Bhandari Sudhir
Oral Health Sciences Centre, Unit of Prosthodontics, PGIMER, Chandigarh, India.
J Indian Prosthodont Soc. 2017 Jan-Mar;17(1):68-73. doi: 10.4103/0972-4052.197939.
Cleft lip and palate (CLP) is the most frequent congenital facial abnormality and multidisciplinary treatment extending over many years is necessary to rehabilitate the affected individuals to normal function and esthetics.
To evaluate the clinical treatment outcome for missing teeth with tooth supported fixed partial dentures in unilateral cleft lip and palate patients.
Tooth supported fixed partial denture (T-FPD) was utilized for restoration of missing teeth in the cleft area for 9 non syndromic, unilateral cleft lip and palate patients (U-CLP). The mean age of the patients was 25±4 years. The edentulous sites were prepared to receive ovate pontic for best possible esthetic results. Survival and complications were recorded following various biologic, technical and esthetic parameters up to 10 years of follow up. A clinical comparison was also made with respect to the periodontal status and development of new carious lesion between the restored cleft side teeth and corresponding teeth of the normal side with in the same patient.
Three failures experienced with fixed partial dentures were a result of ceramic chipping after 10 years, functional fracture after 3 years, and fracture due to external trauma after 2 years.
CLP patients undergo a lot of treatment; therefore understanding their opinions, expectations, and perspectives towards the prosthodontic intervention was given due importance. The provisional phase was utilized to educate the patients on the achievable treatment outcome and its limitation. In the present case series, out of three failed FPDs, only one restoration failed relatively early due to functional factors. Re-treatment was successfully achieved without change in the original material and extent of the FPDs.
The outcome accomplished endorses the integral role of T-FPDs in the overall cleft care and it will remain a viable treatment alternative in select few patients in meeting their esthetic and functional desires.
唇腭裂（CLP）是最常见的先天性面部畸形，需要多年的多学科治疗才能使受影响个体恢复正常功能和美观。
评估单侧唇腭裂患者使用牙支持式固定局部义齿修复缺失牙的临床治疗效果。
对9例非综合征性单侧唇腭裂（U-CLP）患者，采用牙支持式固定局部义齿（T-FPD）修复腭裂区域的缺失牙。患者的平均年龄为25±4岁。对无牙区进行预备，以容纳卵圆形桥体，以获得最佳美学效果。记录随访10年期间各种生物学、技术和美学参数下的存留情况及并发症。还对同一患者修复侧裂牙与正常侧相应牙齿的牙周状况和新发龋损情况进行了临床比较。
固定局部义齿出现3次失败，分别是10年后陶瓷崩裂、3年后功能折断和2年后因外力创伤折断。
唇腭裂患者接受了大量治疗；因此，充分重视了解他们对修复治疗的意见、期望和看法。在临时阶段对患者进行教育，使其了解可实现的治疗效果及其局限性。在本病例系列中，3例失败的固定局部义齿中，只有1例因功能因素相对较早失败。在未改变原固定局部义齿材料和范围的情况下成功完成了再治疗。
所取得的结果证实了牙支持式固定局部义齿在整个腭裂治疗中的重要作用，在少数患者中，它仍是满足其美学和功能需求的可行治疗选择。
