Dental implant treatment for a patient with bilateral cleft lip and palate (original) (raw)
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The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association, 2018
To evaluate 2 iliac corticocancellous-block grafting techniques for dental implant placement in residual alveolar clefts. Nonrandomized prospective clinical trial between March 2010 and December 2014. National Hospital of Odonto-Stomatology, Hanoi, Vietnam. Thirty-two patients (23 female, 9 male; mean age, 21.28 years; range, 16-31 years) with unilateral complete alveolar cleft after reconstructive surgery for cleft lip and palate (CLP). Harvested iliac crest bone was cut into 2 corticocancellous blocks. The smaller block was adapted against the sutured nasal mucoperiosteum and overlaid with cancellous bone; the larger one overlapped the labial cleft margin and was fixed with screws. Endosteal dental implants were placed after 4 to 6 months, and final restorations were delivered 6 months later. Flap statuses were assessed clinically. Bone formation was assessed using the Enemark scale. Cone-beam computed tomography was used for graft height and width measurements. Implant health was...
This case report aimed to present the course of surgically combined comprehensive orthodontic treatment of a male adult with cleft lip and palate, showing a left alveolar cleft, lateral deviation of the major segment of the maxilla, and palatal transposition of the lateral incisor. Preoperatively, the midline of the upper central incisors was shifted by 7.0 mm to the right, the right lateral incisor showed palatal transposition, and the residual alveolar cleft was 6.5 mm. Segmental Le Fort I osteotomy of the major segment, and simultaneous bone grafting into the extended alveolar bone and former cleft region were performed at 18 years and 4 months of age. Thus, midline correction, alignment of the right lateral incisor, and cleft closure were achieved; no further prosthetic treatment was required.
The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association, 2018
To identify factors of oral health important for the final outcome, after secondary alveolar bone grafting in patients born with unilateral cleft lip and palate and compare occlusal radiographs with cone beam computed tomography (CBCT) in assessment of alveolar bone height. Observational follow-up study. Cleft Lip and Palate Team, Craniofacial Center, Uppsala University Hospital, Sweden. 40 nonsyndromic, Caucasian patients with unilateral complete cleft lip and palate. Clinical examination, CBCT, and occlusal radiographs. Alveolar bone height was evaluated according to Bergland index at a 20-year follow-up. The alveolar bone height in the cleft area was significantly reduced compared to a previously reported 10-year follow-up in the same cohort by total ( P = .045) and by subgroup with dental restoration ( P = .0078). This was positively correlated with the gingival bleeding index (GBI) ( r = 0.51, P = .0008) and presence of dental restorations in the cleft area ( r = 0.45, P = .017...
The Journal of prosthetic dentistry, 2018
The multidisciplinary teams involved in the treatment of individuals with cleft lip and palate are challenged when implants are indicated in the cleft area. Difficulties include obtaining a healthy peri-implant area and, especially, obtaining the natural-looking papilla essential for esthetic success. The area affected by the cleft has a bone deficiency, which is typically augmented with an alveolar bone graft at adolescence. Guidelines for the 3-dimensional placement of implants at the cleft area are presented based on clinical reports. The patients were followed up for at least 1 year. Adoption of the proposed guidelines enables satisfactory esthetic and functional outcomes in patients with cleft lip and palate.
Prospective analysis of secondary alveolar bone grafting in cleft lip and palate patients
Journal of international oral health : JIOH, 2015
To assess the success of the uptake of bone graft in cleft alveolus of the cleft lip and palate patients, quantitatively through computed tomography (CT) scan 6 months postoperative. To assess the successful eruption of permanent lateral incisor or canine in the bone grafted area. The children age group of 9-21 years with unilateral cleft lip and palate came to the hospital, needing secondary alveolar bone grafting. A detailed history and clinical examination of the patient was taken. A 3D CT scan was taken and the volume of the cleft was measured pre-operatively. After ambulatory period, 3D CT scan of the alveolar cleft region was taken and volume of the bone grafted was measured and patient was discharged from the hospital. After 6 months, patient was recalled and again 3D CT scan was taken and the volume of remaining bone was measured. The mean volume of the defect pre-operatively is 0.80 cm(3) with a standard deviation of 0.36 cm(3) with minimum volume of the defect 0.44 cm(3) a...
Dental implants placed into alveolar clefts reconstructed with tongue flaps and bone grafts
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2010
Objective. The aim of this study was to describe a case series using surgical and prosthodontic modifications of tongue flaps necessary to adapt them for use in the reconstruction of large cleft deformities refractory to customary measures using dental implants and to study their outcomes in patients with complex cleft lip and palate deformities. Study Design. Five patients were treated with iliac crest bone grafts and covered by anteriorly based tongue flaps divided at either 3 or 4 weeks after surgery. The patients were followed clinically and radiographically for 3-12 years after placement of their dental implants to monitor implant survival and success. Results. One of the 5 patients suffered a partial tongue flap detachment, graft dehiscence, and recurrence of an oronasal fistula, which was successfully treated by shifting the tongue flap tissue from its new location in the palate. A total of 18 dental implants were placed into bone-grafted tissue covered by the tongue flaps. There was 1 implant failure. There were no cases of periimplantitis or bone loss in the 17 surviving implants. Conclusions. Tongue flaps are rarely used clinical entities with a very narrow range of indications. Tongue flaps are useful in the preprosthetic reconstruction of select cases with large residual oronasal fistulae with soft tissue deficits due to scarring from previously failed surgery. Tongue flaps are extremely stressful procedures for patients to endure.