Home | About Us | Editorial Board | Current Issue | Archives | Search | Instructions | Subscription | Feedback | e-Alerts | Login 
Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
 Users Online: 570  
 
  Print this page Email this page   Small font sizeDefault font sizeIncrease font size


 
  Table of Contents    
CASE REPORT
Year : 2010  |  Volume : 28  |  Issue : 4  |  Page : 311-314
 

A new technique of impression making for an obturator in cleft lip and palate patient


1 Professor and HOD, Department of Pedodontics and Preventive Dentistry, St. Joseph Dental College, Eluru, Andhra Pradesh, India
2 Professor, Department of Pedodontics and Preventive Dentistry, St. Joseph Dental College, Eluru, Andhra Pradesh, India
3 Sr. Lecturer, Department of Pedodontics and Preventive Dentistry, St. Joseph Dental College, Eluru, Andhra Pradesh, India

Date of Web Publication25-Jan-2011

Correspondence Address:
K S Ravichandra
Prof & HOD, Department of Pedodontics and Preventive Dentistry, St. Joseph Dental College, Eluru - 534 003, Andhra Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.76165

Rights and Permissions

 

   Abstract 

Cleft lip and palate is a birth defect occurring in the orofacial region. One of the immediate problems to be addressed in a newborn with this defect would be to aid in suckling and swallowing. Here we present a case of a 5-day-old infant with unilateral cleft lip and palate for whom feeding obturator was made by using a simplified impression technique to facilitate feeding.


Keywords: Cleft lip palate, impression, infant, obturator


How to cite this article:
Ravichandra K S, Vijayaprasad K E, Vasa A, Suzan S. A new technique of impression making for an obturator in cleft lip and palate patient. J Indian Soc Pedod Prev Dent 2010;28:311-4

How to cite this URL:
Ravichandra K S, Vijayaprasad K E, Vasa A, Suzan S. A new technique of impression making for an obturator in cleft lip and palate patient. J Indian Soc Pedod Prev Dent [serial online] 2010 [cited 2019 Oct 23];28:311-4. Available from: http://www.jisppd.com/text.asp?2010/28/4/311/76165



   Introduction Top


Clefts of the lip and palate are the most common congenital deformities involving the orofacial region. [1] Cleft palate can be defined as a furrow in the palatal vault. [2] Facial clefting results from a wide variety of genetic and environmental causes. Essentially, a cleft is caused by hypoplasia, abnormal directional growth of mesenchymal process, or failure of fusion or breakdown of fusion of mesenchymal process. [3] The reported incidence of cleft lip and palate is approximately one in 800 newborn infants and varies widely among races. Among the unilateral clefts, clefts involving the left side are more common (70% of the cases). [3]

There are numerous problems associated with individuals with a cleft lip or palate, which affects the functions performed by the oral and nasal cavities. The foremost problem would be feeding the infant as there will be no sufficient negative intraoral pressure to prevent regurgitation of food into the nasal cavity. Addressing these problems necessitates a multidisciplinary approach, requiring a team of experts to facilitate case for these individuals.

The basic goal of any approach to cleft lip, alveolus, and palate repair, whether for the unilateral or bilateral anomaly is to restore normal anatomy. [4] If the palatal defect is wide and complete, an obturator may be required to close the defect and prevent regurgitation of the food into the nasal cavity. [5] Many appliances exist for use in the cleft infant for maxillary orthopedics and may be broadly grouped under active, semi-active, or passive categories. [6] In addition are the presurgical nasoalveolar molding plates. [7]

Presurgical nasoalveolar molding is an evolving technique in the treatment of cleft lip and palate. Used properly, molding can create improved nasal symmetry in unilateral cases and columellar lengthening in bilateral cases. So the first stage of management would be the fabrication of a feeding plate or passive maxillary obturator. The crucial step in fabrication of any appliance or obturator is the impression procedure. Patient positioning, tray, and impression material selection are the important factors to consider in any impression procedure. [4],[8],[9],[10]

This case report aims at providing an overview of the management of a cleft lip and palate patient with emphasis on the role of a pedodontist.


   Case Report Top


A 5-day-old female infant was referred to our department with parents complaining of difficulty in suckling of milk. Mother had a full-term, normal uneventful pregnancy, and medical and dental history was not contributory. Family history revealed that parents and the maternal grand parents were of consanguineous marriage.

Intraoral examination of the child revealed left unilateral cleft lip involving alveolus and hard and soft palate of that side (Veau Class III) [Figure 1] and [Figure 2].
Figure 1 :A 5-day-old infant with cleft lip and palate

Click here to view
Figure 2 :Intraoral examination showing left unilateral cleft lip involving palate, alveolus

Click here to view


A stepwise procedure is described to obtain accurate reproductions of maxillary arch for the fabrication of an obturator in infants with cleft lip and palate.

Primary impression

The impression is made when the infant is fully awake without any anesthesia or premedication. The infant is held face down to prevent the possible aspiration of regurgitated stomach contents. Back of the small-sized (U-0) impression tray was used in delivering the impression material. Angle of the impression tray was filled with wax and covered with guaze piece material and then loaded with alginate material. When the material was fully set, the impression was removed and inspected to ensure that all the desired landmarks have been captured [Figure 3] and [Figure 4].
Figure 3 :Primary impression taking with alginate

Click here to view
Figure 4 :Primary impression with angle of the impression tray

Click here to view


Cast preparation

Primary cast was made with dental plaster. The cleft region of the palate and alveolus were adapted with wax to approximate the contour [Figure 5] and on which a custom acrylic tray was prepared. The tray was smoothened and polished to avoid rough areas.
Figure 5 :Primary cast

Click here to view


Secondary impression

In the next appointment, fast setting elastomeric putty material was loaded onto the custom tray and impression obtained with the infant in the same position as mentioned earlier for primary impression [Figure 6] and [Figure 7].
Figure 6 :Light body elastomeric impression material

Click here to view
Figure 7 :Secondary impression with elastomeric impression material

Click here to view


Master cast

Master cast was made with dental stone. The master cast was then lubricated with a thin layer of petroleum jelly.

Obturator

For fabrication of obturator or oral molding plate, we followed "Sprinkle method" where small controlled portions of powder and liquid of clear acrylic were incrementally added to the cast. At the delivery appointment, the oral molding plate was carefully fitted in the infant's oral cavity [Figure 8]. Initial attention was given to the retention of the appliance. Care was taken to prevent the acrylic resin from impinging on any muscle attachment or extending to the depth of the buccal vestibule. Parents were instructed on placement and removal of the appliance and its daily cleaning. The infant was seen for adjustments a week after initial delivery of the appliance. The oral cavity was examined for any possible sores or ulcerations in areas other than where molding force was applied.
Figure 8 :Final obturator

Click here to view



   Discussion Top


Impression procedures in cleft infants pose a unique set of challenges in infants, including the size constraints imposed by the infant's oral cavity, anatomical variations associated with the severity of clefts and a lack of ability of the infant to cooperate and respond to commands. The use of fast setting color-timed alginate has been suggested in cleft infants, which has the advantages to record the details even in the presence of saliva, is comfortable to the patient, easy to manipulate, relatively inexpensive, and prevents respiratory arrest. In addition to this, the elastomeric putty, which has been used as secondary impression material does not extrude deep into the undercut areas in the region of cleft and also resist tearing during removal.

The feeding plate or the passive maxillary obturator is a passive prosthetic appliance that is used to restore the palatal cleft and aid in creating sufficient negative pressure, which allow adequate sucking of milk. Thus the comprehensive management of children born with cleft lip and palate is best accomplished by the multidisciplinary team approach. As a team member, pedodontists are expected to keep abreast of new and innovative treatment options to assure the most current care available.


   Acknowledgment Top


We are greatful to Dr. Sunil Chandra, Asst Professor, Department of Prosthodontics, St. Joseph Dental College, Eluru.

 
   References Top

1.Proffit WR, Fields HW, Sarver DM. Contemporary Orthodontics. 4 th ed. India: Mosby (an imprint of Elsevier); 2007. p. 287-8.  Back to cited text no. 1
    
2.Singh G. Text book of Orthodontics. 1 st ed. India: Jaypee; 2004. p. 629-44.  Back to cited text no. 2
    
3.Booth PW, Schendel SA, Hausamen JE. 2 nd ed, Vol. 2. Churchill Livingstone. Philadelphia: Elsevier; 2007. p. 1000-48.   Back to cited text no. 3
    
4.Taylor TD. Clinical maxillofacial prosthesis. China: Quintessence; 2000. p. 63-84.  Back to cited text no. 4
    
5.Shah CP, Wong D. Management of children with cleft lip and palate. CMAJ 1980;122:19-24.  Back to cited text no. 5
    
6.Berkowitz S. Cleft lip and palate. 2 nd ed. Springer: Berlin; 2006. p. 381-407.  Back to cited text no. 6
    
7.Grayson B, Santiago PE, Brecht LE, Cutting CB. Presurgical nasoalveolar molding in infants with cleft lip and palate. Cleft Palate Craniofac J 1999;36:486-98.  Back to cited text no. 7
    
8.Yang S, Stelnicki EJ, Lee MN. Use of nasoalveolar molding appliance to direct growth in newborn patient with complete unilateral cleft lip and palate. Pediatr Dent 2003;25:53-6.  Back to cited text no. 8
    
9.Jacobson BN, Rosenstein SW. Early maxillary orthopedics for the newborn cleft lip and palate patient: An impression and an appliance. Angle Orthod 1984;54:247-63.  Back to cited text no. 9
    
10.Grayson B, Shetye P, Cutting C. Presurgical nasoalveolar molding treatment in cleft lip and palate patients. Cleft J 2005;1:4-7.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]


This article has been cited by
1 Role of obturators and other feeding interventions in patients with cleft lip and palate: a review
M. Goyal,R. Chopra,K. Bansal,M. Marwaha
European Archives of Paediatric Dentistry. 2014; 15(1): 1
[Pubmed] | [DOI]
2 Simplified design and precautionary measures in fabrication of a feeding obturator for a newborn with cleft lip and palate
Dubey, A. and Mujoo, S. and Khandelwal, V. and Nayak, P.A.
BMJ Case Reports. 2013;
[Pubmed]



 

Top
Print this article  Email this article
 

    

 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (2,665 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
    Introduction
    Case Report
    Discussion
    Acknowledgment
    References
    Article Figures

 Article Access Statistics
    Viewed13845    
    Printed179    
    Emailed9    
    PDF Downloaded925    
    Comments [Add]    
    Cited by others 2    

Recommend this journal


Contact us | Sitemap | Advertise | What's New | Copyright and Disclaimer 
  2005 - Journal of Indian Society of Pedodontics and Preventive Dentistry | Published by Wolters Kluwer - Medknow 
Online since 1st May '05