Esthetic and functional rehabilitation in patients with cleft lip and palate

Impact of a new combined preoperative cleft assessment on dental implant success in patients with cleft and palate: a retrospective study

Background

Bone height assessment alone is frequently used to guide rehabilitation choice, without consideration for soft tissues or adjacent teeth. This study aimed to evaluate the impact of different preoperative cleft assessments on implant success and patient satisfaction.

Methods

The study involved a retrospective assessment of records from 40 patients with cleft lip and palate (CLP). The alveolar cleft score (ACS; clinical criteria), interdental alveolar bone height (IABH) score (radiological criteria), patient compliance score (dental hygiene, medical visit observance, and smoking), and a novel combined score (IABH-ACS-Compliance) were assessed from patient records. Patients who required prosthetic tooth rehabilitation in the cleft dental arch space were included. Twenty-six patients (Group 1) were treated with dental implants, and 14 patients (Group 2) selected another prosthetic option (fixed prosthodontics, removal prosthesis), orthodontic space closure, or no rehabilitation. The main outcomes measured were relative implant success (no implant loss involving marginal bone loss ≤ 1.9 mm) for patients treated with dental implant therapy (Group 1) and patient satisfaction for all patients (Groups 1 and 2).

Results

Forty dental implants were placed in the patients in Group 1. Four implants in four patients (Group 1 relative failure, RF) were lost (implant survival rate of 90%) after 36 (± 12.4) months of follow-up. Twenty-two patients who received implants belonged to the relative implant success group (Group 1 RS). The average “IABH-ACS-Compliance” scores were significantly different (p < 0.05): 16.90 ± 2.35 and 12.75 ± 0.43 for the Group 1 RS and RF groups, respectively.

Conclusions

Preoperative cleft parameters have an impact on relative implant success and patient satisfaction. The new cleft assessment combined-score (“IABH-ACS-Compliance”) allows an accurate selection of cleft cases eligible for dental implants, thereby improving postoperative outcomes.

[The role of restorative oral rehabilitation in orthodontic treatment of cleft lip and palate patients]

The purpose of the study is improving the effectiveness of rehabilitation of adolescents with a cleft lip and palate based on the orthopedic technologies implementation aimed at replacing the tooth-alveolar defect in the area of the alveolar ridge cleft at the active orthodontic treatment stage.

MATERIALS AND METHODS

In the period from 2013 to 2020, 44 patients aged 10 to 18 years with unilateral and bilateral cleft lip and palate were observed. During orthodontic treatment with active appliances all patients received a removable plastic prosthesis with an artificial tooth (or several teeth) in it covering the defect of the alveolar process in the cleft area. An experimental dental alveolar model was made in a 1:1-scale, based on an axial computed tomographic section of the upper jaw, examined in polarized light on the installation with a source of scattered white light with a 1600-2000 cd/m² brightness to study the distribution of stresses in the dental alveolar complex using an active orthodontic arch. The assessment of chewing efficiency was carried out on the evaluation of the nut (hazelnut) crushing degree.

RESULTS

The study of the experimental tooth-alveolar model with a bracket system with an active orthodontic arch with an included defect in the dentition in the area of the cleft of the alveolar process showed an uneven and deviant distribution of stresses in the tooth-alveolar complex, the vector of which depends on the presence or absence of a rigid connection between the alveolar fragments (imitation of the presence or absence of bone regenerate in the cleft). The use of a restorative construction reduces the time when performing a chewing test and increases the efficiency of chewing in patients with unilateral (p=0.02) and bilateral (p=0.008) cleft. It is associated not only with the restoration of the continuity of the dentition with an orthopedic structure, but also with the activation and structuring of the function of the tongue when performing chewing movements.

CONCLUSION

The use of a proposed restorative appliance allows: to create the continuity of the upper dentition that harmonizes the distribution of forces from the active orthodontic arch; increases the stability of the teeth in the areas of the upper jaw adjacent to the cleft (incisors and canines) and prevents their unwanted displacement; promotes directional movement of the teeth; in the retention period, to maintain the achieved expansion of the dentition while maintaining space for the future fixed prosthesis; isolate the mouth of the anterior palate; hold the achieved position of the fragments of the upper jaw until bone grafting.

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.