An Innovative Solution for Patients With Cleft Lip and Palate Defects
Inside Dentistry provides the latest in endodontics, implantology, periodontics, and more, with in-depth articles, expert videos, and top industry insights.
May 1, 2024
Volume 20, Issue 5, May 2024
Page(s): p. 30
Varisha Parikh, DMD
Patients with cleft lip and palate defects often face distinctive challenges when it comes to oral rehabilitation. The nature of the defect can result in significant discrepancies in tooth development and alignment, which can make it difficult for traditional orthodontic and surgical approaches to be successful. This case report illustrates the transformative impact that a rotational path removable partial denture can have for these patients.
The 32-year-old female patient in this case had been in active orthodontic treatment for more than 6 years. Although the patient's mandibular arch form had been idealized and her posterior occlusion had been established with 3 maxillary posterior teeth on either side, her impacted maxillary anterior teeth could not be moved, and scarring and a lack of bone resulting from her cleft lip and palate repair would prevent implant placement without extensive and unpredictable grafting surgeries. Therefore, a treatment plan involving a rotational path removable partial denture was developed and executed.
After all of the patient's orthodontic appliances were removed, and the impacted teeth (Nos. 5, 6, 11, and 12) were extracted, an interim partial denture was delivered to provide the patient with acceptable esthetics and to serve as a retainer for her remaining maxillary posterior teeth.
After an initial healing period, the case was remounted, and a diagnostic wax-up was completed for the remaining maxillary posterior teeth (Nos. 2, 3, 4, 13, 14, and 15). The diagnostic wax-up was used to determine the best possible occlusal relationship for the posterior teeth and also to determine the placement of the guide planes and undercuts necessary for the denture's framework design.
Next, the teeth were prepared for survey crowns, and impressions were acquired. After the correct vertical dimension was established and a wax rim was created for the laboratory and verified, a wax-up of the survey crowns was created and verified on a surveyor to confirm their design elements.
Once the survey crowns were placed, another impression was made to begin the design and fabrication of the framework for the rotational path removable partial denture. After the frame was fabricated, a try-in appointment was completed to verify its retention, support, and stability using acrylic denture teeth set in wax. The final rotational path removable partial denture included a heat-processed acrylic base with acrylic teeth.
Rotational path removable partial dentures have emerged as a beacon of hope for patients with cleft lip and palate defects. By combining innovative design with a patient-centric focus, these prostheses can enable patients to smile with confidence and lead fulfilling lives.
Varisha Parikh, DMD
Private Practice
Los Angeles, California
