3. WHAT IS CLEFT ?
• Any opening or division in some part of anatomy that is not normaly open or devided
.
4. WHAT IS CLEFT LIP?
• This defect is formed when one or both maxillary processes do not fuse
with the medial nasal process. If there is a failure on one side, the patient
suffers a unilateral defect and if on both the sides, the individual suffers a
bilateral defect
• Two types 1. unilateral cleft lip
2. bilateral cleft lip
5. WHAT IS CLEFT PALATE ?
• An opening in the hard and/or soft palate due to improper union of
the maxillary process and the median nasal process during the second
month of intra uterine development.
• GPT 8
6. TREATMENT……………………..?
• The ideal treatment for cleft areas is closure by bone graft and orthodontics , whwnn
this is not feasible many cases are solved with PROSTHETIC REHABILITATIONS
7. VEAU ‘S CLASSIFICATION OF
CLEFT PALATE
• Class I: Isolated soft palate cleft
• Class II: Isolated hard and soft palate
• Class III: Unilateral cleft lip and palate
• Class IV: Bilateral cleft lip and palate
10. MATERIAALS USED OFOR IMPRESSION
MAKING IN CLEFT PATIENTS
• ELASTOMERIC IMPRESSION
MATERIALS
POLYVENYE SILICONE
• IRRIVERSIBLE
HYDROCOLLOID
ALGINATE
• LOW FUSION AND
MEDIUM FUSING
IMPRESSION COMPOUNDS
GREEN STICK AND
IMPRSSION COMPOUND
11. ELASTOMERIC IMPRESSION MATERIAL
(POLYVENYL SILAXANE )
• BEST MATERIALS FOR MALING IMPRESSIONS IN CLEFT PATIENTS AND THEY NOT
CAUSE ANY COMPLICATIONS .
• ADVANTAGES :
GOOD ELASTIC
BEHAVIOUR
HIGH TEAR
STRENGTH
ACCURATE
REPRODUCTION
OF SURFACE
DETAILS
LONG TERM
DIAMESINAL
STABILITYU
12. IRRIVERSIBLE HYDROCOLLOIDS
(ALGINATE )
1. Ease of
mixing and
manipulation
2.Economical
3.Pleasant
colour and taste
1.Poor tear
strength
2.May be cause
shrinkage
ADVANTAGE
S
DISADVANTAGES
13. HIGH FUSION IMPPESIION COMPOUND
( IMPRESSION COMPOUND )
• It is an thermoplastic impression material and used for impressions of infants withj
oral clefts
ADVANTAGES
•EASY REMOVAL
•BETTER
RESISTSNCE
DISADVANTAGES
•Scalding or burn
14. LOW FUSING IMPRESSION COMPOUND
( GREEN STICK COMPOUND )
ADVANTAGES
1.Softened easily
and quite hard on
setting .
DISADVANTAGES
1.Can cause burn.
15. IMPRESSIONS POSITIONS
• The most important part of the oral rehabilitation of a patient with cleft lip and cleft
palate is the IMPRESSION MAKING PROCEDURE
• In cleft [patient which is CRETICAL procedure .
• For an accurate and safe impression procedure ,a proper patient and dentist position
17. SELECTION OF IMPRESSION TRAYS
• USE OF WAX
• ICE CREAM STICK
• HAND ADOPTATIION
• REVERSE SIDE OF SPOON
• PREFABRICATED TRAYS ALSO COMMERCIALLY AVILABLE
18. PROSTHETUIC CARE FOR INFANTS
• Prosthetic treatment in infants includes ,
IMPROVE
FEEDING
TONGUE
FUNCTION
SPEECH
DEVELOPMENT
19. FEEDING APPLIANCES
• Feeding plate obturators ,restore the separation between oral and nasal cavities
• It aid in creating sufficient negative pressure which allows adequate sucking of milk and
creates rigid platform towards which baby can press nipple and extract milk
• It fecilitates feeding by ,
Reduces the nasal regurgitation
Reduces the incidence of choking and shortens the length of time required for feeding
It restores the basic function of mastication ,deglitation speech production until cleft lip
or palate can be surgically corrected .
20. FABRICATION OF FEEDING PLATE
PRIMARY
IMPRESSION
CUSTOMIZED
SPECIAL TRAY
FINAL
IMPRESSION
25. COMPLETE DENTURE
• Due to alternation of alveolar ridge of individuals with cleft lip and palate patient
,the rehabilitation with complete denture is challenging to dentist
Physica
l factors
Dtenure
stability
DIFFICULTY
Retentio
n
Unrepa
ired
cleft
Alveolar
ridge
anatomy
Presence of
fistula
26. REMOVABLE PARTIAL DENTURE
• RPD is most often used but it is a TEMPRARY form of tooth replacement .
• R.P.D are especially indicated in patients with tissue deficiency several fistulas, soft
palate dysfunction or uncoordinated nasopharyngeal sphinctor action.
• Although it provide good esthetics, it rests on soft tissue of the palate and causes
irritation. Planning of R.P.D should be combined to clinical &radiographic
examination & dental cast analysis andocclusal analysis and determination of site of
retainer,connector and dental bar.
27. There may be movement of the prosthesis during function. Hence it is used only as a
definitive means of tooth replacement in which multiple teeth are missing and the
edentulous space is too long to be spanned by a fixed restoration and when
patient cannot afford
28. FIXED PARTIAL DENTURES
• A fixed partial denture provides a more natural toothreplacement.
• Whenever, possible conservative, i.e. resin-bonded fixed partial denture should be
provided for anterior replacement only.
• Alternatively, a conventional fixed partial denture can be used
29. DENTAL IMPLATS
Osseointegrated implants are of immense value for those with cleft lip and palate,
particularly edentulous or partially edentulous patients.
In edentulous patients they enhance stability, retention, and support of the
prosthesis to enable significant improvement ofmasticatory performance..
Recently several researches reported the efficacy of dental implanttreatment after
the repair of alveolar cleft with secondary bonegrafting.
Dental implant insertion into the reconstructed alveolus gives functional
stimulation to the grafted bone and can prevent resorption of grafted bone
30.
31. CONCUSION
• Prosthodontist are one of member of multi disciplinary cleft team.
• In the care of patient with cleft lip and palate prosthetic treatment retains an
important place.
• Prosthodontist must be able to diagnosis the defect and provide a preventive,
interventional and rehabilitative treatment to reduce the impact of the defect in
patient quality of life.
