Esthetic and functional rehabilitation of a bilateral cleft palate patient with fixed prosthodontic therapy

Patients with bilateral cleft lip and palate present with multiple challenges to the prosthodontist. Some of them include mobility of the premaxillary segment, multiple missing and malposed anterior teeth, unfavorable soft tissues, and a tense maxillary lip. This clinical report describes the fixed prosthodontic management of a bilateral cleft lip and palate patient with a surgically corrected lip and a mobile premaxillary segment. The patient presented with an 11-unit metal-ceramic fixed partial denture made of a base metal alloy that was made 25 years ago. He had multiple porcelain fractures over the years that compromised his esthetics and function. Prosthodontic therapy involved sectioning the old prosthesis, followed by careful treatment planning and fabrication of a new fixed dental prosthesis with improved design and superior materials. At a 3-year follow-up, the fixed dental prosthesis remained intact and functional, and no further complications were noted. A discussion of approaches to treatment planning, biomechanical principles involved, and choice of biomaterials in designing a fixed prosthesis for such patients is presented.

As cleft palate patients require life-long prosthodontic follow-up and maintenance, revisional treatments should incorporate superior materials and methods to minimize future complications.