|Year : 2010 | Volume
| Issue : 4 | Page : 311-314
A new technique of impression making for an obturator in cleft lip and palate patient
KS Ravichandra1, KE Vijayaprasad2, A.A.K Vasa3, S Suzan3
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 Publication||25-Jan-2011|
K S Ravichandra
Prof & HOD, Department of Pedodontics and Preventive Dentistry, St. Joseph Dental College, Eluru - 534 003, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
| 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 Jul 22];28:311-4. Available from: http://www.jisppd.com/text.asp?2010/28/4/311/76165
| Introduction|| |
Clefts of the lip and palate are the most common congenital deformities involving the orofacial region.  Cleft palate can be defined as a furrow in the palatal vault.  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.  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). 
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.  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.  Many appliances exist for use in the cleft infant for maxillary orthopedics and may be broadly grouped under active, semi-active, or passive categories.  In addition are the presurgical nasoalveolar molding plates. 
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. ,,,
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|| |
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 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.
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].
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.
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].
Master cast was made with dental stone. The master cast was then lubricated with a thin layer of petroleum jelly.
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.
| Discussion|| |
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|| |
We are greatful to Dr. Sunil Chandra, Asst Professor, Department of Prosthodontics, St. Joseph Dental College, Eluru.
| References|| |
|1.||Proffit WR, Fields HW, Sarver DM. Contemporary Orthodontics. 4 th ed. India: Mosby (an imprint of Elsevier); 2007. p. 287-8. |
|2.||Singh G. Text book of Orthodontics. 1 st ed. India: Jaypee; 2004. p. 629-44. |
|3.||Booth PW, Schendel SA, Hausamen JE. 2 nd ed, Vol. 2. Churchill Livingstone. Philadelphia: Elsevier; 2007. p. 1000-48. |
|4.||Taylor TD. Clinical maxillofacial prosthesis. China: Quintessence; 2000. p. 63-84. |
|5.||Shah CP, Wong D. Management of children with cleft lip and palate. CMAJ 1980;122:19-24. |
|6.||Berkowitz S. Cleft lip and palate. 2 nd ed. Springer: Berlin; 2006. p. 381-407. |
|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. |
|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. |
|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. |
|10.||Grayson B, Shetye P, Cutting C. Presurgical nasoalveolar molding treatment in cleft lip and palate patients. Cleft J 2005;1:4-7. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
|This article has been cited by|
||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]|
||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; |