Simplifying cleft surgery by presurgical nasoalveolar molding (PNAM) for infant born with unilateral cleft lip, alveolus, and palate: a clinical report.

PATIENT: A 2-day-old female infant with complete unilateral cleft lip, alveolus, and palate (left side) was presented to the Department of Prosthodontics, Government Dental College and Hospital, Nagpur for evaluation and treatment with presurgical nasoalveolar molding (PNAM) prior to surgical intervention. DISCUSSION: The alignment of the alveolar segments creates the foundation upon which excellent results of primary lip and nasal surgery are dependent in the repair of the cleft lip, alveolus, and palate patient. Presurgical infant orthopedics has been employed since the 1950s as an adjunctive neonatal therapy for the correction of cleft lip and palate. One of the problems that the traditional approach failed to address was the deformity of the nasal cartilages and the deficiency of columella tissue in infants with unilateral and bilateral cleft lip and palate. The purpose of this article is to illustrate the step-by-step fabrication process of the PNAM prosthesis used to direct growth of the alveolar segments, lips, and nose in the presurgical treatment of cleft lip and palate. CONCLUSION: As a result, the primary surgical repair of the lip and nose heals under minimal tension, thereby reducing scar formation and improving the esthetic result. Frequent surgical intervention to achieve the desired esthetic results can be avoided by PNAM.

Achieving a desired esthetic outcome for a single-tooth implant restoration with tissue excess using a multidisciplinary treatment approach: a clinical report.

Achieving ideal emergence profile and restoration contours for implant-supported prostheses in the anterior esthetic zone is a prime requisite. In this report, the patient presented with decreased restoration space and unfavorable tissue contours for an implant restoration. Correction of space deficiency and reshaping of excess bone height and soft tissue were planned and executed carefully prior to definitive restoration of a maxillary anterior missing tooth with an implant-retained prosthesis. Post-treatment evaluation of the papillary levels and soft tissue profile helped in assessing maintenance of the restored emergence profile.