A retrospective study on clinical outcomes of implant-supported rehabilitations in patients with alveolar cleft

doi:10.19439/j.sjos.2025.03.018

Abstract

Abstract: PURPOSE: To retrospectively evaluate the clinical outcomes of implant-supported prosthesis in alveolar cleft patients. METHODS: A total of 14 patients with alveolar cleft underwent implant restoration in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2015 to January 2023 were collected. Among them, 9 were male and 5 were female. The age ranged from 18 to 52 years, with a mean of (26.1±10.6) years. The sequence treatment history of patients with cleft lip and palate and the effect of implant repair were retrospectively analyzed. RESULTS: Bone grafting in the fissured area failed repeatedly in 1 patient and no implant was implanted. A total of 21 implants were implanted in the remaining 13 patients with alveolar cleft, all of which achieved good osseointegration. In 10 cases, one implant was implanted in each fissure area for single crown or single end bridge repair. In 3 cases, 11 implants were implanted in the non-fissure area for fixed bridge repair. Seven patients with single implant were followed up for 6 to 96 months, with an average of (39.4±29.2) months. During their visits, patients underwent various examinations, including pink aesthetic score (PES) averaging 10.16±0.98, white aesthetic score(WES) averaging 8.50±1.23, and probing depth(PD) with a mean of (2.68±0.61) mm. Additionally, gingival index(GI) was recorded with a mean of 1.33±1.10, and marginal bone loss(MBL) was measured with a mean of (0.17±0.35) mm. The width of the mid-labial keratinized mucosa was observed to be (5.14±2.10) mm. CONCLUSIONS: Implant-supported prosthesis in the alveolar cleft area after well-established multidisciplinary sequential treatments have predictable middle-term success rate, satisfactory aesthetic outcomes and stable peri-implant soft and hard tissue conditions.

Key words: Cleft lip-palate, Alveolar cleft, Implant-supported dental prosthesis, Success rate, Peri-implant disease

CLC Number:

R783.4

Lan Rong, Wu Yiqun, Huang Wei, Chen Zhenqi, Pan Xiaogang, Wang Feng. A retrospective study on clinical outcomes of implant-supported rehabilitations in patients with alveolar cleft[J]. Shanghai Journal of Stomatology, 2025, 34(3): 326-331.

References

[1] Yu Y, Zhen Q, Chen W, et al.Genome-wide meta-analyses identify five new risk loci for nonsyndromic orofacial clefts in the Chinese Han population[J]. Mol Genet Genomic Med, 2023, 11(10): e2226.
[2] Alighieri C, Bettens K, Perry J, et al.Achieving the next level in cleft speech intervention: a protocol of a randomized sham-controlled trial to provide guidelines for a personalized approach in children with cleft palate[J]. Int J Lang Commun Disord, 2023,58(4): 1405-1418.
[3] Miura S, Ueda H, Iwai K, et al.Masticatory function assessment of adult patients with cleft lip and palate after orthodontic treatment[J]. Cleft Palate Craniofac J, 2022, 59(3): 390-398.
[4] Xia W, Yang R, Zong Y, et al.Depression in Chinese patients with cleft lip and/or palate: a preliminary study[J]. J Clin Med, 2023, 12(4): 1366.
[5] Mangione F, Nguyen L, Foumou N, et al.Cleft palate with/without cleft lip in French children: radiographic evaluation of prevalence, location and coexistence of dental anomalies inside and outside cleft region[J]. Clin Oral Investig, 2018, 22(2): 689-695.
[6] López-Giménez A, Silvestre-Rangil J, Silvestre FJ, et al.Tooth agenesis code (TAC) in complete unilateral and bilateral cleft lip and palate patients[J]. Odontology, 2018, 106(3): 257-265.
[7] Tereza GPG, Santos M, Winckler V, et al.The maxillary lateral incisor in the rehabilitation of cleft lip and palate[J]. J Appl Oral Sci, 2018, 26: e20170125.
[8] Tannyhill RJ 3rd, Troulis MJ. Implant therapy in alveolar cleft sites[J]. Oral Maxillofac Surg Clin North Am, 2019, 31(2): 207-217.
[9] Abreu A, Londono J, Torosian A, et al.Aesthetic concepts and interdisciplinary approach in a patient with bilateral cleft lip and palate and missing premaxilla: a case report[J]. Cleft Palate Craniofac J, 2021,58(8): 1056-1062.
[10] Gillgrass T.The orthodontic management of patients with cleft lip and palate: from the permanent dentition and the adult returning to the service[J]. Br Dent J, 2023, 234(12): 892-898.
[11] Bidra AS.Esthetic and functional rehabilitation of a bilateral cleft palate patient with fixed prosthodontic therapy[J]. J Esthet Restor Dent, 2012, 24(4): 236-244.
[12] Yu D, Xing G, Nie P, et al.Multidimensional esthetic evaluation of patients with a cleft lip and palate wearing a maxillary partial removable dental prosthesis: a 5-year retrospective study[J]. J Prosthet Dent, 2016, 115(4): 456-461.
[13] Verdi FJ Jr, GL SL, Cohen SR, et al.Use of the Branemark implant in the cleft palate patient[J]. Cleft Palate Craniofac J, 1991,28(3): 301-303.
[14] Slagter KW, Meijer HJA, Hentenaar DFM, et al.Immediate single-tooth implant placement with simultaneous bone augmentation versus delayed implant placement after alveolar ridge preservation in bony defect sites in the esthetic region: a 5-year randomized controlled trial[J]. J Periodontol, 2021, 92(12): 1738-1748.
[15] Santing HJ, Raghoebar GM, Vissink A, et al.Performance of the Straumann Bone Level Implant system for anterior single-tooth replacements in augmented and nonaugmented sites: a prospective cohort study with 60 consecutive patients[J]. Clin Oral Implants Res, 2013, 24(8): 941-948.
[16] Arora H, Ivanovski S.Clinical and aesthetic outcomes of immediately placed single-tooth implants with immediate vs. delayed restoration in the anterior maxilla: a retrospective cohort study[J]. Clin Oral Implants Res, 2018, 29(3): 346-352.
[17] Critchlow SB, Popat S.Restorative dentistry in the young cleft patient[J]. Br Dent J, 2023, 234(12): 881-886.
[18] Stelzle F, Rohde M, Oetter N, et al.Gingival esthetics and oral health-related quality of life in patients with cleft lip and palate[J]. Int J Oral Maxillofac Surg, 2017, 46(8): 993-999.
[19] Buser D, Weber HP, Lang NP.Tissue integration of non-submerged implants. 1-year results of a prospective study with 100 ITI hollow-cylinder and hollow-screw implants[J]. Clin Oral Implants Res, 1990, 1(1): 33-40.
[20] Löe H.The gingival index, the plaque index and the retention index systems[J]. J Periodontol, 1967, 38(6): S610-S616.
[21] Taheri M, Akbari S, Shamshiri AR, et al.Marginal bone loss around bone-level and tissue-level implants: a systematic review and meta-analysis[J]. Ann Anat, 2020, 231: 151525.
[22] Saint-Surin I, Roman T, Touzet-Roumazeille S, et al.Implant-borne rehabilitation for alveolar dental cleft: retrospective analysis of thirty-nine cases[J]. J Stomatol Oral Maxillofac Surg, 2020, 121(4): 339-343.
[23] Yatabe MS, Garib DG, Janson G, et al.Is the presence of Simonart's band in patients with complete unilateral cleft lip and palate associated with the prevalence of missing maxillary lateral incisors?[J]. Am J Orthod Dentofacial Orthop, 2013, 144(5): 649-653.
[24] Kim JH, Lee IH, Lee SM, et al.Distraction osteogenesis and orthognathic surgery for a patient with unilateral cleft lip and palate[J]. Am J Orthod Dentofacial Orthop, 2015,147(3): 381-393.
[25] Alberga JM, Stellingsma K, Meijer HJA, et al.Dental implant placement in alveolar cleft patients: a retrospective comparative study on clinical and aesthetic outcomes[J]. Int J Oral Maxillofac Surg, 2020, 49(7): 952-959.
[26] Bengazi F, Lang NP, Caroprese M, et al.Dimensional changes in soft tissues around dental implants following free gingival grafting: an experimental study in dogs[J]. Clin Oral Implants Res, 2015, 26(2): 176-182.
[27] Monje A, Blasi G.Significance of keratinized mucosa/gingiva on peri-implant and adjacent periodontal conditions in erratic maintenance compliers[J]. J Periodontol, 2019, 90(5): 445-453.
[28] Levy-Bercowski D, Abreu A, Londono J, et al.Use of an esthetic overdenture as an alternative treatment in a patient with bilateral cleft lip and palate[J]. J Prosthet Dent, 2019,121(2): 200-205.
[29] Wang F, Wu Y, Zou D, et al.Clinical outcomes of dental implant therapy in alveolar cleft patients: a systematic review[J]. Int J Oral Maxillofac Implants, 2014, 29(5): 1098-1105.
[30] Yatabe M, Natsumeda GM, Miranda F, et al. Alveolar bone morphology of maxillary central incisors near grafted alveolar clefts after orthodontic treatment[J]. Am J Orthod Dentofacial Orthop, 2017,152(4):501-508.e1.