Cephalometric changes with modified Fan and Three-way expanders in Bilateral cleft lip and palate patients: A Randomized clinical trial

Background: Maxillary deficiency in the three planes characterizes cleft lip and palate (CLP) patients, requiring interceptive treatment to restore arch integrity, adding up to the total burden of care for these families. Bilateral cleft lip and palate (BCLP) present a more complex deformity, where the premaxilla can be severely malaligned requiring extensive orthopedic or surgical correction. This randomized clinical trial aimed to compare the effects of a new design of the three-way palatal expander and the modified fan expander in maxillary arch development in cleft lip and palate patients. Methods: Twenty patients were recruited suffering from bilateral cleft lip and palate (age from 8 to 15 years). They were divided into two groups; A) Modified Fan expander (10 patients) and B) Three-way palatal expander (10 patients). Cephalometric radiographs were taken before expansion (T0) and after expansion was completed (T1) and were digitized and analyzed using a special orthodontic tracing software program. Dolphin Ver. 11.5 (Dolphin Imaging and Management Solutions, Chatsworth, Calif. USA) was used in this study. Statistical analysis through Paired t-test was used to evaluate the changes in each group. Results: Analysis of cephalometric radiographs showed positive statistically significant differences in maxillary length and dental measurements of both groups, where all incisor measurements increased significantly. Group (A) showed significantly greater increase in anteroposterior position of maxilla and showed distal molar movement and tipping. Conclusion: Both the fan expander with palatal springs and three-way expander can widen and lengthen maxilla of BCLP patients simultaneously, decreasing the burden of care of these patients by their families through using just one appliance. Trial registration: ClinicalTrials.gov Identifier: NCT07056296 (https://clinicaltrials.gov/); June 29, 2025, retrospective registration.