Cleft Palates, By Sol Soroca- CDT
Former President – The Flexite Company
Cleft palate and cleft lip comprise the fourth most common birth defect in the United States. One of every 700 newborns is affected by lip and / or cleft palate. A cleft palate is an opening in the roof of the mouth in which the two sides of the palate did not fuse or join together as the unborn baby was developing. Over the years, the patient may require different types of service e.g., surgery, dental, and speech therapy. Speech is impeded until an oral device is made to cover up the opening. I have documented two cases that may be of interest to you.
The patient had a hugh opening in the palatal region and was diagnosed as having a cleft palate. (Figure 1) A prosthesis was considered for this application. Consideration for the patients tolerance and allergies to different plastics were discussed. Because the cavity was quite large we decided on a combination of two plastics, silicone and acrylic. Specifically, we chose Flexite MP (multipolymer semi flexible acrylic) because it is monomer free, very receptive to silicone (Flexil), and it is kinder to the internal area.
The patient was an African American who wanted to have the color of the restoration match his gums. A moderate shade was selected. (Figure 2) The upper cast was surveyed and all undercuts were blocked out. (Figure 3) The diagnosis for complete coverage was necessary because of the location of the cleft in the palate. The two molars #15 and #16 were missing. (Figure 4) A double clasp was designed according to the survey on tooth #15 and #16 and a clasp was carried to the opposite side on tooth #1.
Setup and bite registration were confirmed and the master cast was separated for duplication. The design was copied to the duplicated model. The setup and final waxup (Figure 5) was sealed onto the duplicated model and processed. After deflasking, finishing and polishing were done in the conventional manner. Flexite MP is a derivative of methyl methacrylate and is easily finished and polished.
Attaching the silicone to the palate. (Figure 6)
The cavity has to be prepared by roughing up the area that will be receiving the silicone. A small green stone is used to accomplish this. A solvent is brushed on before the bonding agent is applied. Flexil has a two catalyst system and the silicone is mixed with both catalysts for a quick cure. The silicone is applied to the cavity in a ball shape and compressed until seated into position. It is put into a warm bath (temperature 140F) for thirty minutes. The excess is then trimmed away.
The final restoration is completed and appears lighter than the picture in Figure 2. This is because Flexite MP is very translucent and is not on the model. (Figure 7)
Here we have the cleft in the post palatal region. (Figures 8+9) It is hard to imagine the effect that even a small opening would have in the palatal region. The procedure was the same regarding the steps taken previously for case #1 (e.g. surveying, blocking out the undercuts, and working off a duplicate model) No setup or tryin was required. The patient is Caucasian so the color of the plastic is noticeably lighter than the plastic used in case #1 for the African American. In case #2 the process is the same except there is no need for the silicone.
It is easy to undertake these unique cases when you have a plastic like Flexite MP to work with. MP is easy to add to, it works well with silicone, and it is dimensionally superior to most plastics. Flexite MP is semiflexible and is the choice for gasket type restorations as well as tmj’s, bruxism-splints, provisional and full dentures. Both patients were completely satisfied.
For additional information on Cleft Palates contact:
Cleft Palate Foundation
American Cleft Palate – Craniofacial Association/Cleft Palate Foundation
1504 East Franklin Street
Suite 102, Chapel Hill, N.C. 27514-2820 USA
Tel: (919) 933-9044 E-mail: www.cleftline.org