Orthodontic Care Delivery Across American Cleft Palate and Craniofacial Association (ACPA) Teams in the US

Abstract

Introduction: American Cleft Palate and Craniofacial Association (ACPA) teams consist of trained professionals collaborating in an interdisciplinary approach to optimize outcomes for patients with cleft palate. Orthodontic care is essential to correct dental malocclusion, guide maxillary growth, enhance surgical outcomes, and improve oral function and aesthetics. Although ACPA approval requires an orthodontist in the multidisciplinary team, the methods of delivering orthodontic care remain unclear. This project aims to elucidate how orthodontic care is integrated into ACPA teams.

Methods: A list of ACPA teams (n = 204) and reported orthodontists (n = 374) was obtained from the ACPA directory. Teams outside the US. and duplicate listings were excluded. Each team's website was reviewed to identify orthodontists, care delivery types (university/hospital, private practice, mixed, not listed), and orthodontic craniofacial fellowship status. Team geographic distribution was compared across the 4 US Centers for Disease Control and Prevention (CDC) Census regions: West, Midwest, South, and Northeast.

Results: Among 184 ACPA-approved teams, only 46.7% listed an orthodontist on their public websites, despite guidelines requiring orthodontic inclusion. The most common care model was university/hospital-based (25%), followed by private practice (18.5%), with variation across teams ( P < 0.001). Only 16.3% of teams included a craniofacial fellowship-trained orthodontist, whereas over half did not report training status. Private practice teams were less likely to include a fellowship-trained orthodontist compared to university/hospital-based teams (OR, 0.086; P < 0.001). Most teams had 1 to 2 orthodontists (mean, 1.84), with no difference by region or care model. Regionally, the South had the highest proportion of teams (33.2%) and orthodontists (33.2%), whereas the Northeast had the fewest. Fellowship-trained orthodontists were most common in the South but showed no regional difference ( P = 0.989).

Discussion: Orthodontists are inconsistently represented across ACPA teams with limited public reporting and low rates of fellowship training. Variation in care delivery models and regional access highlights structural gaps in interdisciplinary cleft care. Standardizing orthodontic integration and increasing fellowship training may improve the consistency and equity of craniofacial care nationwide.

Keywords: access to care; cleft lip and palate; craniofacial fellowship training; craniofacial teams; health care disparities; multidisciplinary care; orthodontics; workforce distribution.