Orthodontic treatment planning in cleft and craniofacial patients with clear aligners: burden of care and informed consent

INTRODUCTION: Orthodontic treatment in cleft lip and palate and craniofacial anomalies is complex and requires a multidisciplinary approach. There are often multiple possible treatment plans. To properly explain and discuss the various options, such as management of frequently missing incisors or the choice between orthognathic surgery and dental compensation, assessment of burden of treatment must be made and adequately communicated to the patients and families. PATIENTS AND METHODS: 105 patients affected by cleft lip and palate and craniofacial anomalies were retrospectively collected and divided into two groups. The first group included patients whose orthodontic diagnosis involved missing elements, where treatment could be either space closure or space opening. The second group included patients with skeletal discrepancies, who could be treated with dental compensation ​or with orthognathic surgery. For all patients of both groups two different virtual treatment plans with the Clin Check® software were developed, corresponding to the different treatment possibilities. Clinical aspects which might have influenced treatment choice, such as treatment time, need for extractions, need for prosthetic replacements and need for cooperation were quantified. Logistic regression and Fisher exact test were applied to assess which aspects of treatment led patients to one of the different binary solutions. RESULTS: Length of treatment was not an aspect which differed between choices, while the need for high cooperation and need for tooth extractions were. The clear explanation and visual description of advantages and disadvantages of a treatment, seem to help patients in the selection of the expected solution in terms, not only of final occlusal and aesthetic result, but also in terms of burden of care. Though far from sufficient, the visual tool aids patients and families to take an "informed" decision, with significant legal inferences. Embracing these principles is essential to meet legal standards and foster trust, helping patients make well-informed decisions that align with their personal values and clinical needs. This approach not only respects patient autonomy but also reduces the risk of non-compliance, emotional strain, and potential legal issues, ultimately leading to better therapeutic outcomes and stronger clinician-patient relationships.