families the timing of future dental care needed by their child and the sequence of that treatment. The dental team meets with families yearly thereafter to attend to any of their needs and answer any of their concerns.

One of the most unique features of the VCU Craniofacial Team is the dental team that provides full maxillofacial rehabilitation for these patients. A majority of patients seen at the VCU Craniofacial Team receive their pediatric dentistry care through the department of Pediatric Dentistry at the VCU School of Dentistry. The Department of Orthodontics provides orthodontic care to craniofacial patients once a month, on a Friday morning. An average of about 40 active patients are currently under the care of the VCU Department of Orthodontics.

The dental team that provides this care includes an orthodontist (Dr. Steven J. Lindauer), a maxillofacial prosthodontist (Dr. Harlan Schufeldt) and an oral and maxillofacial surgeon (Dr. Omar Abubabker). Patients are referred from the VCU Craniofacial Team directly to the department of Orthodontics and screened by Dr. Shroff at the patient’s convenience.

Typically, patients with cleft lip and palate will need a first phase of treatment around the age of 7-9 that includes the alignment of their front maxillary teeth and the expansion of their palate in preparation for alveolar bone grafting. This phase usually takes about 9-12 months and patients are placed in retention after the bone graft until their permanent dentition erupts. Patients are then ready for a second phase of orthodontic therapy, which in some cases may be combined with orthognathic surgery. The treatment planning of cleft lip and palate patients is achieved with the input of the orthodontist, the prosthodontist and the oral and maxillofacial surgeon. This comprehensive approach offers true multidisciplinary and coordinated care to our patients and is of great benefit to them.

For the orthodontic faculty, residents, and other team members involved in care delivery, as well as for the patients themselves, this treatment is a very rewarding experience. These patients present with severe malalignment of teeth and/or skeletal discrepancies that are challenging to treat but also result in dramatic functional and esthetic improvements.

The care provided by the VCU Craniofacial Team is not limited to patients with cleft lip and palate, and the team is also available for patients presenting any other types of craniofacial deformities.

©Virginia Dental Association Journal, Spring 20111

References:

1 Strauss, RP. Cleft Palate and Craniofacial Teams in the United States and Canada: A National Survey of Team Organization and Standards of Care. Craniofacial Journal, November 1998, Vol. 35 No. 6.

2 Ronald P. Strauss (1999) The Organization and Delivery of Craniofacial Health Services: The State of the Art. The Cleft Palate-Craniofacial Journal: Vol. 36, No. 3, pp. 189-195.

3 American Cleft Palate–Craniofacial Association (ACPA). Parameters for evaluation and treatment of patients with cleft lip/palate or other Craniofacial anomalies. Cleft Palate Craniofac  J. 1993;30(suppl): S1–S16.

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