prosthodontics aspect of cleft lip and palate.

1. Presented by
Sanjiv Bairwa
PG 1st yr
Prosthodontics Dept.
Jaipur dental college

2.  Introduction
 Classification
 Impression material
 Impression position
 Impression trays
 Feeding plate
 Tooth replacement
 Conclusion
 References

3.  The oral rehabilitation of individuals with cleft
lip and palate is directly related to severity of
anatomical and functional alterations
determined by malformation and the age at
treatment.
 The ideal treatment of cleft area is closure by
bone graft and orthodontics, when this not
feasible, many cases are solved with
prosthetic rehabilitations.

4.  According to mazaheri, 60% of individuals
with clefts will require some type of denture,
and this percentage tends to increase if cleft
affects the alveolar ridge.
 The prosthetic rehabilitation contributes
directly and positively to the psychological
aspects of individual.

5.  The main prosthetic treatment involved in
oral rehabilitation of the individuals with cleft
lip and palate are --
 Fixed partial denture
 Removable partial denture
 Complete denture
 Implant-supported denture.

6.  Orbicularis oris
 Cupids Bow
Philtral column
Dimple
 Vermilion border
 Tubercle

7.  Any opening or division in
Some part of anatomy that
Is not normally open or
Divided.

10.  Class 1: incomplete cleft involving only the
soft palate
 Class 2 :cleft involving the hard and soft
palate
 Class 3 :complete unilateral cleft involving
the lip and palate
 Class 4 :complete bilateral cleft

12.  Surgery
 Dentistry - Pedodontist
Orthodontist
Prosthodontist
Maxillofacial surgery
 Speech therapist
 Audiology
 ENT
 Pediatrics
 Psychology

13. • Elastomeric
impression
material.
Polyvinyal
siloxane
• Irreversible
hydrocolloids
Alginate
•Low fusing and
medium fusing
impression
compounds.
Green stick
Impression
compound

14.  It is a thermoplastic impression material and
used for impressions of infant with oral
clefts.
• Easy removal
• Better resistanceAdvantages
• Scalding or burn
Disadvantages

15.  Green stick compound is a low fusing impression
compound.
Advantage
 Softened easily and quite
Hard on setting
Disadvantage
 Can cause burn

16.  Alginate
Adavnatge
 Ease of mixing and manipulation
 Economical
 Pleasant color and taste
Disadvantage
 Poor tear strength

17.  Use of Fast setting color timed alginate has
been suggested in cleft infants , which has
advantages to record the details even in
presence of saliva.
Advantage
 Comfortable to patient
 Easy to manipulate
 Relatively inexpensive
 Prevents respiratory arrest

18.  Elastomeric impression materials
are better suited in making of cleft
impression and they don’t lead to
any complications.
Advantage
 good elastic behaviour
 high tear strength
 accurate reproduction of surface detail
 long term dimensional stability

19. In Infants
 The most important part of the oral rehabilitation
of a patient with cleft lip and cleft palate is the
impression making procedure.
 The making of the impression in an infant with a
cleft palate is a critical procedure.
 For an accurate and safe impression procedure, a
proper patient and dentist position are vital.

20.  A no. of impression positions have been
adopted for cleft palate in infants are --
Positions
Facedown
Upright
Prone
Upside
down

25.  Prefabricated trays that are commercially
available(coe laboratory, chicago)for cleft
palate impressions in infants.
 Shatkin and stark described the use of a wax
as impression trays in cleft lip and palate
patients.
 Icecream sticks can also be used to carry
materials for infant impressions.

26. The prosthetic treatment in infants includes--
 Improve feeding
 Tongue function
 Speech development
It reduces the risk of aspiration the as oro-nasal
communication is eliminated and it is an
easier procedure with good aesthetic results.

28.  Feeding plate obturates cleft and restores the
separation between oral and nasal cavities.
It aid in creating sufficient negative pressure
which allows adequate sucking of milk and
creates a rigid platform towards which baby
can press nipple and extract milk.

29.  It facilitates feeding by –
• Reduces the nasal regurgitation .
• Reduces the incidence of choking and shortens
the length of time required for feeding.
• It restore the basic function of mastication ,
Deglutition , speech production until cleft lip
or palate can be surgically corrected.

30.  Primary impression was made with molding with low
fusion impression compound with hand adaptation to
the palate of the patient.
 The infant was held upright by
mother to prevent aspiration
of any extra material.
 Primary cast was fabricated by
dental stone( type 3 gypsum
product )
Showing the primary
impression

31.  A customized special tray
fabricated by auto polymerizing
acrylic resin.
 The final impression made by
rubber base impression material
to record the precise detail of
supporting structure and defect.
Customized special tray
Final impression

32.  Master cast fabricated and excessive undercuts
blocked out with modeling wax.
 Wax pattern of the feeding plate
adapted on master cast. Flasking ,
de-waxing done and feeding plate
fabricated with heat activated
clear acrylic for obturating the
defect in the soft palate involving uvula.
Master cast with block out

33. Palatal plate on master
cast
Palatal plate with
thread

34. Extra oral
view
Intraoral view

35.  Options for tooth replacement includes--

37.  Due to alteration of alveolar ridge of
individuals with cleft lip and palate
patient, the rehabilitation with
complete denture is challenging to
dentist.

38. Denture
stability
Physical
factors
Retention
Unrepaired
clefts
Presence
of fistula
Alveolar
ridge
anatomy

39. Impression
Anatomical
Functional
Stock tray
Addition
Condensation
silicon

41. Impression
Anatomical Functional
Stock tray Fistula
absent
Fistula
present
High fusing
impression
compound
High fusing
impression
compound

42.  A removal partial denture is most often used but it
is a temporary form of tooth replacement.
 R.P.D are especially indicated in patients with tissue
deficiency several fistulas, soft palate dysfunction or
uncoordinated nasopharyngeal sphinctor action.

43.  Although it provide good esthetics , it rests on soft tissue
of the palate and causes irritation.
 Planning of R.P.D should be combined to clinical &
radiographic examination & dental cast analysis and
occlusal analysis and determination of site of retainer ,
connector and dental bar.
 There may be movement of the prosthesis during
function. Hence it is used only as a definitive means of
tooth replacement in which multiple teeth are missing
and the edentulous space is too long to be spanned by a
fixed restoration and when patient cannot afford
implants.

46.  It provides a more natural tooth replacement.
Whenever , possible conservative , i.e. resin
bonded fixed partial denture should be provided
for anterior replacement only.
 This conservative restoration requires very little
tooth preparation, and provides excellent
appearance and function.
 Alternatively , a conventional fixed partial denture
can be used. This provides long – term success.

47.  Prosthodontist are one of member of multi
disciplinary cleft team.
 In the care of patient with cleft lip and palate
prosthetic treatment retains an important place.
 Prosthodontist must be able to diagnosis the
defect and provide a preventive, interventional
and rehabilitative treatment to reduce the
impact of the defect in patient quality of life.

48.  Maxillofacial rehabilitation : Prosthodontic and surgical
considerations by Beumer.
 Clinical maxillofacial prosthetics by Taylor.
 Dentistry for the child and adolescent by Mc’donald and
Averys 9th edition.
 Textbook of Pediatric dentistry :by Damle.
2nd edition.
 Textbook of Pediatric dentistry by Nikhil Marwah
2nd edition.
 Internet.

49. Thank you