JICDRO is a UGC approved journal (Journal no. 63927)

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CLINICAL SCIENCE AND TECHNIQUES/CASE REPORT WITH DISCUSSIONS
Year : 2019  |  Volume : 11  |  Issue : 2  |  Page : 114-116

Simultaneous stabilization and prosthetic rehabilitation of cleft maxilla using modified palatal arch holding appliance


Division of Orthodontics and Dentofacial Orthopaedics, Department of Dental Surgery and Oral Health Sciences, Armed Forces Medical College, Pune, Maharashtra, India

Date of Submission13-Aug-2019
Date of Acceptance31-Aug-2019
Date of Web Publication23-Dec-2019

Correspondence Address:
Dr. Varun Govindraj
Department of Dental Surgery and OHS, AFMC, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jicdro.jicdro_22_19

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   Abstract 


Introduction: Various prostheses have been tried for intermediate restoration of esthetics, function, and speech in cleft patients but are usually associated with frequent breakages and oral hygiene problems. Hence, this modified arch holding appliance was designed to simultaneously replace the missing anterior teeth and stabilize the transverse changes in the maxillary arch, so as to restore the form and esthetics. Fabrication: Pickup impression with the molar bands was recorded; casts were poured in type III dental stone. Palatal arch holding appliance was fabricated and soldered to the molar bands on the first molars. Stainless steel wires were soldered vertically over labial aspect of the arch holding appliance forming plus (+)-shaped attachment, at positions of missing teeth. Acrylic teeth matching the patient's teeth were selected and adapted over this plus attachment and acrylized. Conclusion: This appliance may provide dual benefits to cleft lip and palate patients by restoration of esthetics while maintaining the transverse changes. It is easy to fabricate, durable, economical, and esthetically acceptable to the patient.

Keywords: Cleft maxilla, modified arch holding appliance, prosthetic rehabilitation in cleft lip and palate patients


How to cite this article:
Govindraj V, Thakur V, Chauhan D, Datana S, Agarwal SS, Nagpal V. Simultaneous stabilization and prosthetic rehabilitation of cleft maxilla using modified palatal arch holding appliance. J Int Clin Dent Res Organ 2019;11:114-6

How to cite this URL:
Govindraj V, Thakur V, Chauhan D, Datana S, Agarwal SS, Nagpal V. Simultaneous stabilization and prosthetic rehabilitation of cleft maxilla using modified palatal arch holding appliance. J Int Clin Dent Res Organ [serial online] 2019 [cited 2020 Jul 9];11:114-6. Available from: http://www.jicdro.org/text.asp?2019/11/2/114/273760




   Introduction Top


Improvement of facial esthetics is one of the most important treatment objectives in management of cleft lip and palate (CLP) patients apart from restoration of proper function. Various modalities have been adopted in literature for prosthetic rehabilitation in CLP patients, which include removable/fixed prosthesis and dental implants.[1] Early restoration of facial esthetics will enhance morale and self-esteem in these patients.[2] With this objective in mind, a modified appliance for simultaneous arch holding (after maxillary expansion) and replacement of missing anterior teeth was designed, which has been mentioned in this article.


   Fabrication of the Appliance Top


Pretreatment photographs [Figure 1]a, [Figure 1]b, [Figure 1]c shows missing 11, 12, and 13 along with maxillary arch after expansion and fixed orthodontic treatment in progress. Pickup impression with the molar bands was recorded using irreversible hydrocolloid impression material, and casts were poured in type III dental stone. Design of the appliance was marked [Figure 2]a. Palatal arch holding appliance was fabricated using 19-gauge stainless steel wire and soldered to the molar bands on the first molars. The horizontal extension of the wire in defect zone was extended up to the middle of buccolingual surface of the adjacent teeth (14 and 21). Seven-millimeter length (19 gauge) stainless steel wires were soldered vertically over labial aspect of this horizontal wire forming plus (+)-shaped attachment at planned positions of 11, 12, and 13 [Figure 2]b. Tooth shade and tooth shape were matched to the patient's natural teeth. Marking of plus (+) was transferred to the lingual surface of selected teeth at appropriate level. Grooves were made on these plus (+) markings to accommodate the wire same for additional retention [Figure 2]c. Teeth were placed in plus (+) shaped attachment, wax build up done to extend till the gingival contours and acrylised using heat cure acrylic. The gingival surfaces of the prosthesis were made in pink acrylic to match the gingival shade. Adjustments were done on the tissue side of the prosthesis to make itself cleansing [Figure 2]d. Posttreatment photographs showed marked improvement in smile esthetics of the patient [Figure 3]a, [Figure 3]b, [Figure 3]c.
Figure 1: (a) preappliance extraoral photograph, (b) intraoral frontal photograph, (c) occlusal view

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Figure 2: (a) marking done for fabrication of appliance, (b) 7-mm length (19 gauge) stainless steel wires soldered vertically over the labial aspect forming plus (+)-shaped attachment, (c) plus (+) marking transferred to the palatal surface of the selected teeth, and (d) prosthesis in situ (arrow showing gingival clearance for self-cleansing)

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Figure 3: (a) postappliance extraoral photograph, (b) intraoral frontal photograph, and (c) occlusal view

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   Discussion Top


Arch expansion in CLP patients is usually done prior to alveolar grafting to reveal the entire cleft defect and to facilitate the eruption of teeth through the graft. Patients usually require long-term/permanent palatal retention to hold the transverse changes.[3] Early restoration of esthetics by replacement of anterior teeth is usually difficult due to the palatal arch holding appliance and various other fixed orthodontic attachments. Various prostheses have been tried for intermediate restoration of esthetics, function, and speech in these patients, but these are usually associated with frequent breakages and oral hygiene problems.[4],[5] Hence, this appliance was designed to simultaneously replace the missing anterior teeth and stabilize the transverse changes in the maxillary arch. This appliance is easy to fabricate, durable, economical, and esthetically acceptable to the patient. In addition, it does not interfere with fixed orthodontic treatment.


   Conclusion Top


This appliance may provide dual benefits to CLP patients by restoration of esthetics while maintaining the transverse changes. However, long-term clinical data are required to validate the results of this article.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to b'e reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Long ER, Spangler EB, Yow M. Cleft width and secondary alveolar graft success. Cleft Pal Craniofac J 2005;32:5-8.  Back to cited text no. 1
    
2.
Miglani CD, Drane JB. Maxillofacial prosthesis and its role as a healing art. J Pros Dent 1959;9:159-68.  Back to cited text no. 2
    
3.
Ramstad T, Jendal T. A long-term study of transverse stability of maxillary teeth in patients with unilateral complete cleft lip and palate. J Oral Rehabil 1997;24:658-65.  Back to cited text no. 3
    
4.
Randow K, Glantz PO, Zöger B. Technical failures and some related clinical complications in extensive fixed prosthodontics. An epidemiological study of long-term clinical quality. Acta Odontol Scand 1986;44:241-55.  Back to cited text no. 4
    
5.
Saito M, Notani K, Miura Y, Kawasaki T. Complications and failures in removable partial dentures: A clinical evaluation. J Oral Rehabil 2002;29:627-33.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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