The system of prosthetic treatment for CLAP patients

Use of Individually Designed CAD/CAM Suprastructures for Dental Reconstruction in Patients with Cleft Lip and Palate

This patient series reports the outcomes of CAD/CAM prosthetic reconstructions in patients with cleft lip and palate (n = 9, aged 27 to 76) who have experienced significant failure with conventional restorative and fixed prosthodontic treatments. The objective of the protocol is to establish a functional and patient-friendly prosthetic structure for individuals with unilateral/bilateral cleft lip and palate (UCLP/BCLP) while minimising the requirement for specialised follow-up care in the cleft unit. The study data were obtained from a retrospective cohort at Helsinki University Hospital. Prosthetic reconstructions were performed using CAD/CAM bar structures by the Atlantis 2in1 system or Createch removable telescope structures, supported by four to eight maxillary dental implants. Out of the nine patients, seven experienced no complications. One prosthesis fracture occurred after 16 months due to a design error in the original framework, and one patient experienced failure of osseointegration in a dental fixture (specifically, one fixture out of the eight maxillary implants in this patient). In total, 56 implants were successfully placed. The maxillary dentition of elderly patients with cleft lip and palate often poses challenges due to periodontal and reconstructive issues. An implant-supported CAD/CAM bar with a removable telescope suprastructure offers an easily maintained and functional solution for dental rehabilitation.

Prosthodontic Rehabilitation of a Residual Post-surgical Cleft Defect

Cleft lip/palate is a common birth defect globally, and the impact of this condition on the dental health of affected individuals can be profound. During intricate rehabilitation of cleft lip and palate patients, the final phase is achieved with definitive prosthodontic treatment. Prosthodontic rehabilitation is often necessary due to missing teeth and the alveolar ridge, malocclusion, residual defects, and the discrepancy between maxillary and mandibular arches. This article presents a case report of a young female patient with residual post-surgical cleft palatal defect having a mobile anterior segment with missing lateral incisors rehabilitated by a cast partial denture. The prosthesis utilized provided improvements in the patient's speech and esthetics but at a low level of cost and ongoing maintenance.

Dental rehabilitation of a cleft lip and palate patient by implant-supported overdenture: A case report

Our patient was a 27‐year‐old male with a unilateral cleft lip and palate. Considering the mobility of bone segments around the cleft, an implant‐supported removable overdenture (obturator) was fabricated, which improved the function and esthetics and led to patient satisfaction. The treatment results are still satisfactory after 5 years of follow‐up.

Implant Therapy in Alveolar Cleft Sites

Dental implant therapy in the non-cleft patient is familiar to most oral and maxillofacial surgeons. Understanding the differences in surgical treatment planning in the cleft patient versus the non-cleft patient is the key to highly functional and esthetic long-term outcomes. CBCT and computer-assisted planning, as well as improved technology in grafting and implant materials, result in excellent outcomes. Communication with the restorative team remains of paramount importance in planning treatment.

Esthetic and functional rehabilitation in patients with cleft lip and palate

Oral rehabilitation of missing teeth in cleft patients has acceptable success rates. A two-stage approach is indicated; however, timing of implant placement in the grafted maxilla varies within existing protocols. This case highlights successful implant osseointegration and esthetic oral rehabilitation following placement of two implants at 5 months after maxillary grafting (alveolar bone grafting) with a corticocancellous block obtained from the iliac crest. A 31-year-old male patient had already undergone repair of his bilateral cleft lip and soft palate according to established guidelines for cleft patients. Initial closure of his alveolar clefts and further correction of the maxillary hypoplasia with a bi-maxillary osteotomy were completed in 2002. However, bone resorption due to infection in 2003 necessitated removal of all maxillary incisors. The patient was not satisfied with the removable partial denture provided. In 2007, he did undergo anterior maxillary augmentation under general anesthesia, and 5 months later two implants were placed. A 3-unit bridge did replace functional and esthetic demands. Postoperative recovery was uneventful, and overall bone loss, and oral health remain within standards 28 months following implant placement. Optimal outcome is achievable when replacing missing teeth in cleft patients when timing does not exceed approximately a 6-month interval from bone grafting to implant placement. This article demonstrates that overall esthetic and functional rehabilitation is feasible in cleft lip and palate patients. In this patient, overall oral treatment was achieved with an implant prosthesis.

[Implant-borne prosthetic rehabilitation in patients with cleft lip and palate: A retrospective study on 43 patients]

INTRODUCTION

Implant-borne rehabilitation in cleft lip and palate patient are aimed to allow for good orofacial functions, stable occlusion, and adequate support for the naso-labial region. The goal of our study was to evaluate the functional and esthetic results of the implant-born dental rehabilitation of the cleft lip and palate patients in our department.

MATERIAL AND METHODS

Our retrospective study concerned patients operated between 1995 and 2010 in our department. All included patients suffered from a cleft alveolus and lip, with or without cleft palate. Dental implants were placed in the bone-grafted alveolus and the end of growth and at distance from the bone graft procedure. Criteria of implant survival and implant-borne rehabilitation success were defined.

RESULTS

A total of 78 implants were placed in 43 patients between 1995 and 2010. Two implants were lost (implant survival rate: 97.4%). Despite this loss, all the patients could be rehabilitated with good functional and esthetic results.

DISCUSSION

Implant-borne rehabilitation is a reliable solution for prosthetic rehabilitation in patients with cleft lip and palate. This solution allows for avoiding removable prosthesis and dental mutilation.

Multi-unit fixed partial denture for a bilateral cleft palate patient: a clinical report

Patients with cleft palates eventually require definitive fixed or removable dental prostheses after the maintenance of arch alignment and occlusal relationship during adolescence. This case report presents application of a resin composite veneered fixed partial denture utilized as a definitive prosthesis for a bilateral cleft palate patient after stable occlusion had been established orthodontically. The composite veneered long span fixed partial denture provides adequate aesthetics and function.

Fixed partial denture supported by all-ceramic copings: a clinical report

This clinical report describes the prosthodontic treatment of a partially edentulous patient who had a surgical closure of bilateral cleft of the lips, alveolar processes, and palate. The prosthodontic treatment included the fabrication of a "telescopic" fixed partial denture supported by reinforced all-ceramic primary copings. The use of all-ceramic primary copings, rather than gold copings, offers an alternative fixed partial denture and improves the esthetic result in certain clinical situations.

Reconstruction of residual alveolar cleft defects with one-stage mandibular bone grafts and osseointegrated implants

PURPOSE

This study evaluates a treatment regimen for reconstruction of residual maxillary alveolar cleft defects consisting of mandibular bone grafting and immediate implant installation.

PATIENTS AND METHODS

Sixteen cleft patients (five female and 11 male) had residual cleft defects of the alveolar ridge reconstructed with bone grafts from the mandibular symphyseal region. The bone graft was pretapped at the donor site before fixation in the residual ridge with Brånemark implants. Twenty implants were installed according to this concept. The period of observation ranged from 36 to 69 months, with a mean of 48 months after implant installation.

RESULTS

Five patients developed wound dehiscenses that resulted in total or partial bone graft sequestration. Two implants were lost, one due to sequestration and the other due to mobility at the abutment procedure; 18 implants were still well functioning at the end of the observation period. However, all patients showed significant periimplant bone resorption after this one-stage treatment.

CONCLUSION

Because of the observed complication rate, the one-stage procedure may not be optimal for reconstructing residual cleft defects.