Digital Transition from Fixed to Removable Prosthesis in a Unilateral Cleft Lip and Palate Patient: A Case Report
Cleft, Digital Technology, Prosthesis
AuthorsIntroductionPatients with unilateral cleft lip and palate present complex challenges in prosthodontic rehabilitation. These patients often have a combination of anatomical and functional impairments,1-3 including compromised occlusal relationships, bone defects, rotated or malpositioned teeth, scar tissue, and a shallower oral vestibule. Such factors not only complicate the design and fabrication of a prosthesis but also contribute to diminished oral function and esthetics, significantly impacting quality of life.4,5 Conventional prosthodontic approaches, particularly fixed prostheses, may not have predictable long-term outcomes in these cases because of poor retention, recurrent detachment, and difficulty achieving optimal support from compromised dentoalveolar structures.2 Furthermore, a fixed partial denture in patients with a cleft lip may not accommodate changes in oral conditions over time to allow adequate dental hygiene, leading to increased maintenance needs and patient dissatisfaction.6 On the other hand, a removable denture is frequently associated with negative perceptions on the part of patients, including a perceived decrease in comfort, esthetic concerns, and psychosocial acceptance.7 In addition, the replacement of a fixed partial denture with a removable prosthesis may be a rather difficult matter regarding the adaptation of the patient, especially due to the presence of complex anatomical deficiencies that are inherent in cleft patients. The case report is the clinical management of a patient with a unilateral cleft lip and palate who had undergone recurrent detachment of a fixed partial denture. Through the incorporation of digital technology, a removable prosthesis was created and produced as a transitional device to enhance functionality, comfort, and serviceability. Case History A 57-year-old patient who had a history of unilateral cleft lip and palate was referred to our department to deal with a continuously dislodging fixed dental prosthesis. The patient has used a fixed partial denture since childhood, which was remade three times. However, in recent years, the prosthesis had started to detach as often as every 7 days. This instability made it hard to do the mastication, and it affected the professional communication of the patient, producing a lot of anxiety. Clinical observation showed that the short and narrow abutment teeth were due to the repeated replacement of the fixed partial denture, and there was a saddle pontic that overranged the alveolar cleft. The periodontal involvement of the abutment tooth that was next to the cleft was severe as well and exhibited high levels of mobility. Radiographic evaluation proved that there was insufficient support for further usage of a fixed prosthesis. As a result, no longer was fixed rehabilitation possible. The patient had never experienced a removable prosthesis and had serious concerns about the possible alterations in appearance, a different voice, and pain. Since the patient was referred to another institution, there was a lack of rapport and, therefore, psychological acceptance of the removable prosthesis
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