Fifth APO General Meeting 08-09

By Dr. Maria Emilyn Bautista de Marcaida

The 5th APO General meeting 2008-2009 held at Palm Grove, Rockwell Club, Makati last Aug 5 2009 was particularly memorable because aside from the socially relevant topics discussed, this day marked the occasion of the interment of our dear Mother of Democracy Corazon Aquino. With that in mind, Dr. Rossana Sanchez led the invocation with special intention for our beloved ex-President at about 8:40 am. This was followed by the National Anthem. After which, APO president, Dr. Jose Manuel Rivera gave the welcome remarks.

This meeting was hosted by Quezon City 4 with Drs. Maria Elenor Estrada and Maria Victoria Reyes as masters of ceremonies.

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The committee reports proceeded with Dr. Laarni Serraon (substituting for Dr. Bernadette Go-Lim) tackling membership concerns, warning that members who can’t update their membership dues shall be dropped from the roster.

Dr. Ermelinda S. Galang spoke on behalf of the PBO regarding the symposium that will be held in Feb 2010 during the World Federation of Orthodontists in Australia. Dr. Galang and APO president-elect Dr. Roberto Tan will represent the PBO in a symposium that will discuss Board Certification in Orthodontics. Our PBO is one of just a few recognized boards by the international community as a legitimate governing body.

This was then followed by the awarding of the research grant to Dr Frances Tamayo by Dr Martin Reyes, editor of PJO. Her research is entitled Biologic markers for evaluation of Root Resorption among orthodontic patients treated at the UP Graduate Program from 2009 to 2010. 

And kudos to Dr Rachel Yang-Lim who flew-in from Cebu for the table clinic presentation of her PBO Phase III Examination Cases.

At about 9 am PROS-APAC, the meeting sponsor, through Dr. Ethel Escultura-Lingat (an APO member herself) presented  MRC (Myofunctional Research Co.). They are offering a wide range of myofunctional appliances, catering to a variety of orthodontic concerns like the Trainer, Interceptive, Myobrace and TMJ systems.

The highlight of the session was the Cleft Lip and Palate: Management and Case Presentation by experts from Our Lady of Peace Craniofacial Center. Our very own Dr. Janet Pandan together with Drs. Cecile Tuano, Xenia Velmonte and Glenda de Villa showed us the team approach in managing patients with cleft lip and palate.

The Our Lady of Peace Craniofacial Center is a project of the Noordhoff Craniofacial Foundation of the Philippines. It will be interesting to know that the APO assists in this project by subsidizing orthodontic treatment of some cleft patients from panoramic and lateral cephalometric radiographs to materials needed for treatment.

Dr  Cecile Tuano started the presentation by giving the introduction and overview. Surprisingly, it was noted that the incidence of cleft lip and palate in the Philippines is higher at 1:500 live births compared to the world record of 1:600. There is a mainly genetic predisposition to clefting that is acted upon by environmental factors. She also mentioned that timing of treatment is very important and at 1 to 3 months the use of the NAM or Nasoalveolar Molding may be greatly beneficial to the patient. The appliance allows the tissues to align well prior to primary lip and nose repair, which enables the surgeon to achieve a better and more predictable outcome.

Dr Glenda de Villa came next with the topic Cheiloplasty and Palatoplasty. She stressed that the goal for all cleft patients needs to be good to excellent facial esthetics, normal dental occlusion, and normal speech. Dr. de Villa showed several cases of unilateral and bilateral lip repair, and also mentioned that if the palate is operated just on time the chances for normal speech is better. Patients who were repaired at a later stage develop VPI- velopharyngeal incompetence, thus retaining the same speech pattern though structurally corrected already. 

The orthodontic side was discussed then by Dr Janet Pandan. She mentioned that it would be better to see patients as early as the primary dention. Though treatment will just be limited to simple correction of anterior and posterior crossbite it will be wise to monitor the cases periodically with cephalometric and panoramic radiographs. Dental care must also be stressed to the patient and parents. During the mixed dentition stage, transverse maxillary discrepancy, rotated maxillary incisors, hypomineralization, assymetrical development of tooth pairs may be noted. To address the transverse problems, expansion appliances eg.quadhelix may be used. She showed some cases where she used the biteplate, facemask, 2×2 or 2×4. Full orthodontic treatment is also needed eventually to remove interferences/ malpositioned teeth to promote adequate surgical access and flap during alveolar bone grafting.

This was then expounded by Dr Xenia Valmonte. The rationale for Alveolar Bone Grafting is to provide bone in the area of the alveolar cleft for the eruption of the unerupted teeth, to stabilize the premaxilla especially in bilateral clefts, to allow orthodontic manipulation, and to support the alar base and nasal contour. Normally, bone is harvested in the anterior iliac crest, occasionally in the chin and the lateral body and ramus of the mandible. The autologous graft is done between 9-11 year with 1/2 to 2/3 root formation of the unerupted canine.

Orthodontic treatment after grafting must commence as early as 6-8 wks with labial and medial positioning of canines to promote arch expansion and elimination of crossbite. Delayed orthodontic treatment may cause loss of AP growth, impaction of canine lingual collapse of incisors and collapse of maxillary arch.
To summarize, the treatment protocol in the center is Nasoalveolar molding, lip repair, palate repair, orthodontics- primary and mixed dentition,  alveolar bone grafting, orthodontics in the permanent dentition,  orthognatic surgery, and revision surgeries. All in all, the presentation was highly informative and interesting, many thanks to the group.