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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 2  |  Issue : 2  |  Page : 57-59

A complete denture with pharyngeal bulb in an edentulous patient with cleft palate


Department of Prosthodontics, Luxmi Bai Institute of Dental Sciences, Patiala, Punjab, India

Date of Web Publication15-Mar-2017

Correspondence Address:
Sakshi Malhotra Kaura
1, Ranbir Marg, Near Model Town Police Post, Patiala, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sidj.sidj_18_16

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  Abstract 

A cleft palate whether congenital or acquired is present when an oro-nasal communication exists between palate and nose. Selected cleft patients with gross deficiencies of palatal tissues are best treated prosthodontically, without surgical intervention. This article presents a case report of an edentulous patient with palatal insufficiency successfully rehabilitated with a complete denture along with pharyngeal bulb.

Keywords: Congenital, edentulism, palatal defect, prosthodontic rehabilitation, velopharyngeal defect


How to cite this article:
Kaura SM, Wangoo A, Kaur M, Gupta C. A complete denture with pharyngeal bulb in an edentulous patient with cleft palate. Saint Int Dent J 2016;2:57-9

How to cite this URL:
Kaura SM, Wangoo A, Kaur M, Gupta C. A complete denture with pharyngeal bulb in an edentulous patient with cleft palate. Saint Int Dent J [serial online] 2016 [cited 2019 Oct 17];2:57-9. Available from: http://www.sidj.org/text.asp?2016/2/2/57/202224

The major cause of palatal defect is either acquired (tumor resection) or congenital (cleft palate). Although cleft lips and palates are not regularly seen in general dental practice, their number is not negligible. These congenital anomalies are quite frequent although their prevalence among the general population depends on racial, ethnic and geographic factors, as well as on socioeconomic status. It has been estimated to range from 1:500 to 1:2500 live births.[1] Cleft lips occur in 20%–30% of cases; a cleft lip and palate in 35%–50%, and cleft palate alone in 30%–45%.[2]

Oral functions include chewing, swallowing, respiration, and speech. Whenever the patient suffers from a palatal defect, nasal leakage of food and fluid, and hypernasality of speech become inevitable. Therefore, swallowing and speech become serious problems in daily activity. In patients with both palatal defect and complete absence of upper teeth, maxillary complete edentulism further complicates the fabrication of an obturator prosthesis.[3]

The prosthetic rehabilitation of patients with a cleft lip or palate requires a multidisciplinary team of professionals so that long-term success in treatment can be achieved. Plastic surgeons, orthodontists, and prosthodontists are only part of the therapeutic team responsible for the medical care, which in many cases begins soon after birth and continues along the various stages of patients' lives until they reach maturity.[4]

Palatal defect can be repaired by reconstructive surgery and/or a dental prosthesis. In patients with a tumor, it is accepted that a dental prosthesis is generally preferable to reconstructive surgery because the former provides easier inspection of the residual tissue after surgery. Moreover, recurrent disease can be identified at an early stage.[5],[6] There are two groups of cleft palate patients for whom prosthodontic intervention might be a good option. One group is patients whose clefts are confined to the secondary palate. The other group includes patients with hypernasality and inadequate speech after surgical reconstruction.[6]

There are other complex cases of cleft palate involving function, aesthetics and phonetics that require a more invasive restorative intervention. However, an alternative conservative treatment can be sought in conventional prostheses for patients who choose not to undergo surgery.[7] Complete dentures are especially indicated in patients with a tissue deficiency, several fistulae, soft palate dysfunctions, or uncoordinated nasopharyngeal sphincter action, which can lead to hypernasal speech.[8]

Prosthodontists face a unique challenge to fabricate an obturator prosthesis to restore oral functions in patients with palatal defects. In addition to understanding the fundamentals of fabricating a functional complete denture, prosthodontists also need to understand the physiology of the velopharynx to modify the palatal extension of prosthesis to make prosthesis functionally acceptable. With increased knowledge of craniofacial growth and development and improved surgical and orthodontic treatment, today's cleft palate/lip patients receive better care, and in less time.[8]

This clinical report describes the rehabilitation of a cleft palate patient using a complete denture with a pharyngeal bulb.


  Case Report Top


A 68-year-old male patient aged reported to the Department of Prosthodontics for the construction of complete denture. On examination, cleft was found in hard and soft palate [Figure 1], but the patient was unaware of it. Patient also had unintelligible speech along with nasal twang.
Figure 1: Patient with defect in hard and soft palate

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Maxillary complete denture obturator with pharyngeal bulb was planned for this patient along with mandibular complete denture.

Clinical procedures

A suitable maxillary and mandibular commercial tray for edentulous arches was chosen and preliminary impressions were made in impression compound [Figure 2]. Intraoral modeling of green stick impression compound was performed to roughly adapt it to the defect area.
Figure 2: Primary impression with defect modelled with greenstick impression compound

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Custom trays were fabricated with autopolymerizing acrylic resin. Border molding was performed and final impressions were made with zinc oxide eugenol impression paste [Figure 3]. Maxillary complete denture with velopharyngeal bulb and mandibular complete denture was formed as the final prosthesis [Figure 4].
Figure 3: Final impressions made with zinc oxide impression paste

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Figure 4: Final prosthesis with pharyngeal bulb

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Maxillary complete denture had adequate retention and stability [Figure 5] and patient had negligible discomfort wearing it.
Figure 5: Postoperative image with prosthesis placed intra-orally

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  Discussion Top


The ideal protocols for prosthetic treatment of patients with a palatal defect can be divided into three stages: immediate obturator, interim obturator, and definitive obturator. Each type of obturator can fulfil the patient's needs at different stages.

The retention of complete dentures predominantly comes from the proper border seal and intimate fit of the denture base. There was a concern that the extra weight due to the denture modification to improve speech function might break the border seal and cause loss of retention. Most prosthodontists agree that, except for well-designed prostheses, the patient's skill to wear complete dentures plays an important role in the stability of the dentures.[9],[10] In general, patients with a congenital palatal cleft need speech therapy, with or without cleft repair. The long-term un-repaired cleft palate deprived this patient of normal speech. To improve speech quality, the patient was strongly advised to accept a speech therapy program after the placement of the prostheses.

Passavant's pad is a good indicator for the proper placement of the soft palate obturator. Although this pad is more likely to be observed in patients with velopharyngeal incompetence or insufficiency, many individuals with this deficiency do not show a prominent pad. Its presence may be a compensatory phenomenon due to long-term velopharyngeal incompetence. If the conventional obturator prosthesis does not fulfil patients' needs, then treatment with dental implants becomes mandatory.[7]


  Conclusion Top


Fabricating a successful complete denture with pharyngeal bulb for prosthetic rehabilitation of congenital or acquired defects in maxillae depends on making a detailed impression and constructing prosthetic parts compatible with the oral tissues. Unlike some of the disciplines involved in the treatment of the cleft-palate patient, prosthodontics can have application from birth to death. Once surgical care or speech therapy has been completed, the need for follow up care is ended unless specific problems manifest. Prosthodontic care provides restoration of the anatomic, physiologic, and cosmetic deficiencies and a continual vigilance for the signs of dental and periodontal problems. Preventive care is imperative if long-term preservation of the supporting structures and the well-being of the patient are to be attained.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Slayton RL, Williams L, Murray JC, Wheeler JJ, Lidral AC, Nishimura CJ. Genetic association studies of cleft lip and/or palate with hypodontia outside the cleft region. Cleft Palate Craniofac J 2003;40:274-9.  Back to cited text no. 1
    
2.
Abadi BJ, Johnson JD. The prosthodontic management of cleft palate patients. J Prosthet Dent 1982;48:297-302.  Back to cited text no. 2
    
3.
Hickey AJ, Salter M. Prosthodontic and psychological factors in treating patients with congenital and craniofacial defects. J Prosthet Dent 2006;95:392-6.  Back to cited text no. 3
    
4.
Watanabe I, Kurtz KS, Watanabe E, Yamada M, Yoshida N, Miller AW. Multi-unit fixed partial denture for a bilateral cleft palate patient: A clinical report. J Oral Rehabil 2005;32:620-2.  Back to cited text no. 4
    
5.
Montgomery WW. Surgery of the Upper Respiratory System. 3rd ed. Philadelphia: Williams & Wilkins; 1996. p. 367.  Back to cited text no. 5
    
6.
Beumer J, Curtis TA, Marunick MT, editors. Maxillofacial Rehabilitation: Prosthodontic and Surgical Considerations. St. Louis: Shiyaku. Euro America; 1996. p. 347.  Back to cited text no. 6
    
7.
Bohle GC, Mitcherling WW, Mitcherling JJ, Johnson RM, Bohle GC 3rd. Immediate obturator stabilization using mini dental implants. J Prosthodont 2008;17:482-6.  Back to cited text no. 7
    
8.
Reisberg DJ. Dental and prosthodontic care for patients with cleft or craniofacial conditions. Cleft Palate Craniofac J 2000;37:534-7.  Back to cited text no. 8
    
9.
Winkler S. Essentials of Complete Denture Prosthodontics. 2nd ed. Littleton: PSG Publishing; 1988. p. 332.  Back to cited text no. 9
    
10.
Zarb GA, Hickey J. Boucher's Prosthodontic Treatment for Edentulous Patients. 8th ed. Philadelphia: C.V. Mosby; 1980. p. 8-9.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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