Prosthodontic Rehabilitation Alternative of Maxillary Dentoalveolar Defect in A Patient With Cleft Lip and Palate (CLP) Case Report

Volume 8, Issue 5, May – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Prosthodontic Rehabilitation Alternative of Maxillary

Dentoalveolar Defect in a Patient with Cleft Lip and
Palate (CLP): Case Report
1 4
Dr. Balkis Khadhraoui Dr. Zohra Nouira ( Professor)
Department of Fixed Prosthodontics, Department of Fixed Prosthodontics,
Dental Faculty of Monastir, Dental Faculty of Monastir,
University of Monastir, Tunisia University of Monastir, Tunisia
2 5
Dr. Raouf Turki Dr. Belhassen Harzallah ( Professor)
3 6
Dr. Yosra Gassara (Assistant Professor) Dr. Mounir Cherif ( Professor)
Abstract:- Cleft lip and palate are common birth Thanks to advanced knowledge of craniofacial growth
defects, occurring in approximately 1 in 800 births. and development, along with enhanced surgical and
Most clefts are believed to be caused by a combination orthodontic treatments, patients with cleft palate now
of genetic and non-genetic factors. It may be attributed receive improved care and in a more efficient manner (2) .
to factors such as malnutrition, irradiation during As a result, they require fewer prosthetic interventions.
pregnancy, psychological stress, teratogenic agents, However, prosthetic treatment still plays a crucial role in
infectious agents (viruses), and heredity. There are cleft palate care. (3)
various options available to treat the missing soft and
hard tissues, including removable dental prostheses, Cleft palate patients often have missing anterior teeth
fixed dental prostheses, and implant prostheses. since birth. The lateral incisors are the most commonly
However, different authors have different opinions on missing teeth in unilateral or bilateral clefts, although the
the standard of care for prosthetic treatment of cleft lip canines and central incisors may also be affected (4) . In
and palate. Some prefer removable prostheses, while cases where the teeth are present, they may be malformed
others recommend conventional tooth-supported fixed or malpositioned. Moreover, the bone support for teeth near
dental prostheses. This case report describes prosthetic the cleft is typically compromised (5)
treatment of a congenital cleft lip and palate, where a
direct zirconia-ceramic fixed dental prosthese was Various authors have presented different standards for
chosen based on the patient's preference and prosthetic treatment of cleft palate/lip in literature. While
agreement. some suggest removable prosthesis as the ideal choice,
others consider conventional tooth-supported Fixed Dental
Keywords: Cleft Lip and Palate; Prosthodontics; Ceramic; Protheses to be the standard of care (6) (7) (8)
Zirconia; Orthodontics; Fixed Protheses;.
A carefully planned combination of prosthetic,
I. INTRODUCTION periodontal, and surgical therapies can lead to satisfactory
function and improved appearance, reducing the impact of
When offering maxillofacial prosthetic treatment to deformities. With proper education and regular check-ups,
patients with craniofacial and congenital defects, it is patients should be able to maintain good oral health.
crucial not only to address their physical and functional
shortcomings but also to take into account the potential The purpose of this clinical case report is to detail the
psychological impact of these deformities (1). interdisciplinary approach to treating a young adult patient
with Cleft Palate and Lip and Maxillary Dentoalveolar
Even though cleft palate patients may not be a Defect, as well as their prosthodontic rehabilitation.
common occurrence in general dental practice, it is a
prevalent congenital anomaly with roughly one in every
800 live births resulting in a cleft lip and palate (1)
IJISRT23MAY876 www.ijisrt.com 3764

ISSN No:-2456-2165
II. CASE DESCRIPTION
A 22-year-old woman was referred to the department of

fixed prosthodontics at the faculty of dental medicine of
Monastir. The patient’s history revealed that she had a
congenital unilateral complete lip and palate cleft, which
had previously been ortho-surgically reconstructed.
An intraoral examination revealed the absence of maxillary

anterior residual ridge on the left side. The maxillary left
lateral incisor tooth was outside the bone in the center of
the cleft (Figures 1 and 2).
Fig 2 (a) Intraoral View
Fig 2 (b) Lateral Intram Ural View

Fig 1 (a) Extraoral View
The extraction of this tooth was indicated.
After comprehensive evaluation of the case, it was

determined that the prosthodontic treatment plan would
include a zirconia-based fixed dental prosthesis to mask the
bony defect and restore both the facial and dental aesthetics
with tooth-colored layered porcelain on the labial surface of
the teeth, and pink- colored porcelain on the soft tissue area
of the prosthesis. Abutment teeth included #11, #12, #23.
To create a diagnostic wax-up, tooth proportions,

gingival contours, and facial ratios commonly employed for
restoring non-cleft patients were used as a reference.
The abutment teeth were prepared for zirconia-

ceramic fixed dental protheses. (Figure 3)
Final impression of the maxillary abutments was

made using a combination of heavy and light-body PVS
impression material, after conventional gingival retraction
using a double cord technique.
Fig 2 (b) Profile View

ISSN No:-2456-2165
Fig 3 Teeth Preparation

Fig 6 Intra-Oral View Two-Year Follow-Up
Fig 4 The Zirconia Coping
After obtaining the working cast, the zirconia coping

was designed digitally, fabricated with a milling machine
and checked intraorally to verify insertion and marginal
adaptation (Figure 4).
Then the veneering ceramic was layered according to

the selected shade.
Fig 7 Frontal View of Smile Two-Year Follow-Up
The ridge was finalized before the try-in. Occlusal
interference was checked with articulating paper. Finally, A two-year follow-up confirmed the patient's
the ridge was cemented with self-adhesive resin cement complete satisfaction with her smile (Figures 6 and 7)
(RelyX U200; 3M ESPE, Cuxhaven, Germany) (Figure 5).
III. DISCUSSION
Providing treatment to patients with CLP is a highly

complex process and requires an interdisciplinary team to
achieve successful outcomes. The difficulty level can be
further increased in cases where there are additional
complicating factors, such as maxillary hypoplasia or the
absence of a premaxilla. In these cases, prosthodontists face
challenges such as multiple missing teeth, teeth with
abnormal shapes or sizes, and insufficient soft tissue.
Various treatment options are available for patients

with cleft lip and palate. Removable partial dentures can be
used with telescopic crowns cemented to natural teeth, and
overdentures can be utilized to camouflage large defects
with major bone and soft tissue deficiencies (9). Another
Fig 5 Final Result recently published technique is interdental alveolar
distraction, which reduces the cleft area and eliminates the

ISSN No:-2456-2165
need for bone grafting large alveolar deformities (10) (11). IV. CONCLUSION
Implant-supported fixed prostheses and conventional fixed
dental prostheses are also viable options depending on the This clinical report describes an innovative approach
severity of the case (12). to the prosthodontic rehabilitation of a patient with Cleft
Palatal and Lip, involving the use of a zirconia-based fixed
Removable partial denture can be used temporarily as partial denture with pink porcelain to restore facial and
a form of tooth replacement, as noted by Saito et al. dental aesthetics. The complex case required lengthy
(2002)(13) . However, despite their good appearance, these treatment time and interdisciplinary collaboration. Despite
removable dental prostheses may cause discomfort for these challenges, the final restoration achieved the patient's
patients due to irritation caused by the soft tissues desired outcome, providing an aesthetically pleasing smile
supporting them (14). Therefore, they should only be used and satisfactory occlusion.
as a permanent solution for tooth replacement when
multiple teeth are missing and the gap is too large to be ACKNOWLEDGMENT
filled by a fixed partial denture.
All authors are members of the Research Laboratory
After careful evaluation, it was determined that a of Occlusodontics and Ceramic Prosthesis LR16ES15
fixed dental prosthesis would be the optimal treatment
option for this particular patient. However, there were  Conflicts of Interest
concerns about the ceramic structure's ability to adequately The authors declare no conflicts of interest.
address the soft tissue and bone deficiencies present in the
edentulous area.  Authors’s Contributions
All the authors to the production of this article. They
The framework made with Zirconia was planned with read and approved the final version of this manuscript.
adequate volume and vertical dimension to compensate for
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Volume 8, Issue 5, May – 2023 International Journal of Innovative Science and Research Technology

Prosthodontic Rehabilitation Alternative of Maxillary

IJISRT23MAY876 www.ijisrt.com 3764

A 22-year-old woman was referred to the department of

An intraoral examination revealed the absence of maxillary

Fig 2 (a) Intraoral View

Fig 2 (b) Lateral Intram Ural View

After comprehensive evaluation of the case, it was

To create a diagnostic wax-up, tooth proportions,

The abutment teeth were prepared for zirconia-

Final impression of the maxillary abutments was

IJISRT23MAY876 www.ijisrt.com 3765

Fig 3 Teeth Preparation

Fig 4 The Zirconia Coping

After obtaining the working cast, the zirconia coping

Then the veneering ceramic was layered according to

Providing treatment to patients with CLP is a highly

Various treatment options are available for patients

IJISRT23MAY876 www.ijisrt.com 3766

IJISRT23MAY876 www.ijisrt.com 3767

IJISRT23MAY876 www.ijisrt.com 3768

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