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The treatment goal for cleft lip and palate (CLP) patients is to restore the normal anatomy of the affected structures. Many surgical procedures and infant maxillary orthopedic appliances have been described to achieve these goals. A variety of appliances have been described for maxillary orthopedics in infants. Prior to the fabrication of any of t...
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The applications of computer-guided technologies for three-dimensional image analysis provide a unique opportunity to quantify the morphological dimensional changes of the face in a practical and convenient way. Symmetry of the nasolabial area is one of the main factors of facial attractiveness as well as being the main objective of the treatment o...
Citations
... There are many problems that could be associated with the fabrication and usage of the feeding appliances in CLP infants, one of them is the regular examinations of the oral mucosa are necessary due to its fragility and susceptibility to damage from the obturator; growth necessitates constant modifications and replacement [53], [54]. Also they might be coupled with bad oral hygiene, which might result in fungus overgrowth on the palate if the appropriate cleansing instructions for the prosthesis are not fulfilled [41], [54], [55]. ...
... Also they might be coupled with bad oral hygiene, which might result in fungus overgrowth on the palate if the appropriate cleansing instructions for the prosthesis are not fulfilled [41], [54], [55]. Associated with risks faced during impression making for the obturator, likewise difficulties retrieving the impression materials engaging the undercuts, and, due to breakdown of the impression material as it is taken out from the oral cavity with a consequent airway blockage and cyanotic events [53]. In addition the obturator insertion might be difficult and increase the maintenance efforts [54], [55]. ...
Cleft palate, Infants, obturator, feeding appliance One of the most prevalent structural birth malformations is cleft lip and palate, which is a common congenital anomaly. Feeding, facial development, swallowing, speaking, as well as psychosocial issues that have an effect on the infant and parent, are just a few of the systems and functions that are impacted by its effects. Standard feeding methods could not provide the baby the right nourishment. If the problem is significant enough obturators for feeding will assist the baby get suction and will make it easier for the baby to eat properly. Also obturators can facilitate weight gain, and proper nourishment of the infant with the cleft lip and/or palate before having repair surgery. For this reason the purpose of this study was to give the reader, caregivers, and health centers concerned with the care of infants with cleft lip and palate the necessary information about the feeding obturators, indications of their use, types, and benefits. This work is licensed under a Creative Commons Attribution Non-Commercial 4.0 International License.
... There is no need for the neonatal patient to be fasting to minimize the risk of vomiting with IOS. This clearly differs from the CI procedure, where some authors suggest that the patient should have had the last meal at least two to four hours in advance (17,31,33,38). ...
Summary
Objective
The aim of this study was to evaluate intraoral scanning (IOS) in infants, neonates, and small children with craniofacial anomalies for its feasibility, scanning duration, and success rate. Impression taking in vulnerable patients can be potentially life-threatening, with the risk of airway obstruction and aspiration of impression material. The advantage of increasingly digitalized dentistry is demonstrated.
Materials and methods
IOS was captured with the Trios 3® (3Shape, Copenhagen, Denmark) intraoral scanner. The underlying disorders were divided into cleft lip and palate (CLP), Trisomy 21 (T21), Robin Sequence (RS), Treacher Collins syndrome (TC), and isolated mandibular retrognathia (MR). Scan data were analysed by scanning duration, number of images, possible correlations of these factors with the different craniofacial disorders, patient age, and relationship between first and subsequent scans. Clinical experiences with the repeated digital impressions are described.
Results
Patient data of 141 scans in 83 patients were analysed within an 11-month period. Patients had a median age of 137 days. Median scanning duration was 138 seconds, resulting in a median of 352 images. There was a statistically significant difference in scanning duration (P = 0.001) between infants and neonates. IOS took longest in patients with CLP (537 seconds) and shortest in T21 patients (21 seconds), although there was no statistically significant difference between aetiologies. There was no statistically significant difference between first and subsequent scans in scanning duration. In four cases the IOS had to be repeated, and one patient ultimately required conventional impression taking (all CLP patients; success rate 94%). No severe adverse events occurred.
Conclusion
IOS is a fast, safe, and feasible procedure for neonates, small children, and infants with craniofacial malformations. One special challenge for both technician and user was identified in patients with CLP, though implementing this new approach of digital impression taking was otherwise found to be highly successful in everyday clinical routine.
... The other objectives are to motivate breastfeeding aided with feeding appliance thus taking care of overall nutrition, diagnosing future malocclusions & also informing about specialist referrals in correct timing. 81,82 Pediatric dentists are well aquainted with a child"s overall knowledge, thus in a way by understanding a cleft child"s psychology & different aspects of behavior management, they deliver treatment in a most empathetic way. Be it preventive, restorative or interventional care in management of a cleft individual, a committed pedodontist who follows up all the appointments in time will be the need of the hour. ...
Cleft lip and palate is one of the most common congenital anomalies requiring multidisciplinary care. Such anomaly is associated with many problems such as impaired feeding, defective speech, hearing difficulties, malocclusion, dental abnormalities, gross facial deformity as well severe psychological problems. Cleft of the lip and palate is one of the complex conditions that occur at a functionally potential area in the orofacial region and also at such a crucial time that strategic interventions at the right age by the concerned specialists becomes the need of the hour. Pediatric dentist is an integral part of the cleft rehabilitative process right from the neonatal period upto the phase of permanent dentition. Being well versed with a childs growth and development, both physical and mental, a Pedodontist helps in restoring function and esthetics in a cleft child, in a most empathetic way. This article describes the enormous challenges faced by these innocent souls and the vital role played by a Pedodontist, to provide comprehensive cleft care, be it preventive, restorative, or interventional care, in order to achieve the best possible outcome and meaningfully improve their quality of life.
... Impression procedures in cleft infants pose a unique set of challenges that includes size constraints of the oral cavity, anatomical variations, lack of ability of the infant to cooperate and respond to commands, cyanotic episodes, poor nasopharyngeal reflexes, obligatory nasal breathing difficulties in adaptation of stock instruments, and difficulty in retrieval of the impressions. Therefore, while preparing an impression, proper patient and dentist positioning is an essential prerequisite for a safe and accurate procedure 21 . Specialists use various techniques for making impressions, including the finger technique, use of spoon or ice cream sticks, and use of trays fabricated from pre-existing casts of other patients. ...
Objectives:
Cleft lip and palate (CLP) is one of the most common congenital deformities with worldwide prevalence. It causes a range of issues for infants that mainly involve difficulty in feeding due to abnormal oronasal communication. For this purpose, feeding plates are provided to infants to act as an artificial palate to aid in feeding. The most crucial procedure in fabrication of a feeding plate is creation of the impression using the traditional finger technique or impression trays. This preliminary research aims to compare the effectiveness of novel impression trays with that of the traditional finger technique for recording impressions of infants with CLP.
Materials and methods:
This randomized controlled trial was conducted among 30 infants who were divided into two groups based on the method of obtaining impressions: Group I, finger technique; Group II, specialized acrylic tray (cleftray).
Results:
Use of cleftray required less impression time, a reduced amount of material, no incidence of cyanosis/choking in infants, and lower anxiety among doctors compared to the traditional method. Additionally, there was no distortion of cleft impressions, recorded maxillary tuberosity, or other fine details. Therefore, the novel impression tray (cleftray) exhibited superior outcomes in all the parameters compared to the finger technique.
Conclusion:
Within the limitations of this study, we conclude that impression trays are superior to the traditional finger, spoon, or ice cream stick methods of creating impressions of CLP. However, it is necessary to conduct more clinical trials on a larger population based on other parameters to compare the effectiveness of the two techniques to draw definitive conclusions.
... 9 Various types of feeding plate like passive plates, molding plates, and Latham's obturator are available to assist in feeding. 10 The feeding appliance does not alter the dimensions of the cleft but provide a "false palate" for the infant and permit functions like swallowing and feeding in a more normal manner. 11 The feeding appliance also prevents cleft widening due to the activity of the tongue and corrects tongue function, leading to the development of speech, providing positive guidance for growth and development of the maxillary segments, and have a positive psychological effect, at least on the parents. ...
... Heavy-body silicone impression material was used due to its superior properties over other impression materials. 10 The modified plastic spoon tray is discarded after its use, preventing any risk of cross infection. The modified plastic spoon tray described in this report is readily available and cost effective. ...
Cleft lip and palate is the most common congenital defect of orofacial region, which results in difficulty in feeding, deglutition and speech. Before surgical intervention, feeding appliance is used to restore the palatal cleft and aid in feeding of an infant. The impression procedure during the fabrication of a feeding appliance is a crucial step and selection of impression tray and impression material is a challenging task. This article attempts to briefly describe an alternative technique for making impression in infants with cleft palate.
... Impression is made when a child is awake and is not under any anaesthesia. Various positions for impression making have been suggested in literature like facedown, prone, upright down and upright positions [8,[30][31][32]. Some authors prefer the impression making in the hospital crib as it provides a work surface which is at a convenient height [33]. ...
Introduction: Nasoalveolar moulding is a medically prescribed appliance with the objective of molding the maxillae at the orona- sal cavity, thus enhancing suckling and swallowing by approximating lip with the right and left maxillary segments of infants with cleft palates in their proper orientation until surgery is performed to repair the cleft. This procedure helps in reducing the number of surgeries required by the cleft lip and palate baby and enhances the results of the surgery.
Aim: To evaluate knowledge and awareness on application of presurgical nasoalveolar moulding for cleft lip and palate patients among dentists in India.
Material and Methods: A cross-sectional study using a questionnaire format was formulated for the dentists in India. 266 vol- unteers participated in this study between March to April 2020. A validated questionnaire consisting of 15 close-ended questions intended to solicit the level of participants' knowledge concerning the use of presurgicalnasoalveolar moulding in cleft lip and palate patients was circulated using online media sharing platforms. The responses were collected using web protocol forms that enabled quick and secure access to data. Chi square test and Pearson’s correlation was to determine awareness between males and females and between professions.
Results: This study showed that dentists had a general awareness about the term presurgical nasoalveolar moulding. But only 21.1% of participants knew about the rationale of presurgical nasoalveolar moulding. Similarly, knowledge about force vectors delivered by presurgical nasoalveolar moulding was minimal (13.2%). There was a statistically significant difference seen between responses given by males and females and even between responses given by professionals in different fields of dentistry. Conclusion: Awareness about the application of pre surgical nasoalveolar moulding for cleft lip and palate patients is minimal as determined by the results of this survey. Increased awareness of this technique could improve the aesthetic outcome of newborns with cleft lip and palate as well as reduce the number of surgeries required to correct their deformity. Hence, Presurgical Nasoal- veolar Moulding for Cleft repair should be included as part of the dental education curriculum across all dental schools.
... 34 Treatment goal for cleft lip and palate (CLP) patients is to restore the normal anatomy of the affected structures. 35 The cleft alveolus component of the oral cleft deformity is addressed with a separate surgical stage. 36 There have been many changes in the management of alveolar cleft in the past 100 years. ...
... There are hazards associated with while taking impressions for construction of the obturator, such as difficulty in removing the impression due to engagement of undercuts and fragmentation of the impression upon withdrawal from the mouth with subsequent respiratory obstruction and cyanotic episodes. 37 Repeated construction of new obturators because of baby's growth is often associated with poor oral hygiene, which can lead to fungal growth on the palate if the proper cleaning procedure for the prosthesis is not followed. Intraoral placement of the obturator is challenging and can add to the burden of maintenance. ...
Cleft lip and palate (CLP) is one of the most common craniofacial anomaly affecting newborns. In the early years of life to survive baby requires nutrition from the mother. Lip seal of infant is affected because of cleft palate and thereby feeding is greatly compromised. As there is communication between nasal cavity and oral cavity there are more chances of aspiration of milk into the lungs. The main role of pedodontist is to fabricate a palatal obturator which facilitates feeding. In this article we have discussed fabrication of feeding obturator in single visit in infants with cleft palate.
How to cite this article:
Tirupathi SP, Ragulakollu R, Reddy V. Single-visit Feeding Obturator Fabrication in Infants with Cleft Lip and Palate: A Case Series and Narrative Review of Literature. Int J Clin Pediatr Dent 2020;13(2):186-191.
... Cleft of the lip and palate are commonly encountered congenital anomalies and often result in severe functional deficiency on the patient's chewing ability, appearance, and ability to speak. [1] It is estimated that between 28,000 and 35,000 children are born with clefts in India each year, or about 1 out of every 500-800 live births. [2] The numbers have been slowly improving, but until recently, only one-third of the new Indian cleft cases were corrected each year, and only half of those cases were treated by a trained surgeon. ...
Context:
Altered orofacial morphology and poor dental status affects the dietary intake of cleft patient, making susceptible to nutritional imbalance. Oral health care planning for this population is impossible without the evaluation of stomatognathic functional status as well as prosthetic and nutritional status and need.
Aims:
The aim of this study was to evaluate prosthetic status and prosthetic treatment need, bite force and nutritional status, in adult cleft patients and to compare them with the adult noncleft population of similar definition.
Settings and design:
Cleft (n = 250) and noncleft (n = 250) individuals of either sex, aged 18 years or above, excluding severe medically compromised and differently abled, were examined and individual biteforce was measured after obtaining written consent and ethical clearance from the two institutions in Kolkata.
Subjects and methods:
A "raw data sheet" was prepared according to the parameters of the "Oral Health Surveys: Basic methods," World Health Organization (1997) for evaluation of prosthetic status and need, dentition status and Mini-Nutritional Assessment, Nestlé (1994) for the evaluation nutritional status. A Gnathodynamometer was used to record bite force.
Statistical analysis used:
Statistical analysis was performed using SPSS 20.0.1, Graph Pad Prism version 5, Student's t-test, and Chi-square test.
Results:
The mean bite force of frontal area in cleft group (3.4356 ± 0.9457 kgf) was found to be significantly lower (P < 0.0001) than in noncleft (22.8749 ± 5.3644 kgf) group. The difference of mean bite force in the right side (2.4576 ± 0.6131 kgf) and left side (1.2708 ± 0.1036 kgf) in cleft group was found to be statistically significant (P < 0.0001). Prosthetic need in maxillary arch was found to be significantly (χ2: 490.0000; P < 0.0001) higher in cleft than in noncleft group. Nutritional status was observed to be significantly (χ2: 179.4049; P < 0.0001) higher "at risk" in cleft than in noncleft group.
Conclusions:
Lack of adequate Government concern leading to significantly higher prosthetic need and lower prosthetic status, hence lower bite force resulting lower nutritional status in adult cleft patients in Kolkata.
... Ultimately, the feeding interventions and obturators were analysed from the identified randomised controlled trials (n = 4) (Brine et al. 1994;Shaw et al. 1999;Prahl et al. 2005;Masarei et al. 2007a) and descriptive studies (n = 22) (Tisza and Gumpertz 1962;Williams et al. 1968;Paradise et al. 1969;Paradise and McWilliams 1974;Campbell and Tremouth 1987;Clarren et al. 1987;Saunders et al. 1989;Choi et al. 1991;Richard 1991;Lang et al. 1994;Trenouth and Campbell 1996;Kogo et al. 1997;Oliver and Jones 1997;Turner et al. 2001;Mizuno et al. 2002;Da Silva Dalben et al. 2003;Garcez and Giugliani 2005;Masarei et al. 2007b;Sabarinath et al. 2008Sabarinath et al. , 2009Britton et al. 2011;Ize-Iyamu and Saheeb 2011) and are discussed in detail below regarding their role in patients with clefts. ...
Newborns with cleft palate have a distorted maxillary arch at birth. Depending upon the type of cleft, infants suffer from a variety of problems, many of which are related to feeding difficulties. Feeding these babies is an immediate concern because there is evidence of delayed growth of children with cleft lip and palate (CLCP) compared to normal infants. Many methods have been devised to overcome these problems, including the use of special bottles, nipples, and initial obturator therapy.
A Pub Med search was conducted using the following search terms: feeding interventions in cleft lip and palate, feeding plate/obturator in cleft palate. All the relevant articles were studied and the reference list of selected articles was also studied. Effects of different feeding interventions in infants with cleft palate with special emphasis on obturators, based on descriptive reports, expert opinions, and available data from clinical trials was reviewed.
The combination of search terms generated a list of 74 articles out of which 51 articles were excluded based on analyses of abstracts and full texts. Three additional publications were identified by the manual search. A total of 26 relevant articles were selected which included randomised controlled trials and descriptive studies on feeding interventions and obturators.
A single intervention may not fulfil all feeding requirements of infants with CLCP. Combined use of different feeding interventions such as palatal obturator, Haberman feeder, and breast milk pump and lactation education may successfully meet the feeding needs of both mother and child.
