|Year : 2016 | Volume
| Issue : 2 | Page : 57-59
A complete denture with pharyngeal bulb in an edentulous patient with cleft palate
Sakshi Malhotra Kaura, Anuj Wangoo, Mandeep Kaur, Chirag Gupta
Department of Prosthodontics, Luxmi Bai Institute of Dental Sciences, Patiala, Punjab, India
|Date of Web Publication||15-Mar-2017|
Sakshi Malhotra Kaura
1, Ranbir Marg, Near Model Town Police Post, Patiala, Punjab
Source of Support: None, Conflict of Interest: None
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 2020 Oct 1];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. Cleft lips occur in 20%–30% of cases; a cleft lip and palate in 35%–50%, and cleft palate alone in 30%–45%.
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.
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.
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., 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.
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. 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.
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.
This clinical report describes the rehabilitation of a cleft palate patient using a complete denture with a pharyngeal bulb.
| Case Report|| |
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.
Maxillary complete denture obturator with pharyngeal bulb was planned for this patient along with mandibular complete denture.
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].
Maxillary complete denture had adequate retention and stability [Figure 5] and patient had negligible discomfort wearing it.
| Discussion|| |
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., 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.
| Conclusion|| |
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
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]