J Korean Acad Prosthodont.  2019 Jan;57(1):18-23. 10.4047/jkap.2019.57.1.18.

Prosthetic treatment for patient with congenital bilateral cleft lip and palate to close oro-nasal communication using maxillary double crown and clasp retained removable denture

• Doh SJ
• Cho JH

• KMID: 2431997
• DOI: http://doi.org/10.4047/jkap.2019.57.1.18

Abstract

Patients with cleft lip and palate have several problems such as oro-nasal communication, dental cross-bite caused by the insufficient growth of maxilla, poor pronunciation and esthetic problem. Removable denture with maxillary double crown near cleft palate and with clasp in the posterior teeth was used to solve the problems of the patient with cleft lip and plate. Double crowns make up for the insufficient mucosal support caused by the mucosa and alveolar bone loss in cleft lip and palate. Double crowns also allow easy repair of denture in case of abutment teeth extraction. In this case, 55-year-old female patient had bilateral cleft lip and palate and few remaining teeth on anterior maxilla. Prosthetic treatment was done for patient with bilateral cleft lip and palate to close oro-nasal communication using maxillary double crown and clasp retained removable denture. As a result, oro-nasal communication was effectively closed and the cross-bite was easily corrected by double crown and clasp retained denture. In addition, pronunciation and appearance were also improved.

Keyword

Double crown; Clap retained removable denture; Cleft lip and palate

MeSH Terms

Alveolar Bone Loss
Cleft Lip*
Cleft Palate
Crowns*
Dentures*
Female
Humans
Maxilla
Middle Aged
Mucous Membrane
Palate*
Tooth

Figure

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  Fig. 1 Initial panoramic radiograph of the patient.

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  Fig. 2 (A) Intra-oral frontal view after fixed prosthesis removal, and (B) occlusal view.

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  Fig. 3 Preparation & impression of #23 and #24 after extraction of #11 and endodontic treatment of #23.

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  Fig. 4 Maxillary inner crown and mark of modification point of teeth with milling guide.

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  Fig. 5 Modification of #14 and #26 teeth for the guiding plane of partial denture.

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  Fig. 6 Maxillary pick up impression. (A) One step border molding, (B) Inner crown splinting with pattern resin, (C) Pick up impression.

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  Fig. 7 Mater cast with inner crown.

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  Fig. 8 Wax trial denture. (A) Fontal view, (B) Occlusal view.

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  Fig. 9 Maxillary double crown and clasp combined partial denture after curing. (A) Frontal view, (B) Internal view show outer crown with friction pin and projecting resin for blocking oro-nasal communication.

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  Fig. 10 Maxillary denture delivery. (A) Internal frontal view, (B) Mx. occlusal view indicate lingually positioned outer crown on #23, 24, (C) External frontal view, (D) Occlusal view without denture, (E) Mn. occlusal view.

Reference

1. Avhad R, Sar R, Tembhurne J. Presurgical management of unilateral cleft lip and palate in a neonate: a clinical report. J Prosthet Dent. 2014; 112:676–679.

2. Zheng Y, Zhang D, Qin T, Wu G. Correction of nasal deformity in infants with unilateral cleft lip and palate using multiple digital techniques. J Prosthet Dent. 2016; 115:788–791.

3. Reisberg DJ. Prosthetic habilitation of patients with clefts. Clin Plast Surg. 2004; 31:353–360.

4. Weber H, Frank G. Spark erosion procedure: a method for extensive combined fixed and removable prosthodontic care. J Prosthet Dent. 1993; 69:222–227.

5. Budtz-Jørgensen E, Thylstrup A. The effect of controlled oral hygiene in overdenture wearers. Acta Odontol Scand. 1988; 46:219–225.

6. Budtz-Jörgensen E. Effects of denture-wearing habits on periodontal health of abutment teeth in patients with overdentures. J Clin Periodontol. 1994; 21:265–269.

7. Morrow RM, Feldmann EE, Rudd KD, Trovillion HM. Tooth-supported complete dentures: an approach to preventive prosthodontics. J Prosthet Dent. 1969; 21:513–522.

8. Lord JL, Teel S. The overdenture. Dent Clin North Am. 1969; 13:871–881.

9. Wenz HJ, Hertrampf K, Lehmann KM. Clinical longevity of removable partial dentures retained by telescopic crowns: outcome of the double crown with clearance fit. Int J Prosthodont. 2001; 14:207–213.

10. Widbom T, Löfquist L, Widbom C, Söderfeldt B, Kronström M. Tooth-supported telescopic crown-retained dentures: an up to 9-year retrospective clinical follow-up study. Int J Prosthodont. 2004; 17:29–34.

11. Ishida K, Nogawa T, Takayama Y, Saito M, Yokoyama A. Prognosis of double crown-retained removable dental prostheses compared with clasp-retained removable dental prostheses: A retrospective study. J Prosthodont Res. 2017; 61:268–275.

12. Breitman JB, Nakamura S, Freedman AL, Yalisove IL. Telescopic retainers: an old or new solution? A second chance to have normal dental function. J Prosthodont. 2012; 21:79–83.