Systemic and oral abnormalities in Kabuki syndrome: a case series.

OBJECTIVE: This study analyzed the systemic and oral abnormalities in individuals with Kabuki syndrome (KS) that might be investigated to enhance the early diagnosis and treatment by a multidisciplinary team, minimizing the consequences to the individual's health. STUDY DESIGN: Clinical examination was conducted on 15 individuals to investigate orodental alterations such as tooth abnormalities and cleft lip and/or palate, and the patient records were also reviewed to investigate systemic diseases such as cardiopathies, infectious and immunologic diseases, nephropathies, and delayed neuropsychomotor development. RESULTS: All individuals with KS presented cleft lip and/or palate, 11 (73.34%) tooth abnormalities, 5 (33.34%) congenital cardiopathies, 12 (80%) infectious or immunologic diseases, 1 (6.67%) nephropathy, and 14 (93.34%) had an intellectual disability. CONCLUSION: Individuals with KS often have dental anomalies such as hypodontia, cleft or palate, and systemic disorders such as congenital heart disease and infectious diseases. Intellectual disability is present in most cases. These alterations should be investigated as early as possible to prevent the increase in morbidity in these individuals.

Survival Rate of Dental Implants in the Cleft Area: A Cross-Sectional Retrospective Study.

This study aimed to evaluate the survival rate of osseointegrated implants installed in the cleft area. An extensive data survey was conducted using the medical records of individuals who had implants installed in the cleft area between 1999 and 2020. The variables assessed were age, sex, implant follow-up time, implantation procedures, and rehabilitation with implant-supported prostheses. Data were analyzed in terms of implant survival time, correlating with the factors: age, sex, execution, or no-execution of bone regrafting, the time interval between secondary alveolar bone grafting and regrafting, the time interval between regrafting and implant installation, and the time interval between implant installation and provisional and definitive prosthesis. Data were analyzed with respect to implant survival. χ 2 and Student t tests were used with a 5% significance level. A total of 1295 medical records were analyzed, of which 688 reported implants in cleft areas (56.1% in females, 43.9% in males) with a success rate of 92.73% and a mean follow-up time of 53.2 (±45.0) months. There were no statistically significant differences in the correlation between the survival rate and sex ( P = 0.895, χ 2 test), between the implant survival rate and regrafted area ( P = 0.904, χ 2 test), or between the survival rate and patient age ( P = 0.246, Student t test). The survival rate of implants in the cleft area was 92.73%. Age, sex, and the need for regrafting did not influence the survival rate of implants installed in the cleft area. Clinical studies that evaluate the survival rate of implants installed in patients with cleft maxilla are of great relevance to the dental field.

Bone Substitutes Graft for Regeneration of the Anterior Maxillary Alveolar Process: A Systematic Review.

The objective of this systematic review was to identify the available scientific evidence on bone substitutes (BSs) compared with autogenous bone grafts (ABGs) for regeneration of horizontal bone resorption in the anterior maxillary alveolar process, aiming at rehabilitation with endosseous implants. This review was performed according to the PRISMA guidelines (2020) and registered in the database PROSPERO (CRD: 42017070574). The databases searched were PUBMED/MEDLINE, EMBASE, SCOPUS, SCIENCE DIRECT, WEB OF SCIENCE, and CENTRAL COCHRANE, in the English language. The Australian National Health and Medical Research Council (NHMRC) and Cochrane Risk of Bias Tool were used to assess the study's quality and risk of bias. A total of 524 papers were found. After the selection process, 6 studies were selected for review. A total of 182 patients were followed for a period of 6 to 48 months. The mean age of patients was 46.46 years, and 152 implants were installed in the anterior region. Two studies achieved a reduced graft and implant failure rate, whereas the remaining 4 studies had no losses. It may be concluded that the use of ABGs and some BSs is a viable alternative for the rehabilitation with implants in individuals with anterior horizontal bone loss. However, additional randomized controlled trials are warranted due to the limited number of papers.

A Narrative Review on Non-Invasive Diagnostic Tools for the Analysis of Dental Arches in Orofacial Cleft Patients.

BACKGROUND: It is necessary to analyze and monitor the facial growth of orofacial cleft patients. The documentation should therefore begin before and after primary surgeries. Technological evolution has transformed plaster models into 3D images through scanners that allow rational storage, manipulation, and rotation without the possibility of breakage or damage. Based on this fact, this narrative review aims to provide a feature on the three-dimensional tools available for the assessment of dental arches in children with orofacial cleft and mixed dentition. MATERIAL AND METHODS: Three databases were chosen (PubMed, ScienceDirect, and Scopus) and keywords were used to select papers. RESULTS: During the database screening, 292 potentially relevant papers were found. After removing duplicates, titles, and abstracts, 32 papers presented qualifications for analysis. Through evaluating each document by reading it one by one, 24 papers fulfilled the eligibility criteria. CONCLUSIONS: It was concluded that digital tools-i.e., benchtop scanners which evaluate the dental arches of children with cleft lip, palate, and mixed dentition-are reproducible and reliable, without the use of ionizing radiation, allow storage, manipulation with sustainability, and help preserve the environment.

Fixed partial dentures in adult patients with cleft lip and palate and their relationship with the quality of life: A cross-sectional clinical study.

STATEMENT OF PROBLEM: Reports on the impact of fixed partial denture treatments on the quality of life of patients with cleft lip and palate are lacking. PURPOSE: The purpose of this cross-sectional clinical study was to assess the impact of fixed partial dentures on the quality of life of adults with cleft lip and palate. MATERIAL AND METHODS: A total of 52 participants (23 women and 29 men) with cleft lip and palate, aged between 20 and 50 years old, and who required treatment with fixed partial dentures were enrolled in the study. They responded to the Oral Health Impact Profile (OHIP)-14 questionnaire before and 30 days after the fixed prosthodontic treatment. The final value from the OHIP-14 was generated by totaling the 14 answers, giving a range from 0 to 56, with higher values indicating a worse relationship between oral health and the quality of life. Nonparametric statistical analysis was performed with the Wilcoxon test (α=.05). RESULTS: Forty-six participants reported some negative experience before the fixed partial denture, and 48 indicated an improved quality of life 30 days after delivery. All domains assessed showed significant quality of life improvements between the periods compared (P≤.014). CONCLUSIONS: Oral treatment with fixed partial dentures improved the quality of life in adults with cleft lip and palate.

Relapse after Le Fort I surgery in oral cleft patients: a 2-year follow-up using digitized and 3D models.

This retrospective observational study aimed to evaluate and identify the relapse rate after orthognathic surgery for maxillary advancement (Le Fort I maxillary osteotomy) in oral cleft patients through digitized cephalograms and 3D dental models, following 2 years. Lateral cephalograms and dental casts of 17 individuals, enrolled in Orthodontics Department in Hospital of Rehabilitation of Craniofacial Anomalies, were carried out. The digital cephalometric tracings were evaluated in: T1-before surgery, T2-immediate after surgery, T3-6-month to 1-year after surgery. The dental study casts were digitized and evaluated in: F1-before surgery; F2-3-month to 1-year after surgery; F3-1 to 2 years after surgery. The analyses of the dental arches were performed directly on the scanned images. A single examiner previously trained and calibrated performed all the assessments. Repeated measures ANOVA was applied to study the variables and compare the periods, followed by Tukey test to evaluate the statistically significant differences, with level of significance of 5%. The digital cephalogram results showed that the vertical movement statistically differed from T2 to T3 (p = 0.002). The right and left premolar relationship in digitized models revealed that at F2 the individuals exhibited » Class II and Class I, in 29.4 and 23.5% of the cases, respectively; and at F3, Class I, 58.8 and 70.6% of the cases, respectively. The cephalometry showed the relapse in the vertical movement after orthognathic surgery for maxillary advancement, but no relapse in the other evaluated parameters.

Impact of Orofacial Dysfunction on the Quality of Life of Adult Patients With Cleft Lip and Palate.

OBJECTIVE: This study assessed the prevalence of orofacial dysfunctions (ODs) and quality of life (QoL) in adults with and without a cleft lip and palate. DESIGN: Cross sectional. SETTING: Craniofacial Center, Hospital for Rehabilitation of Craniofacial Anomalies, Bauru, São Paulo, Brazil. METHODS: The study was composed of a sample of 120 patients: 60 adults in the cleft lip and palate group (CLPG) and 60 adults in the control group with no craniofacial anomalies. Each patient underwent an interview and clinical examination, using the Nordic Orofacial Test-Screening (NOT-S) and the 36-Item Short Form Survey. Data were analyzed using Mann-Whitney U test, χ2, and the Spearman correlation coefficients. RESULTS: There was a higher prevalence of OD in CLPG (P < .001) on the NOT-S. The adults in the CLPG had higher QoL in the areas of general health (P = .003), physical function (P = .014), social function (P < .001), and vitality (P = .006). The CLPG had significant associations between higher OD and lower QoL for general health (P = .004), emotional role function (P = .028), and vitality (P = .05). CONCLUSION: Orofacial dysfunctions were more prevalent in adults with a cleft, negatively impacting their QoL in general health, emotional role function, and vitality. However, adults with a cleft also had significantly higher QoL, reflecting possible resiliency when compared to adults without a cleft.

Measurement properties of gingival biotype evaluation methods.

BACKGROUND: There are numerous methods to measure the dimensions of the gingival tissue, but few have compared the effectiveness of one method over another. OBJECTIVE: This study aimed to describe a new method and to estimate the validity of gingival biotype assessment with the aid of computed tomography scanning (CTS). MATERIALS AND METHODS: In each patient different methods of evaluation of the gingival thickness were used: transparency of periodontal probe, transgingival, photography, and a new method of CTS). Intrarater and interrater reliability considering the categorical classification of the gingival biotype were estimated with Cohen's kappa coefficient, intraclass correlation coefficient (ICC), and ANOVA (P < .05). The criterion validity of the CTS was determined using the transgingival method as the reference standard. Sensitivity and specificity values were computed along with theirs 95% CI. RESULTS: Twelve patients were subjected to assessment of their gingival thickness. The highest agreement was found between transgingival and CTS (86.1%). The comparison between the categorical classifications of CTS and the transgingival method (reference standard) showed high specificity (94.92%) and low sensitivity (53.85%) for definition of a thin biotype. CONCLUSION: The new method of CTS assessment to classify gingival tissue thickness can be considered reliable and clinically useful to diagnose thick biotype.

Orthognathic Surgery or Overlay Prosthesis: Quality of Life in Bilateral Cleft Lip and Palate Patients.

BACKGROUND: The concern to restore and evaluate bilateral cleft lip and palate (BCLP) patients' quality of life, after rehabilitation, is an issue that has been discussed in the literature because it is the ultimate goal of any proposed treatment. OBJECTIVE: To evaluate the overall and oral quality of life of BCLP patients who had completed their treatment with orthognathic surgery (OrSg) compared to those who completed theirs with prosthetic rehabilitation in the form of overlay prosthesis (OP). MATERIALS AND METHODS: The study comprised 40 patients, 20 in OrSg group and 20 in OP group. Epidemiological survey and application of two questionnaires (World Health Organization Quality of Life-brief [WHOQOL-bref] and Oral Health Impact Profile-14 [OHIP-14]) were done. The final results were evaluated statistically by the Mann-Whitney test. RESULTS: Regarding the comparison with the WHOQOL-bref, no significant statistical differences between groups were found. In the analysis of the OHIP-14, only in "psychological limitation" field difference could be observed, where OrSg group showed more negative impact when compared to the OP group. CONCLUSION: Both rehabilitations provide a satisfactory quality of life for patients.

Movement of mandibular molar into edentulous alveolar ridge: A cone-beam computed tomography study.

INTRODUCTION: The purpose of this study was to evaluate the thickness and height of buccal and lingual alveolar bone of mandibular teeth moved to edentulous areas with a remodeled alveolar ridge. METHODS: The sample included 18 adult patients with unilateral or bilateral absence of mandibular permanent first molars with a mean age of 36.1 years before treatment. The mandibular hemiarches were divided into 3 groups: reopening group (15 hemiarches), closure group (12 hemiarches), and control group (9 hemiarches with no missing teeth). Cone-beam computed tomography scans with a 0.2-mm voxel size were performed 4 months after space closure or reopening. Cross sections 0.2 mm thick passing through the center of the mandibular permanent second molar and second premolar roots were used for measurements of the buccal and lingual bone plate thickness and level. Intergroup comparisons were performed with 1-way analysis of variance followed by Tukey tests (P <0.05). RESULTS: No intergroup differences were found for the alveolar bone statuses of the mandibular second premolar. For the mandibular second molar, the closing group showed significantly smaller buccal and lingual crest levels compared with the control group. CONCLUSIONS: Space closure of missing mandibular first molars caused slight buccal and lingual dehiscences at the mandibular second molar areas.

Assessment of Periodontal and Hygiene Conditions of Removable Partial Dentures in Individuals With Clefts.

OBJECTIVE: To assess hygiene conditions in removable partial dentures (RPDs) and to compare the periodontal status between abutment and nonabutment teeth in clefts patients. DESIGN: Cross-sectional. SETTINGS: Tertiary referral hospital. PARTICIPANTS: Forty-five patients of both genders, aged 20 to 75 years, who were upper RPD wearers for at least 2 years, with cleft lip, alveolus, and/or palate who attended follow-up appointments between 2010 and 2012. INTERVENTIONS: The clinical periodontal parameters assessed on abutment teeth (experimental group) and nonabutment teeth (control group) were probing depth, clinical attachment level (CAL), plaque index, and gingival index (GI). The RPDs were evaluated under the following parameters: hygiene conditions and type of clasp on abutment. Both groups were analyzed using Mann-Whitney, Kruskal-Wallis, and Dunn's statistical test. Statistical significance was set at P < .05. RESULTS: One hundred sixty-six abutment teeth and 168 nonabutment teeth were evaluated in 45 patients. A statistically significant difference was found between the groups for the CAL parameter (P = .03). With regard to the prostheses' hygiene conditions through the Tarbet index parameter, of the 186 quadrants evaluated, 143 scored 2 and 3. Ackers' clasps were the most frequent clasps (n = 111). A statistically significant difference was found for the GI parameter (P = .03). CONCLUSIONS: It was possible to conclude, in this cross-sectional study, that in general terms, the use of RPDs did not interfere in the periodontal conditions of abutment teeth; however, most prostheses presented poor hygiene and high quantity of dental plaque.

Success rate in implant-supported overdenture and implant-supported fixed denture in cleft lip and palate patients.

BACKGROUND: The prosthetic treatment in cleft patients is challenging. Based on this, the aim of this study was to evaluate the longevity of prosthetic rehabilitation treatment with implant-supported overdenture (IOD) and implant-supported fixed denture (IFD) in cleft lip and palate patients in a period of 22 years. MATERIALS AND METHODS: The medical records of 72 patients were analyzed (29 males and 43 females), and the survival rate of the implants was evaluated. Moreover, the prostheses' time of use and the reason for the changing of these were also evaluated. RESULTS: Four-hundred-seventeen implants were installed, and 370 implants survive today. The mean survival time of the implants was 7.6 years. Regarding the 97 prostheses made, the time of average use was 3.28 for the IFDs and 3.92 for IODs. The reasons for the replacements of the prostheses were mainly: fracture of the acrylic base (29.6%) and loss of vertical dimension of occlusion (VDO) (18.5%) in the IFDs. Moreover, in IODs, these were accounted for the loss of VDO due to teeth damage (17.2%) and implant loss (14.6%). CONCLUSIONS: The maintenance of the prostheses was challenging because the patients had difficulties returning for periodic control, but this fact did not result in the decrease of the success rate of the implants. The longevity of implants and prostheses was satisfactory; however, the prostheses showed repetitions mainly due to the wear of the teeth, with decreased vertical dimension and fracture of acrylic base.

Aesthetic analysis of an implant-supported denture at the cleft area.

Objective : To evaluate the aesthetics of an implant-supported denture at the cleft area, comparing the peri-implant tissues and prosthetic crown with the contralateral tooth. Settings : Hospital for Rehabilitation of Craniofacial Anomalies, Bauru, São Paolo, Brazil. Patients : A total of 39 individuals of both genders, with complete unilateral cleft lip and palate, who received secondary alveolar bone graft and were rehabilitated with single implant-supported dentures at the area of the missing maxillary lateral incisor after completion of orthodontic treatment. Interventions : The following parameters were analyzed in follow-up sessions: length and width of prosthetic crown and contralateral tooth, characteristics of implants, filling of interproximal space by the papilla, and smile height of the patients. Results : The implant-supported prosthetic crowns were longer than the contralateral tooth (p < .001). Among the 78 papillae analyzed, 29 (37.17%) received a score of 3; 32 (41.02%) papillae had a score of 2; and 17 (21.79%) received a score of 1. Concerning the smile height, among the 39 patients analyzed, 23 (56.41%) had a medium smile, 15 (38.46%) had a high smile, and two (5.12%) presented a low smile. Conclusion : The use of dental implants to rehabilitate the edentulous cleft area is an excellent option. However, adequate evaluation of the bone quantity and quality, positioning and shape of adjacent teeth, smile height, and patient expectations should be considered to achieve success and avoid aesthetic deformities such as elongated teeth and absence of gingival papillae.

Thermo and mechanical cycling and veneering method do not influence Y-TZP core/veneer interface bond strength.

OBJECTIVES: The purpose of this study was to evaluate the influence of thermal and mechanical cycling and veneering technique on the shear bond strength of Y-TZP (yttrium oxide partially stabilized tetragonal zirconia polycrystal) core-veneer interfaces. MATERIALS AND METHODS: Cylindrical Y-TZP specimens were veneered either by layering (n=20) or by pressing technique (n=20). A metal ceramic group (CoCr) was used as control (n=20). Ten specimens for each group were thermal and mechanical cycled and then all samples were subjected to shear bond strength in a universal testing machine with a 0.5mm/min crosshead speed. Mean shear bond strength (MPa) was analysed with a 2-way analysis of variance and Tukey's test (p<0.05). Failure mode was determined using stereomicroscopy and scanning electron microscopy (SEM). RESULTS: Thermal and mechanical cycling had no influence on the shear bond strength for all groups. The CoCr group presented the highest bond strength value (p<0.05) (34.72 ± 7.05 MPa). There was no significant difference between Y-TZP veneered by layering (22.46 ± 2.08 MPa) or pressing (23.58 ± 2.1 MPa) technique. Failure modes were predominantly adhesive for CoCr group, and cohesive within veneer for Y-TZP groups. CONCLUSIONS: Thermal and mechanical cycling, as well as the veneering technique does not affect Y-TZP core-veneer bond strength. CLINICAL SIGNIFICANCE: Different methods of veneering Y-TZP restorations would not influence the clinical performance of the core/veneer interfaces.

Evaluation of the effectiveness of diode laser on pain and edema in individuals with cleft lip and palate submitted to secondary bone graft.

OBJECTIVE : To clinically evaluate the effects of diode laser, Gallium-Aluminum-Arsenide laser (GaAlAs), on the pain and edema after secondary alveolar bone graft. DESIGN : Case-control, double-blind study. Setting : Institutional tertiary referral hospital. Participants : The sample was composed of 60 individuals with complete unilateral cleft lip and palate, of both genders, aged 9 to 15 years, submitted to secondary alveolar bone graft. MAIN OUTCOME MEASURES : The individuals were divided into an experimental group (patients irradiated with diode laser GaAlAs, energy density of 4 J/cm(2), power of 100 mW, and wavelength in the infrared spectrum, for 10 seconds per point on 10 points, adding up to a dose of 40 J/cm(2)) and a placebo group (simulated laser application for 60 seconds per point, also on 10 points). Applications were made on the receptor site immediately postoperatively and after 24 and 48 hours. The pain and edema were assessed preoperatively and at each application. RESULTS : The two groups presented increase in pain and edema in 24 and 48 hours. No statistically significant difference was found between groups. CONCLUSIONS : According to the present methodology, the use of low-level laser to control the pain and edema in the postoperative period of secondary alveolar bone graft was not effective.

Esthetic composition of smile in individuals with cleft lip, alveolus, and palate: visibility of the periodontium and the esthetics of smile.

Objective. To evaluate characteristics of smile related to visibility in individuals with cleft lip, alveolus, and palate. Design. Cross-sectional. Setting. HRAC/USP, Brazil. Patients. Individuals with repaired complete unilateral cleft lip and palate (n = 45), aged 15-30 years. Interventions. Frontal facial photographs were obtained in natural and forced smiles (n = 135). Six specialists in periodontics evaluated the photographs as to the smile line, thickness, and curve of the upper lip. Main Outcome Measures. The cleft area was compared with the contralateral region. Results were expressed as percentages and means. The findings were compared between groups of periodontists. Results. Statistically significant relationship was observed in the smile line between examiners and between natural and forced smiles, regardless of the association with the cleft side. The lip was thicker at rest and thinner in the forced smile, as also evaluated by the group not experienced with cleft care. The curve of the upper lip in natural and forced smiles was considered as close to straight by both groups, regardless of the cleft. Conclusion. The smile in individuals with clefts was regarded as average for both cleft and noncleft sides. The thickness was characterized as average to thin, being thinner in forced smile and when analyzed by the group not experienced with cleft care. In the average, the curve of the upper lip was considered as straight. The present study elucidates some characteristics related to the smile in individuals with repaired unilateral cleft lip, alveolus, and palate.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP)--Part 1: overall aspects.

Cleft lip and palate is the most common among craniofacial malformations and causes several esthetic and functional implications that require rehabilitation. This paper aims to generally describe the several aspects related to this complex pathology and the treatment protocol used by the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC-USP) along 40 years of experience in the treatment of individuals with cleft lip and palate.

Gingival recession in individuals with cleft lip and palate: prevalence and severity.

OBJECTIVE: To analyze the prevalence and severity of gingival recession in individuals with cleft lip and alveolus with or without cleft palate. DESIGN: Cross-sectional. SETTING: Tertiary referral hospital. PARTICIPANTS: A total of 400 individuals with cleft lip and alveolus with or without cleft palate, aged 15 to 49 years, without any previous periodontal treatment. MAIN OUTCOME MEASURES: Gingival recession was evaluated by measuring the distance from the cementoenamel junction to the most coronal point on the gingival margin, analyzing the prevalence and scoring its severity as mild (<3 mm), moderate (3 to 4 mm), or severe (4 mm). The prevalence and severity of gingival recession was compared between sextant 2 (cleft sextant) and the mean of the other sextants (1, 3, 4, 5, and 6: noncleft sextants). The relationship between gingival recession in the cleft area and gender was evaluated and data were analyzed statistically. The correlation between gingival recession and age was assessed also. RESULTS: There was no statistically significant gender difference in gingival recession. The prevalence and severity of gingival recession increased with age, and most of the affected teeth were premolars and molars. The cleft area did not present a higher prevalence and severity of gingival recession. CONCLUSIONS: Individuals with cleft lip and alveolus with or without cleft palate presented the same prevalence and severity of gingival recession compared with other populations. The area adjacent to the cleft (sextant 2) did not show greater risk of gingival recession than other areas (sextants 1, 3, 4, 5, and 6).

The role of keratinized mucosa in peri-implant health.

OBJECTIVE: To evaluate the role of keratinized mucosa around dental implants, correlating with other clinical parameters related to the success of dental implants. DESIGN: Cross-section. SETTING: Institutional tertiary referral hospital. PATIENTS: A total of 202 dental implants fixed in the cleft area of 109 patients with cleft lip and/or palate were evaluated. Interventions: The evaluated clinical parameters were probing depth and gingival and plaque indexes on the buccal surface (three sites). MAIN OUTCOME MEASURES: All clinical parameters were correlated with the width of keratinized mucosa around the implants. RESULTS: The largest probing depths were detected when the width of keratinized mucosa was 2 mm or more, with a statistically significant difference between the means of the probing depth and keratinized mucosa width. CONCLUSION: Even though the present results suggest that peri-implant health can be observed in areas with keratinized mucosa width under 2 mm provided an adequate oral hygiene control is performed, longitudinal randomized studies are necessary to analyze the relationship between the width of keratinized mucosa and the health of peri-implant tissues.

Survival of dental implants in the cleft area--a retrospective study.

OBJECTIVE: To evaluate the survival rate of dental implants placed in the cleft area. DESIGN: Retrospective study. SETTING: Hospital for Rehabilitation of Craniofacial Anomalies, Brazil. Institutional Tertiary Healthcare Center. PATIENTS: 120 patients who received dental implants in the grafted cleft area in the years 1999 to 2005. INTERVENTIONS: Clinical data were evaluated from the records of 120 patients according to the following criteria: placement grafted, cleft area, and age at surgery; age at placement of dental implants; site and dimension of implants; interval between placement of implants and the last clinical follow-up; and interval between placement and removal or indication for removal of implants. MAIN OUTCOME MEASURES: Percentage of survival rate of implants. RESULTS: Mean age at placement of the bone graft was 17.6 years and 21 years at placement of implants. A total of 123 cleft areas received secondary bone graft and bone graft to install implants (regraft). The mean survival rate was 34 months since placement of the implant to the last clinical follow-up and 26 months since placement of the prosthesis. Seven dental implants were removed. The survival rate since placement to the last clinical follow-up was 94.3%. CONCLUSION: Rehabilitation of the cleft area with dental implants is a viable and secure alternative, with good prognosis.