Prosthodontic considerations for patients with cleft lip and palate.

The prosthodontist provides the final active treatment for the patient with a cleft. He must anticipate and decide upon the prosthodontic procedures in collaboration with the plastic surgeon and/or the orthodontist during the period of their interventions. The purpose of prosthodontic treatment is to prevent the relapse of the maxillary segments and the teeth after surgical and/or orthodontic correction, as well as the rehabilitation of mastication, speech and aesthetics. The individual peculiarities of the cleft patient should be taken into consideration from the beginning. They are: discrepancy in the maxillo-mandibular relationship, malposition, malformation and tipping of teeth, caries, flat palate resulting from severe scarring, perforations. It is imperative to preserve the teeth in any condition with the exception of occlusal interference. Extraction of teeth adjacent to the cleft or in scar tissue leads to extensive bone resorption, enlargement of the cleft and gingival recession. Generally speaking, two teeth in each alveolar segment should be used as abutment teeth in bridge work. The teeth likely to relapse should be reconstructed in good intercuspal digitation and splinted primarily or secondarily. Bridge work is the first choice among the various prosthodontic procedures. If, however, a removable prosthesis is inevitable, rigid support should be obtained.