**Author details**

**4. Retention**

**Figure 11.** Hyrax screw after activation.

38 Designing Strategies for Cleft Lip and Palate Care

(a) lack of bony stability,

**5. Recommendation**

(c) missing teeth.

The retention protocol for clefts follows the same principles of orthodontic treatment in Class III malocclusion without clefts. The upper and lower arches should have been coordinated throughout orthodontic and orthopedic intervention. Positive overjet and overbite with adequate intercuspation are necessary for retention. Hawley retainer in the maxillary and mandibular arch is used for retention. Hawley appliance often includes prosthetic teeth that will be displaced later with dental implants or prostheses. Patients are instructed to wear the Hawley appliance for 12 months continuously. After that, if the occlusion is stable, the

Retention in cleft palate cases is longer than for noncleft patients. The reasons are due to:

Treatment approach depends on the age and severity of the patients. Growth modification is the best treatment plan when the patient is still growing. We can take advantages of a child's growing years by guiding proper jaw bone formation with small intraoral appliances such as tongue plate and tongue appliance [6, 27]. These small intraoral appliances are recommended

Hawley retainer is used at night-time for additional six months.

(b) contracture of stretched or scar tissues, and

Letizia Perillo1 , Fabrizia d'Apuzzo1 , Sara Eslami2 and Abdolreza Jamilian2 \*

\*Address all correspondence to: info@jamilian.net

1 Multidisciplinary Department of Medical-Surgical and Dental Specialties, Second University of Naples, Naples, Italy

2 Department of Orthodontics, Cranio Maxillofacial Research Center, Tehran Dental Branch, Islamic Azad University, Tehran, Iran
