Gingivectomy as a Supportive Therapy in Orthodontic Treatment of Bilateral Cleft Lip and Palate Patient: A Case Report


Background: One of the congenital malformation in the early phase of embryogenesis is cleft lip and/or palate that need multidisciplinary treatment in dentistry. Although surgery is performed in the first few months of life, advanced treatment is needed sometimes in the growth age, such as orthodontic, periodontic and esthetic treatment.

Objective: To describe a gingivectomy procedure to support orthodontic treatment in bilateral cleft lip and palate patient.

Case Report: A 13-year-old boy was referred from the orthodontic department with complaints of enlargement in maxillary anterior gingiva teeth, blocking the placement of the orthodontic device. Patient’s examination showed bilateral cleft lip and palate, plaque score 35%, bleeding on probing 73%, dental agenesis on teeth 12 and 22, and gingival enlargement on regions 13–23. The aim of gingivectomy, in this case, was to eliminate pockets, restore physiologic gingival contour and facilitate the placement of the orthodontic device.

Results: Clinical evaluation after gingivectomy showed satisfying results in reducing the pocket depth.

Conclusion: Gingivectomy is effective in supporting the orthodontic treatment for cleft lip and/or palate patient.

Keywords: cleft lip, cleft palate, gingival enlargement, gingivectomy, orthodontic treatment

[1] Chowchuen B, Godfrey K. Development of a network system for the care of patients with cleft lip and palate in Thailand. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery. 2003;37(6):325-331.

[2] Ahmed MK, Bui AH, Taioli E. Epidemiology of cleft lip and palate. Designing strategies for cleft lip and palate care. IntechOpen. 2017: 3-22.

[3] Villagra LN, Domon M, Méndez VS. Comprehensive orthodontic treatment of adult patient with cleft lip and palate. Case Reports in Dentistry. 2014. Volume 2014:1-4.

[4] Guerrero C. Cleft lip and palate surgery: 30 years follow-up. Annals of Maxillofacial Surgery. 2012;2(2):153-157.

[5] Boloor V, Thomas B. Comparison of periodontal status among patients with cleft lip, cleft palate, and cleft lip along with a cleft in palate and alveolus. Journal of Indian Society of Periodontology. 2010;14(3):168-172. 124x.75911

[6] Wyrębek B, Cudziło D, Plakwicz P. Evaluation of periodontal tissues in growing patients with bilateral cleft lip and palate. A pilot study. Developmental Period Medicine. 2017;21(2):154-161.

[7] Perillo L, D’Apuzzo F, Eslami S, Jamilian A. Designing strategies for cleft lip and palate care. Almasari MA, editor. IntechOpen; UK. 2017. Cleft lip and palate patients diagnosis and treatment.

[8] Mancini L, Gibson TL, Grayson BH, Shetye PR. Orthodontic treatment in adolescents with cleft lip and palate. Seminars in Orthodontics. 2017;23(3):295- 304.

[9] de Souza Freitas, J.A., de Almeida, A.L.P.F., Soares, S., et al. Rehabilitative treatment of cleft lip and palate: Experience of the hospital for rehabilitation of craniofacial anomalies/USP (HRAC/USP) - Part 4: Oral rehabilitation. Journal of Applied Oral Science. 2013;21(3):284-292.

[10] Reddy S. Essentials of and periodontics. New Delhi: Jaypee Brothers Medical Publisher (P) Ltd; 2011.

[11] Newman M, Takei H, Klokkevold PCF, Carranca FA. Newman and Carranza’s clinical periodontology. 13th ed. Philadelphia: Elsevier; 2019.

[12] Loose JE, Kirschner RE. Comprehensive cleft care. 2nd ed. New York: Thieme Medical Publisher; 2016.

[13] Van Der Weijden F, Slot DE. Oral hygiene in the prevention of periodontal diseases: The evidence. Periodontology 2000. 2011;55(1):104-123. 0757.2009.00337.x

[14] Nagarale GP, Ravindra S, Thakur S, Setty S. Long term follow up of idiopathic gingival enlargement associated with chronic periodontitis: A case report and review. Journal of Indian Society of Periodontology. 2013;17(2):242-247. 124X.113088