21 November 2025

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Transforming Smiles

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Across Florida, babies diagnosed with cleft lip and/or palate face a difficult reality: specialized care is scarce, and the window for early intervention is measured in weeks, not months. Experts in the University of Florida College of Dentistry, alongside UF Health craniofacial surgeons, have moved quickly to close this gap, custom-fabricating appliances that gently reshape infant faces before surgery — a pursuit that has, since this spring, provided previously out-of-reach care for many Florida families. 

“Watching our residents collaborate with UF Health’s craniofacial team to help these children speak, smile and thrive instills immense pride,” said College of Dentistry Dean Isabel Garcia, D.D.S., M.P.H. “They play a vital role alongside surgeons, orthodontists and specialists, restoring function and hope.” 

Florida’s hub for cleft care 

Clefting of the lip and/or palate occurs in about 1 in 1,050 U.S. newborns, according to the National Institutes of Health. 

Mi Sook Lee, D.M.D., M.S.D., Ph.D., a clinical assistant professor of pediatric dentistry at UF, has taken the lead in mastering the rare skill of customizing appliances for these infants. And pediatric dentistry residents Kaitria Abbatematteo, D.M.D., and Jonathan Sorsok, D.M.D., recently presented this pre-surgical infant orthopedics research at grand rounds. 

“There are not a lot of craniofacial clinics throughout the state,” Abbatematteo said. “So we are the hub for a lot of these children.” 

When an infant is born with a cleft lip and/or palate, time is critical. The treatment team has just six weeks to capitalize on a biological window when residual maternal estrogen makes infant cartilage most malleable.  

“Think of a baby’s face as a puzzle,” Sorsok said. “Most of the time, the pieces connect perfectly. But if one piece doesn’t fuse during the first four to nine weeks of fetal development, the result is a cleft lip or palate.” 

Without early intervention, surgeons must apply more tension to close gaps during repair, affecting jaw development and dental alignment.  

“Pre-surgical infant orthopedics doesn’t always begin with advanced technology; often, it starts with something as ordinary as tape,” Sorsok said, describing medical taping used to gently guide lip segments together. “What’s great is that parents can help daily, and it can be used for any case, even the most severe.”  

Rare expertise in action 

For moderate cases of cleft lip and/or palate, the UF team uses DynaCleft, a pre-surgical treatment that combines lip taping with a nasal elevator.   

“The benefits are that it’s simpler than the molding appliance and requires fewer clinic visits, but it still improves both lip and nasal form,” Sorsok said.  

The most sophisticated option is the nasoalveolar molding appliance, which guides the gums, lips and nose into position. Infants treated with these appliances often require fewer surgeries, with weekly visible improvements. 

Lee custom-makes each appliance with design features like a C-shape to prevent gagging. She acquired her expertise through intensive training that culminated in March 2025 at Duke University, where she learned directly from Barry Grayson, D.D.S., who created the technique in 1993.  

While nasoalveolar molding treatment has become more widely available, mastering the hands-on fabrication of the appliances requires intensive expert-led training, which is why so few treatment centers have an in-house specialist.  

“Not a lot of people in this country have the skillset [to develop these appliances],” Sorsok said. “Most of these babies won’t know how [Lee] is changing their lives until they’re older.”  

The treatment involves frequent clinic visits and significant caregiver commitment. Lee supervises residents who adjust appliances weekly, and the team provides prenatal counseling and teaches families feeding strategies, taping techniques and appliance care. 

“The better you set patients up for success during surgery, the better the outcome,” said Pediatric Dentistry Program Director Matthew Cooke, D.D.S., M.D., M.P.H. “It truly requires a whole village to treat these children.” 

With careful pre-surgical molding, “you may not even know [these patients] had clefting,” Cooke said. 

As children with cleft lip and/or palate grow, secondary effects become apparent: missing, extra or malformed teeth, and inadequate upper jaw development from scar tissue. The UF orthodontics team plays a crucial role, widening the upper jaw and guiding teeth into position. 

“During adolescence, the individual usually gets full braces to align permanent teeth and establish a stable, functional bite,” explained Orthodontics Department Chair Calogero Dolce, D.D.S., Ph.D.  

With the help of UF’s dental and surgical teams — providing everything from early molding to orthodontic treatment — patients born with cleft lip and/ or palate are now eating, growing and speaking with confidence. 

Source: https://dental.ufl.edu/