Restoring the Esthetics for a Cleft Palate Patient by Using Modified Preparation and Pink Porcelain

This report describes the challenges experienced in a unique case involving dental esthetics, and the treatment provided to achieve satisfactory conservative treatment.

Even minor aspects of dental esthetics can significantly affect a patient's quality of life. Moreover, the patient's level of satisfaction with rehabilitative dentition and prosthetics affects oral health, daily living, and dental perceptions. It is not unusual for clinicians to encounter cases with complex esthetics that have affected the patient's life. Such cases need careful treatment planning to meet the patient's expectations. Conservative treatment should be the clinician's goal, because complex treatment may result in negative outcomes.

Here, the patient exhibited severe bone loss due to cleft palate, as well as improper positioning of the teeth. He could not be treated with implants because of poor bone quality and quantity. Orthodontic treatment was performed, but did not improve the outcome. A wax-up was made for each of the three possible options, and then transferred to the patient's mouth by making a mock-up. This allowed the patient to clearly understand the results of each option. After selecting an option, we performed the procedure on the cast before it was undertaken in the patient's mouth. This helped us to precisely determine the preparation needed for all teeth. Teeth were saved where possible to preserve the remaining bone. The lost bone was replaced with pink porcelain. Treatment was conservative and the results were optimal for the patient and our clinical team.

In some cases, clinicians may have few options available to achieve satisfactory results. However, the use of appropriate diagnostic tools, data collection, and conservative treatment procedures can help achieve these goals.

Fabrication of wax-ups and mock-ups can help the clinician and patient predict the results of dental treatment and ensure a conservative procedure.