Long-term esthetic-functional rehabilitation of unilateral cleft lip and palate with a cross-arch monolithic zirconia fixed dental prosthesis following multidisciplinary treatment: 5-year post-prosthetic follow-up

Abstract

Objective: This case report describes the esthetic- functional rehabilitation of a patient with unilateral complete cleft lip and palate who was managed multidisciplinarily from 10 to 18 years of age, and reports the clinical outcome 5 years after definitive prosthetic rehabilitation, which was undertaken after late secondary alveolar bone grafting had yielded insufficient bone volume for implant placement. Clinical Considerations: Phased orthodontic treatment from age 10–17 (slow maxillary expansion, fixed appliances, growth- coordinated space management) was followed by late secondary alveolar bone grafting at age 17, with concurrent extraction of the periodontally compromised lateral incisor. Although grafting achieved meaningful structural and soft- tissue reconstruction of the cleft zone, postoperative cone- beam computed tomography confirmed that the residual bone height and width remained insufficient for implant placement; after the patient declined further augmentation, a six- unit canine- to- canine monolithic zir conia fixed dental prosthesis incorporating a pink- ceramic- extended ovate pontic was adhesively cemented at age 18 with a 10- methacryloyloxydecyl dihydrogen phosphate–containing dual- cure resin cement, combined with continued dual orthodontic retention. Conclusion: Five years after definitive cementation, the restoration was clinically intact, with non- inflamed abutment per iodontal conditions and maintenance of bilateral Class I occlusal relationships, transverse maxillary arch form, and esthetic outcome. Maintenance of the transverse arch form is most plausibly multifactorial and is attributed principally to the sustained orthodontic retention protocol rather than to the anterior restoration. This case illustrates the 5- year performance of cross- arch tooth- supported zirconia rehabilitation combined with prosthetic soft- tissue masking and continued orthodontic retention in a cleft patient in whom implant therapy was not feasible.