Interdisciplinary treatment of an adult with bilateral cleft lip and palate with missing premaxilla: The prosthodontic perspective

Aesthetic Concepts and Interdisciplinary Approach in a Patient With Bilateral Cleft Lip and Palate and Missing Premaxilla: A Case Report

“…The literature reports multiple cases of patients with BCLP with missing premaxilla or a significant bony defect. Treatment options include the use of telescopic crowns cemented to natural teeth in case of removable partial dentures (Kurtulmus et al, 2007;Acharya and Brecht, 2014) and overdentures, to camouflage large defects with major bone and soft tissue deficiencies (Abreu et al, 2015). A more recently published technique is the interdental alveolar distraction to correct large cleft defects, reducing the cleft area and making possible the final restoration without the risk of bone grafting large alveolar deformities (Liou et al, 2000;Shahab et al, 2019).…”

“…More specifically, in bilateral cleft lip and palate (BCLP), deficiency of hard and soft tissues is observed. The premaxilla can be protruded, deviated, mobile or missing, creating a severe deformity with aesthetic, functional and psychological implications (Tipton, 2002;Abreu et al, 2015;Yilmaz et al, 2019). In cases with missing premaxilla or with severe anterior bony defect and multiple missing teeth, the interdisciplinary approach involves plastic and oral maxillofacial surgery, orthodontics, prosthodontics, and speech therapy to obtain the most predictable and successful treatment outcome.…”

“…In cases with missing premaxilla or with severe anterior bony defect and multiple missing teeth, the interdisciplinary approach involves plastic and oral maxillofacial surgery, orthodontics, prosthodontics, and speech therapy to obtain the most predictable and successful treatment outcome. The surgical management in these cases may include maxillary distraction using an external or internal device or conventional orthognathic surgery, depending of the magnitude of the sagittal discrepancy (Abreu et al, 2015). A more recent alternative for cases with a severe anterior maxillary deficiency, palatal fistula, and missing or malformed teeth is the alveolar distraction, which involves the advancement of 1 or 2 segments to the cleft deformity (Yilmaz et al, 2019).…”

“…Soft tissue coverage of a graft is essential to improve the chance of success of the procedure, and tissue deficiency creates a high risk of infection (Witsenburg, 1985). Any surgical intervention usually must be combined with presurgical orthodontic treatment, and in many cases, final prosthodontic rehabilitation is necessary to assure the best functional and aesthetic results (Levy-Bercowski et al, 2011;Bidra, 2012;Abreu et al, 2015;Shahab et al, 2019).…”

“…The prosthodontic evaluation and treatment usually occur in the last phase, when surgical and orthodontic treatment have been completed (Esper et al, 2009;Abreu et al, 2015). Different options are possible in patients with large defects or missing premaxilla, including fixed restorations (Bidra, 2012;Erverdi et al, 2013;Balkaya et al, 2014;Levy-Bercowski et al, 2019), hybrid prostheses, overdenture prostheses, and dental implants (Weischer et al, 1997;Acharya and Brecht, 2014).…”