Citation Information :
Alsubaiy EF, Mously HA. Restoring the Esthetics for a Cleft Palate Patient by Using Modified Preparation and Pink Porcelain. J Contemp Dent Pract 2019; 20 (5):645-649.
Aim: This report describes the challenges experienced in a unique case involving dental esthetics, and the treatment provided to achieve satisfactory conservative treatment.
Background: 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.
Case description: 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.
Conclusion: 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.
Clinical significance: Fabrication of wax-ups and mock-ups can help the clinician and patient predict the results of dental treatment and ensure a conservative procedure.
Klages U, Bruckner A, et al. Dental aesthetics, self-awareness, and oral health-related quality of life in young adults. Eur J Orthod 2004 Oct;26(5):507–514.
Isiekwe GI, Sofola OO, et al. Dental esthetics and oral health-related quality of life in young adults. Am J Orthod Dentofacial Orthop 2016 Oct;150(4):627–636. DOI: 10.1016/j.ajodo.2016.03.025.
Sadowsky SJ. An overview of treatment considerations for esthetic restorations: a review of the literature. J Prosthet Dent 2006 Dec;96(6):433–442.
Tan K, Pjetursson BE, et al. A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. Clin Oral Implants Res 2004 Dec;15(6): 654–666. DOI: 10.1111/j.1600-0501.2004.01119.x.
Turgut S, Bagis B, et al. Achieving the desired colour in discoloured teeth, using leucite-based cad-cam laminate systems. J Dent 2014 Jan;42(1):68–74. DOI: 10.1016/j.jdent.2013.10.018.
Pjetursson BE, Sailer I, et al. All-ceramic or metal-ceramic toothsupported fixed dental prostheses (FDPs)? A systematic review of the survival and complication rates. Part II: multiple-unit FDPs. Dent Mater 2015 Jun;31(6):624-639. DOI: 10.1016/j.dental.2015.02.013.
Raigrodski AJ, Hillstead MB, et al. Survival and compli-cations of zirconia-based fixed dental prostheses: a systematic review. J Prosthet Dent 2012 Mar;107(3):170–177. DOI: 10.1016/S0022- 3913(12)60051-1.
Olsson KG, Fürst B, et al. A long-term retrospective and clinical follow-up study of In-Ceram Alumina FPDs. Int J Prosthodont 2003 Mar-Apr;16(2):150–156.
Raigrodski AJ, Chiche GJ, et al. All-ceramic fixed partial dentures. Part III: Clinical studies. J Esthet Restor Dent 2002;14(5):313–319.
Christel P, Meunier A, et al. Mechanical properties and short-term in vivo evaluation of yttrium-oxide-partially-stabilized zirconia. J Biomed Mater Res 1989 Jan;23(1):45–61. DOI: 10.1002/jbm.820230105.
Guazzato M, Albakry M, et al. Strength, fracture toughness and microstructure of a selection of all-ceramic materials. Part II. Zirconiabased dental ceramics. Dent Mater 2004 Jun;20(5):449–456. DOI: 10.1016/j.dental.2003.05.002.
Sailer I, Gottnerb J, et al. Randomized controlled clinical trial of zirconiaceramic and metal-ceramic posterior fixed dental prostheses: a 3-year follow-up. Int J Prosthodont 2009 Nov-Dec;22(6):553–560.
Boyne PJ, Sands NR. Combined orthodontic-surgical management of residual palato-alveolar cleft defects. Am J Orthod 1976 Jul;70(1): 20–37.
Marcusson A, Paulin G, et al. Facial appearance in adults who had cleft lip and palate treated in childhood. Scand J Plast Reconst Surg Hand Surg 2002 Jan;36(1):16–23.
Meşe A, Özdemir E. Removable partial denture in a cleft lip and palate patient: a case report. J Korean Med Sci 2008 Oct;23(5):924–927. DOI: 10.3346/jkms.2008.23.5.924.