Mark, a dental implant patient in Pennsylvania, asks:
I was born with a bilateral cleft palate. My two front teeth have been diagnosed with extensive external root resorption. I’ve
gotten several opinions, and the consensus is extraction/graft with
dental implants.
One surgeon wants to do the extractions and allograft in
separate procedures, while another surgeon would do the graft at the same time of the
extractions. I’ve had 2 autographs (iliac bone) 10 and 12 years ago to
repair the cleft, both of which were successful.
Are there any special considerations for grafting/ dental implants given the previous work that was done around the cleft? Are there any factors to be considered when placing dental implants for a cleft palate? Would an allograft, as opposed to native bone, be advisable given the greater amount of bone that will be needed?
One surgeon also said that removing the teeth may create a passageway into my nose, necessitating an autograft 3-4 weeks after extraction. He said he wouldn’t be completely sure about the amount of bone surrounding the teeth until the extraction. Any advice is greatly appreciated.
Hi Mark,
great question. Below are two studies which address your question. Hope this helps. I would be interested to hear other surgeons’ experiences for a case like this.
Study I:
Hi Mark,
Check out these resources below:
Nagasao T, et al. The dynamics in implantation for patients with clefts. Cleft Palate Craniocafacial J. 2006;43:84-91.
“In patients with palatal clefts, characteristic stress patterns occur on the bone-implant interface during mastication. This should be taken into consideration when performing an implant treatment in patients with clefts.”
Kramer EJ, et al. Dental implants in patients with orofacial clefts: a long-term follow-up study. Int J Oral Maxillofac Surg. 2005;34:715-721.
“Patient-related parameters of age, gender or type of cleft had no significant influence. The length of an implant was significantly related to an improved survival rate (P
Autografts are in my opinion the best way to prepare secondary implant surgery. Root resorption of your two front teeth is probably due to orthodontics treatment for dental alignement.
When extracting the central incisors, the risk of bucco-nasal communication is low but it depends on bone level : that risk can be evaluated by dentascanner imaging.
This kind of surgery depends on many factors:
Are lateral incisors missing?
How many implants will be planned?
Regards.
Dr JB SEIGNEURIC
French cleft palate surgery team.
Paris France
My son-in-law was born with a cleft palate. although he said he had braces as a child, his teeth are noticeably very crooked, and are different sizes. He does not want to have them fixed, but I feel he needs to do something with his teeth for the health of his mouth, and for his self esteem. Could you please tell me what the implications are for someone not correcting these problems? He is 30 yrs. old. Thank you