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. 2023 Sep 11;11(9):212.
doi: 10.3390/dj11090212.

Use of Individually Designed CAD/CAM Suprastructures for Dental Reconstruction in Patients with Cleft Lip and Palate

Pilvi Mäntynen  1   2 , Marisa Laurila  1 , Tommi Strausz  3 , Jari Mauno  4 , Junnu Leikola  4 , Juho Suojanen  1   2   4
Affiliations

Use of Individually Designed CAD/CAM Suprastructures for Dental Reconstruction in Patients with Cleft Lip and Palate

Pilvi Mäntynen et al. Dent J (Basel). .

Abstract

This patient series reports the outcomes of CAD/CAM prosthetic reconstructions in patients with cleft lip and palate (n = 9, aged 27 to 76) who have experienced significant failure with conventional restorative and fixed prosthodontic treatments. The objective of the protocol is to establish a functional and patient-friendly prosthetic structure for individuals with unilateral/bilateral cleft lip and palate (UCLP/BCLP) while minimising the requirement for specialised follow-up care in the cleft unit. The study data were obtained from a retrospective cohort at Helsinki University Hospital. Prosthetic reconstructions were performed using CAD/CAM bar structures by the Atlantis 2in1 system or Createch removable telescope structures, supported by four to eight maxillary dental implants. Out of the nine patients, seven experienced no complications. One prosthesis fracture occurred after 16 months due to a design error in the original framework, and one patient experienced failure of osseointegration in a dental fixture (specifically, one fixture out of the eight maxillary implants in this patient). In total, 56 implants were successfully placed. The maxillary dentition of elderly patients with cleft lip and palate often poses challenges due to periodontal and reconstructive issues. An implant-supported CAD/CAM bar with a removable telescope suprastructure offers an easily maintained and functional solution for dental rehabilitation.

Keywords: Atlantis; CAD/CAM suprastructure; Createch; cleft alveolus; cleft lip; cleft lip and palate; fixed prosthodontics; implant-supported; prosthetic reconstruction; telescopic suprastructure.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The primary suprastructure with Locator attachments is fixed to the abutments. A residual oronasal fistula in the palate can complicate treatment with conventional restorative and fixed prosthodontics. Patient no. 8.
Figure 2
Figure 2
CAD/CAM prosthetic structure. The Atlantis 2in1 structure combines bar and box constructs with interlocking pins. (a) The framework of the secondary suprastructure (without custom teeth and denture resin); (b) the primary suprastructure that will be fixed to patients’ abutments; (c) the primary suprastructure fixed to the patient’s abutments; and (d) the finalised secondary suprastructure, with the custom teeth and denture resin manufactured on the titanium framework.
Figure 3
Figure 3
Prosthetic failure: A prosthesis fracture occurred after 16 months due to a design error in the original framework (Patient no. 1). The load-bearing connector area had been designed too thin/narrow, as determined in a retrospective analysis.
See this image and copyright information in PMC

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