Long-Term Esthetic-Functional Rehabilitation of Unilateral Cleft Lip and Palate With a Cross-Arch Monolithic Zirconia...

This case report describes the esthetic-functional rehabilitation of a patient with unilateral complete cleft lip and palate who was managed multidisciplinarily from 10 to 18 years of age, and reports the clinical outcome 5 years after definitive prosthetic rehabilitation, which was undertaken after late secondary alveolar bone grafting had yielded insufficient bone volume for implant placement.

Phased orthodontic treatment from age 10-17 (slow maxillary expansion, fixed appliances, growth-coordinated space management) was followed by late secondary alveolar bone grafting at age 17, with concurrent extraction of the periodontally compromised lateral incisor. Although grafting achieved meaningful structural and soft-tissue reconstruction of the cleft zone, postoperative cone-beam computed tomography confirmed that the residual bone height and width remained insufficient for implant placement; after the patient declined further augmentation, a six-unit canine-to-canine monolithic zirconia fixed dental prosthesis incorporating a pink-ceramic-extended ovate pontic was adhesively cemented at age 18 with a 10-methacryloyloxydecyl dihydrogen phosphate-containing dual-cure resin cement, combined with continued dual orthodontic retention.

Five years after definitive cementation, the restoration was clinically intact, with non-inflamed abutment periodontal conditions and maintenance of bilateral Class I occlusal relationships, transverse maxillary arch form, and esthetic outcome. Maintenance of the transverse arch form is most plausibly multifactorial and is attributed principally to the sustained orthodontic retention protocol rather than to the anterior restoration. This case illustrates the 5-year performance of cross-arch tooth-supported zirconia rehabilitation combined with prosthetic soft-tissue masking and continued orthodontic retention in a cleft patient in whom implant therapy was not feasible.

Cross-arch monolithic zirconia rehabilitation with a pink-ceramic-extended ovate pontic can provide an esthetic-functional pathway in cleft lip and palate patients in whom implant therapy is not feasible. In the present case, transverse maxillary arch form was maintained over 5 years under continued orthodontic retention, indicating that anterior-only prosthetic rehabilitation is compatible with preservation of arch form when retention is sustained.