Cleft lip and palate: recommendations for dental anesthetic procedure based on anatomic evidences

Abstract

Patients with cleft lip and palate usually present dental anomalies of number, shape, structure and position in the cleft area and the general dentist is frequently asked to restore or extract those teeth. Considering that several anatomic variations are expected in teeth adjacent to cleft areas and that knowledge of these variations by general dentists is required for optimal treatment, the objectives of this paper are: 1) to describe changes in the innervation pattern of anterior teeth and soft tissue caused by the presence of a cleft, 2) to describe a local anesthetic procedure in unilateral and bilateral clefts, and 3) to provide recommendations to improve anesthetic procedures in patients with cleft lip and palate. The cases of 2 patients are presented: one with complete unilateral cleft lip and palate, and the other with complete bilateral cleft lip and palate. The patients underwent local anesthesia in the cleft area in order to extract teeth with poor bone support. The modified anesthetic procedure, respecting the altered course of nerves in the cleft maxilla and soft tissue alterations at the cleft site, was accomplished successfully and the tooth extraction was performed with no pain to the patients. General dentists should be aware of the anatomic variations in nerve courses in the cleft area to offer high quality treatment to patients with cleft lip and palate.

Removable partial denture with attachment as a treatment option in patients with cleft lip and palate

“…Currently, cleft lip and palate is the most commonly found congenital malformation in the maxillofacial region. Its etiology is multifactorial, and may suffer interference from genetic and/or environmental factors, but its formation is not precisely clear 2 . Patients born with clefts may have dental anomalies of shape, number, size and position, which leads us toperform a thorough case study and the most appropriate planning for each patient 2 .…”

“…Its etiology is multifactorial, and may suffer interference from genetic and/or environmental factors, but its formation is not precisely clear 2 . Patients born with clefts may have dental anomalies of shape, number, size and position, which leads us toperform a thorough case study and the most appropriate planning for each patient 2 . In order to achieve a successful treatment outcome, it is necessary, in addition to multidisciplinary planning, to monitor the progress of the plan, where changes may take place if a procedure does not turn out as expected and also according to the desires and needs of the patient, which may also change over time 4 .…”

“…tense upper lip. There are several options for prosthetic rehabilitation treatment, but the high prevalence of unsuccessful maxillary bone grafts often makes the installation of dental implants impossible, hence the need for oral rehabilitation with a fixed prosthesis or removable partial denture 2 . Regarding treatment planning for oral rehabilitation, the occlusal vertical (OVD) is one of the first items to be analyzed.…”

Apexification of Maxillary Incisor in Adult Patient With Cleft Lip and Palate

“…Mineral trioxide aggregate is a hydrophilic material that has a 3-hour setting time in the presence of moisture [5]. Apexification followed by proper restoration are needed to treat a necrotic tooth with an open apex in cleft lip and palate patients and reach aesthetical and functional rehabilitation [6]…”