UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos
CASE REPORT DOI: https://doi.org/10.4322/bds.2023.e3801
1
Braz Dent Sci 2023 Apr/Jun;26 (2): e3801
Multidisciplinary action in a patient with cleft lip and palate:
esthetic-functional dentofacial treatment for more than two decades
Atuação multidisciplinar em paciente com fissura lábio palatina: tratamento estético-funcional dento-facial de mais de duas décadas
Laura Viviana Calvache ARCILA
1
, Laís Carolina Landim GOMES
1
, Alessandro TRAVASSOS
2
,
Virgilio Vilas Boas FERNANDES
2
, Rodrigo Dias NASCIMENTO
3
, Weber URSI
4
, João Mauricio FERRAZ
5
1 - Universidade Estadual Paulista - UNESP, Instituto de Ciência e Tecnologia, Departamento de Materiais Dentais e Prótese. São José dos
Campos, SP, Brazil.
2 - Universidade Estadual Paulista - UNESP, Instituto de Ciência e Tecnologia, Odontologia Restauradora . São José dos Campos, SP, Brazil.
3 - Universidade Estadual Paulista - UNESP, Instituto de Ciência e Tecnologia, Departamento de Diagnóstico e Cirurgia. São José dos
Campos, SP, Brazil.
4 - Universidade Estadual Paulista - UNESP, Instituto de Ciência e Tecnologia, Departamento de Odontologia Social e Clínica Infantil . São
José dos Campos, SP, Brazil.
5 - Universidade Estadual Paulista - UNESP, Instituto de Ciência e Tecnologia, Departamento de Materiais Dentais e Prótese. São José dos
Campos, SP, Brazil.
How to cite: Arcila LVC, Gomes LCL, Travassos A, Fernandes VVB, Nascimento RD, Ursi W, et al. Multidisciplinary action in a patient
with cleft lip and palate: esthetic-functional dentofacial treatment for more than two decades. Braz Dent Sci. 2023;26(2):e3801. https://
doi.org/10.4322/bds.2023.e3801
ABSTRACT
Cleft lip and palate is a very common congenital defect in which embryonic facial processes do not achieve the
ideal facial formation during their development which can cause malformation. Multiple dentistry specializations,
especially oral and maxillofacial, orthodontics, oral rehabilitation and dental aesthetics are required in order to
correct lip and oral cavity malformations by this congenital defect with the objective of functional and aesthetics
improvement. The clinical case reported show the multidisciplinary approach in a patient with cleft lip and
palate implementing an aesthetic and functional dentofacial rehabilitation. The case involves a 27-year-old
female patient LCLG, Caucasian, with the presence of unilateral congenital cleft lip and palate on the left side,
who started rehabilitative and reparative treatment at 3 months of age. She then started pediatric orthodontic
treatment for angle class 3 crossbite correction at 7 years of age. After complete replacement of deciduous
to permanent dentition at the age of 11, the patient started orthodontic treatment with a xed appliance for
several years and restorative treatment with composite resin reanatomize the anterior teeth due to agenesis
of elements 22 and 25. After a few years when the resin restorations were no longer biologically favorable, an
aesthetic rehabilitation treatment with ceramic laminates was planned through smile digital planning soon
after completing the orthodontic treatment. This case report demonstrates that high aesthetic, functional and
psychological expectations of a patient with congenital defect compromise throughout her life were met through
a multidisciplinary dental treatment based on correct diagnosis and digital planning.
KEYWORDS
Congenital abnormalities; Malocclusion; Dental Technology; Rehabilitation; Diagnosis.
RESUMO
A ssura labiopalatal é um defeito congênito muito comum, no qual os processos faciais embrionários não atingem
a formação facial ideal durante o seu desenvolvimento, podendo causar malformações. Múltiplas especializações da
odontologia, principalmente buco-maxilo-facial, ortodontia, reabilitação oral e estética dental são necessárias para
corrigir as malformações labiais e da cavidade oral por esse defeito congênito com o objetivo de melhoria funcional
e estética. O caso clínico relatado mostra a abordagem multidisciplinar em um paciente com ssura labiopalatal
2
Braz Dent Sci 2023 Apr/Jun;26 (2): e3801
Arcila LVC et al.
Multidisciplinary action in a patient with cleft lip and palate: esthetic-functional dentofacial treatment for more than two decades
Arcila LVC et al.
Multidisciplinary action in a patient with cleft lip and palate:
esthetic-functional dentofacial treatment for more than two
decades
INTRODUCTION
Cleft lip and palate is a very common
congenital defect that occurs between the 4
th
and 12
th
week of pregnancy, in which embryonic
facial processes do not achieve the ideal facial
formation during their development, and can
cause malformation of 3 phenotypes: cleft lip,
cleft palate, and cleft lip and palate. Its etiology
has been shown to be a multifactorial inheritance
pattern involving genes and environment [1,2].
Depending on the development stage
in which the etiological factors act, cleft lip
and palate can cause esthetic, functional,
psychological and social disorders of variable
severity depending on the extent and type of
congenic defect. It can affect the lip and oral
cavity, even causing oronasal communication,
as well as psychological state in the newborn’s
family who are also concerned with the child’s
future social integration.
The occurrence of cleft lip and palate in
Brazil is estimated at one for every 650 births,
with estimates being obtained from the rst study
by Nagem et al. [3] in 1968 [3,4].
Patients with cleft lip and palate from the
rst years of their lives undergo plastic surgery
to correct malformations of the lips and oral
cavity caused by this congenital defect in order
to restore orofacial function and esthetics.
The treatment of these patients requires an
approach from multiple dentistry specializations,
mainly oral and maxillofacial, orthodontics, oral
rehabilitation and dental esthetics.
The malformation type that the patient
presents is analyzed in the surgical stage for
whether it involves deficiencies in hard and
soft tissues, anterior bone defects and/or dental
agenesis. Depending on the demand of the case,
it may be necessary to perform plastic and oral
and maxillofacial surgeries, more or less complex,
depending on the magnitude of the sagittal
discrepancy [5-8].
Despite the low lethality and serious health
complications in patients with cleft lip and
palate due to multidisciplinary rehabilitation
treatment, the vast majority of patients end up
developing dental issues, such as tooth agenesis,
lack of bone support at the cleft site, and poor
dental positioning; furthermore, according to
the literature, the most frequently absent tooth
in individuals with transformed cleft is the
maxillary lateral incisor (ILS), followed by the
2
nd
mandibular premolar and maxillary central
incisor (ICS). The absence of the ILS on the cleft
side can reach 48.3% of the cases. The presence
of a supernumerary tooth in the region is also
very common, which, despite basic dental
intervention, may not obtain a favorable esthetic
result at the treatment end.
Orthodontic intervention is performed at
different multidisciplinary treatment stages; a
pre-surgical orthodontic approach is required
in the early stages [9-11], and then the post-
surgical orthodontic treatment is continued.
At this point, it can be determined whether
the patient’s malocclusion can be treated with
conventional orthodontic treatment, or whether
another orthognathic procedure such as maxillary
advancement will be necessary [1].
The last stage of multidisciplinary treatment
is generally the oral and aesthetic dental
rehabilitation stage, which (depending on the
severity of the defects) may require indirect
implementando uma reabilitação dentofacial estética e funcional. O caso envolve uma paciente do sexo feminino,
27 anos, LCLG, branca, com presença de ssura labiopalatal congênita unilateral à esquerda, que iniciou tratamento
reabilitador e reparador aos 3 meses de idade. Após a substituição completa da dentição decídua pela permanente
aos 11 anos de idade, a paciente iniciou tratamento ortodôntico com aparelho xo por vários anos, e tratamento
restaurador com resina composta para reanatomizar os dentes anteriores devido à agenesia dos elementos 22 e 25.
Após alguns anos em que as restaurações em resina não eram mais favoráveis biologicamente, foi planejado um
tratamento reabilitador estético com laminados cerâmicos através do planejamento digital do sorriso logo após a
nalização do tratamento ortodôntico. Este relato de caso demonstra que as altas expectativas estéticas, funcionais
e psicológicas de uma paciente com comprometimento de defeito congênito ao longo de sua vida foram atendidas
por meio de um tratamento odontológico multidisciplinar baseado em diagnóstico correto e planejamento digital.
PALAVRAS-CHAVE
Anormalidades congênitas; Má oclusão; Tecnologia odontológica; Reabilitação; Diagnóstico.
3
Braz Dent Sci 2023 Apr/Jun;26 (2): e3801
Arcila LVC et al.
Multidisciplinary action in a patient with cleft lip and palate: esthetic-functional dentofacial treatment for more than two decades
Arcila LVC et al.
Multidisciplinary action in a patient with cleft lip and palate:
esthetic-functional dentofacial treatment for more than two
decades
restorations, implant supported prostheses, and/
or aesthetic restorations to achieve functional
occlusion which may not be achieved in the
previous procedures [1,12-14]. In addition,
aesthetic harmony in the smile is also sought [15]
to fulll the high expectations that the patient has
been anxiously awaiting for a long time.
As cleft lip and/or palate is a condition which
directly affects the language and hearing ability
of the patient [2], in addition to the psychological
implications of physical appearance, it can make
social interaction difficult from the earliest
stages of life. Therefore, with multidisciplinary
treatments, the aim is to improve the patient’s
quality of life and fulfill the expectations of
both the patient and their family. Thus, the
objective of this clinical case report is to show
the multidisciplinary approach of a patient with
cleft lip and palate in an aesthetic and functional
dentofacial rehabilitation.
CASE REPORT
Diagnosis and treatment plan
LCLG, female patient, Caucasian, 27 years
old, with presence of unilateral congenital cleft lip
and palate on the left side, diagnosed immediately
after birth. The patient started her rehabilitative
and reparative treatment at 3 months of age
(05/1994) at the Hospital for Rehabilitation of
Craniofacial Anomalies of the University of São
Paulo - HRAC - Bauru, São Paulo, a reference
teaching hospital throughout Latin America and
internationally for the treatment.
Next, the patient underwent reconstructive
and corrective surgery of the lip at the age of
7 months, and she also underwent surgery at
1 year and 8 months to reconstruct the hard
palate and soft palate concomitantly. Her last
reconstructive surgery was performed in a hospital
setting.
Orthodontic treatment
The patient underwent multidisciplinary
follow-ups carried out periodically by the
hospital in the areas of dentistry, medicine and
speech therapy until she was 7 years old. Then,
she started pediatric orthodontic treatment for
crossbite correction (Angle class 3) at 7 years of
age. She used the Hyrax expander together with
the face mask (extra oral expander) to expand the
palatal raphe and better reposition her permanent
teeth. She performed this treatment for a period of
approximately 1 year. After complete replacement
of deciduous for permanent dentition at 11 years
of age, the patient started orthodontic treatment
with a xed appliance to correct her end-to-end
bite, and better dental positioning due to agenesis
of teeth 22 and 25. The orthodontic treatment
was performed for approximately 6 years.
Despite the long period of orthodontics and the
impossibility of performing orthognathic surgery
for health reasons, there was a limitation in the
result obtained in the rst orthodontic treatment
(Figure 1).
Esthetic treatment
The patient then resumed corrective
orthodontic treatment after 6 years in 2017,
this time with the aid of mini-implants with
bimandibular anchor plates for traction and
Angle class 3 correction. Surgical treatments
were performed to place and remove the
miniplates, and after 3 years of using a self-
ligating xed appliance, it was possible to achieve
an adequate overbite and better position of the
dental arches, almost presenting Angle class
1 (within the limitations present). Despite the
excellent orthodontic tooth positioning due to
the agenesis of elements 22 and 25, the patient
had reanatomization using composite resin,
which was no longer biologically favorable for
better t of the midline, spee curve and dental
characterization. In the Figure 2 can see the
panoramic radiographic after the this stage to
start the new restorative treatment (Figure 2).
It is important to highlight that the performance
of the chosen rehabilitation procedure was based
on the patient’s oral condition at the time, with
orthodontic and surgical limitations. Although
the patient had undergone repair treatment for
the cleft lip and palate at the HRAC, she did not
undergo repair with a bone graft in the region due
to systemic complications, thus the region of the
cleft remained without alveolar bone, which meant
that the orthodontic treatment had limitations,
therefore the established occlusion was the most
stable possible. Furthermore, the genesis of
elements resulted in slight neglect of the midline,
so the aesthetic rehabilitation treatment started in
archived of the best viable result within the case’s
orthodontic, surgical, and restorative limitations.
4
Braz Dent Sci 2023 Apr/Jun;26 (2): e3801
Arcila LVC et al.
Multidisciplinary action in a patient with cleft lip and palate: esthetic-functional dentofacial treatment for more than two decades
Arcila LVC et al.
Multidisciplinary action in a patient with cleft lip and palate:
esthetic-functional dentofacial treatment for more than two
decades
Digital planning of the restorative treatment
was performed by DSD (Digital Smile Design)
of 5 ceramic laminates from element 12 to
24 (considering the agenesis of teeth 22 and 25)
(Figure 3) using a slideshow software program
(Keynote, MacBook Air) with reference to the
patient’s facial and dental parameters, such as:
Tooth-labial analysis, buccal corridor, incisal
plane, smile line, dental and facial midline,
Zenith and gingival level, interincisal angles,
tooth shape and beauty proportions and facial
harmony (Figure 3a, 3b, 3c).
The DSD was sent to the prosthesis laboratory
for diagnostic wax-up, and soon after the wall
was made with condensation silicone (Optosil-
Xantopren, Kulzer). Next, the mock-up test was
carried out with Bisacrylic resin (Structur, VOCO)
(Figure 4). After the mock-up was approved by
the patient and the dentist, gingivoplasty was
performed using the Flapless technique (Figure 5)
with a piezoelectric ultrasound (DENTSURG PRO,
CVDentus) on teeth 23 and 24 (as planned in the
DSD) to achieve the smile parameters mentioned
above. First, the teeth were marked with a
periodontal probe (Figure 5a), then the incision
was made with a scalpel blade no.15C around
the gingival margin (Figure 5b). The gingival
collar was subsequently removed (Figure 5c),
and the osteotomy was performed with a TR1-PK
diamond ultrasound tip (CVDentus) (Figure 5d).
After 15 days of tissue healing (Figure 5e),
tooth preparation of the 5 elements was
Figure 1 - Intraoral images after the first orthodontic treatment and before the second orthodontic treatment: (a) frontal occlusion, end-to-end
bite; (b) right lateral occlusion; (c) left lateral occlusion.
Figure 2 - Panoramic radiographic after the latest orthodontic
stage and before the new restorative treatment.
5
Braz Dent Sci 2023 Apr/Jun;26 (2): e3801
Arcila LVC et al.
Multidisciplinary action in a patient with cleft lip and palate: esthetic-functional dentofacial treatment for more than two decades
Arcila LVC et al.
Multidisciplinary action in a patient with cleft lip and palate:
esthetic-functional dentofacial treatment for more than two
decades
performed guided by the Mock-up (Figure 6a).
The preparations were conducted with diamond
ring bits of two different diameters in their active
part (FG 4141 (1.6mm); 4142 (2.1mm), KG
Sorensen) to prepare the elements with guide
grooves, then the grooves were joined by the drill
conical diamond blade with a rounded end (FG
4138 KG Sorensen), with all drills being ne (F)
and ultrane (FF) grained. Finally, the nishing
and polishing of the preparations was carried
out with FF drills and softlex discs, removing
the acute angles and dening the preparation
term (Figure 6b), concluding this step with
provisionals in bisacrylic resin.
The impression was made in the following
session by adding silicone (ExpressTM XT-3M),
and the B1 shade was selected based on the
Ivoclar A-D Vivadent shade guide to manufacture
injected lithium disilicate ceramic laminates
(IPS e.max PRESS, Ivoclar), performing the cut
Figure 3 - DSD: (a) determination of facial parameters, midline, interpolpilary line, and horizontal plane; (b) determination of dental parameters,
interdental proportions, central incisor proportion; (c) smile curvature, gingival curvature, measurement in millimeters of the incisal and gingival
edges; and (d) final result of digital planning (digital mock-up).
6
Braz Dent Sci 2023 Apr/Jun;26 (2): e3801
Arcila LVC et al.
Multidisciplinary action in a patient with cleft lip and palate: esthetic-functional dentofacial treatment for more than two decades
Arcila LVC et al.
Multidisciplinary action in a patient with cleft lip and palate:
esthetic-functional dentofacial treatment for more than two
decades
back technique in the incisal third. Thus, the
cementing process of the ceramic laminates was
continued (Figure 7), the dry proof (Figure 7a)
and the wet proof were made with a try-in
(Allcem Veneer OW, FGM) to dene the resin
cement color (Figure 7b), and then modified
absolute insulation was made with a rubber
sheet (Nictone) and clamps number 13A and 14A
(Hu-friedy) (Figure 7c).
Next, the laminate conditioning was started
with 10% hydrouoric acid (Condac Procelana-
FGM) for 20 seconds on the cementing surface,
and then they were washed with water for
20 seconds and dried with an air jet; then, silane
(Prosil, FGM) was applied with a microbrush
actively for 1 minute. The dental substrate was
simultaneously conditioned with 37% phosphoric
acid (Ultra Etch, Ultradent) for 20 seconds in
enamel. The acid was then removed with a surgical
suction device, washed for twice the etching time,
and dried with a light jet of air. An adhesive layer
(Ambar APS-FGM) was subsequently applied,
light-cured for 20 seconds with a light-curing
Figure 4 - Restorative test (mock-up).
Figure 5 - Flapless gingivoplasty: (a) marking the gingival collar; (b) recontouring the gingival collar; (c) removing the gingival collar;
(d) osteotomy with piezoelectric ultrasound tip; (e) healed tissue after 15 days.
7
Braz Dent Sci 2023 Apr/Jun;26 (2): e3801
Arcila LVC et al.
Multidisciplinary action in a patient with cleft lip and palate: esthetic-functional dentofacial treatment for more than two decades
Arcila LVC et al.
Multidisciplinary action in a patient with cleft lip and palate:
esthetic-functional dentofacial treatment for more than two
decades
device (BluePhase N, Ivoclar Vivadent), and then
the laminates were cemented with light-curing
resin cement (Allcem Veneer APS-FGM). After
removing the cement overow with a brush and
positioning all the pieces, they were light-cured for
20 seconds on each surface, and sprayed with an
air jet at the time of changing the surface due to the
high intensity of the light-curing unit (Figure 7d).
The insulation was removed to remove excess
cement with a periodontal curette and saw
Figure 6 - Dental preparations: (a) mock-up guide in position for preparation of elements 11 and 12; (b) finished preparations.
Figure 7 - Cementing process of ceramic laminates: (a) dry proof; (b) wet proof with Try-in; (c) modified absolute isolation and conditioning of
the dental substrate; (d) cementing of laminates; (e) final result.
8
Braz Dent Sci 2023 Apr/Jun;26 (2): e3801
Arcila LVC et al.
Multidisciplinary action in a patient with cleft lip and palate: esthetic-functional dentofacial treatment for more than two decades
Arcila LVC et al.
Multidisciplinary action in a patient with cleft lip and palate:
esthetic-functional dentofacial treatment for more than two
decades
(Microcut, TDV). Finally, occlusion of excursive
movements was confirmed and polishing was
performed with rubber tips for ceramics (American
Burs) (Figure 7e).
The patient showed complete satisfaction
with the nal result of the restorative treatment,
fullling the esthetic expectations she had waited
for two decades (Figure 8).
DISCUSSION
In the present case report, the patient
concluded the complete treatment at the
HRAC - USP hospital (Craniofacial anomalies
rehabilitation hospital - University of São Paulo);
however, even after the orthodontic treatment,
the dental esthetics were unfavorable due the
dental agenesis of maxillary lateral incisor (ILS),
and the 2
nd
maxillary premolar. Furthermore, the
resin composite facets presented in maxillary
anterior region were stained, along with marginal
leakage and marginal discoloration leading to the
need to change restorations.
The ceramic laminates were considered
for the rehabilitation treatment due to its color
stability, optical and mechanical properties which
enable naturally establishing the esthetics and
dental function. The esthetic treatment with
ceramic laminates also presents biocompatibility,
enabling dental restoration with biomechanical
Figure 8 - Completed treatment: (a) patient before restorative treatment; (b) patient after restorative treatment with ceramic laminates;
(c) final treatment result.
9
Braz Dent Sci 2023 Apr/Jun;26 (2): e3801
Arcila LVC et al.
Multidisciplinary action in a patient with cleft lip and palate: esthetic-functional dentofacial treatment for more than two decades
Arcila LVC et al.
Multidisciplinary action in a patient with cleft lip and palate:
esthetic-functional dentofacial treatment for more than two
decades
characteristics similar to natural teeth [16,17],
in addition to providing better periodontal health
with a prole of adequate emergence and being
a long-term durability treatment when compared
to composite resin restorations [18].
A correct and adequate diagnosis and
planning should be precisely carried out in order
to start a treatment rehabilitation. Nowadays,
technology offers many tools which improve
these essential steps before beginning the
restorative treatment. The diagnostic and
planning restoration in this clinical case was
performed using DSD (Digital Smile Design),
which is a tool which offer facilities such as:
expanded diagnostic vision that could be
overlooked during the evaluation procedures;
improved communication with the patient,
dental technician, and colleagues; and increased
predictability throughout treatment [19].
DSD (Digital Smile Design) was a very important
tool to obtain the rehabilitation result in this case,
because with its use it was possible to correctly
diagnose and plan the treatment individually, taking
into account the esthetic and functional aspects of
the rehabilitation treatment, therefore leading to
greater predictability and condence in the planning
combined with digital dentistry, in addition to being
able to simulate the nal result, which becomes
something more concrete, precise and predictable
for the patient and the dentist.
Interdisciplinary planning, esthetics, and the
design of the new smile are analyzed during the
DSD using extra oral and intra oral photography
of the patient in a specic software or presentation
software program (Keynote). First, facial analyzes
are performed to determine the horizontal plane
by the interpupillary line and the facial midline.
Both are marked with the patient’s features
(glabella, nose, and chin) and are very important
to be transferred to the intraoral image and
analyze the smile line, occlusal plane, the pink
and esthetic evaluation, and measure the tooth
proportion and color [19] (Figure 3a, 3b).
Teeth shape is normally harmonized with
the entire face according to gender, personality,
and age parameters; nevertheless, another
concept exists to help dentists precisely achieve a
successful smile shape during the DSD and meet
the patient’s high expectations. This concept is
called “Visagism” in dentistry, which not only
involves the esthetic aspect but also psychosocial
factors, emotions, behavior, self-esteem, and
personality of the patient. Thus, personality
(sensitive, dynamic, strong, and peaceful) and
smile shape (Oval, Triangular, Rectangular, and
Square) can be identied according to the lines,
angles, and face shape, making it so the patient
identies with the designed smile [20].
Finally, the case described herein achieved
successful restorative treatment complying with
the fundamental bases of esthetics, function,
structure, and biology, and satisfying more than
two decades of expectation.
The rst challenge of returning ideal occlusion,
function and esthetics to meet high expectations
through multidisciplinary treatment after its
conclusion led to enormous acceptance and patient
satisfaction for the nal rehabilitation result; despite
the complexity of a multidisciplinary case of this
type, the treatment planning managed to attain
the esthetic and functional expectations desired
by the patient over the decades of previous dental
treatment in a short amount of treatment time.
CONCLUSION
This case report described herein
demonstrated interdisciplinary dentistry based
on a correct diagnosis and detailed digital
planning which successfully met the patient’s high
expectations in terms of esthetics, dentofacial
and psychosocial function for a patient with a
congenital compromise.
Acknowledgements
The authors are grateful to Christopher J.
Quinn for providing the English language review
of the manuscript.
Author’s Contributions
LVCA, LCLG: Conceptualization. LVCA:
Methodology. JMF, AT, VVBF, RDN, WU:
Validation. LVCA, LCLG: Writing – Original
Draft Preparation. JMF, AT, VVBF, RDN, WU:
Writing – Review & Editing. JMF, AT, VVBF,
RDN, WU: Visualization. JMF, AT, VVBF, RDN,
WU: Supervision.
Conict of Interest
No conicts of interest declared concerning
the publication of this article.
10
Braz Dent Sci 2023 Apr/Jun;26 (2): e3801
Arcila LVC et al.
Multidisciplinary action in a patient with cleft lip and palate: esthetic-functional dentofacial treatment for more than two decades
Arcila LVC et al.
Multidisciplinary action in a patient with cleft lip and palate:
esthetic-functional dentofacial treatment for more than two
decades
Funding
The authors declare that no nancial support
was received.
Regulatory Statement
This study was conducted in accordance with
all the provisions of the local human subjects
oversight committee guidelines and policies of:
FREZATO, Imersões odontológicas.
REFERENCES
1. Lee CCY, Jagtap RR, Deshpande GS. Longitudinal treatment of
cleft lip and palate in developing countries: dentistry as part of
a multidisciplinary endeavor. J Craniofac Surg. 2014;25(5):1626-
31. http://dx.doi.org/10.1097/SCS.0000000000001118.
PMid:25162552.
2. Stuppia L, Capogreco M, Marzo G, La Rovere D, Antonucci I,
Gatta V,etal. Genetics of syndromic and nonsyndromic cleft lip
and palate. J Craniofac Surg. 2011;22(5):1722-6. http://dx.doi.
org/10.1097/SCS.0b013e31822e5e4d. PMid:21959420.
3. Nagem H Fo, Moraes N, Rocha RGF. Contribuição para o estudo
da prevalência das más formações congênitas lábio-palatais na
população escolar de Bauru. Rev Fac Odontol Univ Sao Paulo.
1968;6(2):111-28.
4. Winckler VP, Molena KF, Dalben GD. Prevalence of cleft lip and
palate in Bauru, SP: concordance among registries of HRAC/
USP, DNV and SINASC. Braz Dent Sci. 2021;24(4):e2652.
5. Ambrosio EC, Alcarde AR, Jorge PK, Carrara CF, Valarelli FP,
Soares S, etal. Evaluation of palatal volume in children with
cleft lip and palate: a comparison of two surgical protocols.
Braz Dent Sci. 2022;25(3):e3299. http://dx.doi.org/10.4322/
bds.2022.e3299.
6. Abreu A, Levy-Bercowski D, Yu J, Salgueiro M, Kalathingal S, Susin
LF,etal. Interdisciplinary treatment of an adult with bilateral
cleft lip and palate with missing premaxilla: the prosthodontic
perspective. J Prosthet Dent. 2015;114(4):609-13. http://dx.doi.
org/10.1016/j.prosdent.2014.09.031. PMid:26119020.
7. Abreu A, Londono J, Torosian A, Yu J, Levy-Bercowski D.
Aesthetic concepts and interdisciplinary approach in a patient
with bilateral cleft lip and palate and missing premaxilla: a case
report. Cleft Palate Craniofac J. 2021;58(8):1056-62. http://
dx.doi.org/10.1177/1055665620969290. PMid:33251853.
8. Yilmaz HN, Karabiber G, Erverdi N. A novel approach for the
reconstruction of premaxilla by archwise distraction in bilateral
cleft lip and palate. J Craniofac Surg. 2019;30(1):e40-3. http://
dx.doi.org/10.1097/SCS.0000000000004954. PMid:30507876.
9. Levy-Bercowski D, DeLeon E, Stockstill JW, Yu JC.
Orthognathic cleft-surgical/orthodontic treatment. Semin
Orthod. 2011;17(3):197-206. http://dx.doi.org/10.1053/j.
sodo.2011.02.004.
10. Shahab N, Sar C, Sarac M, Erverdi N. Reconstruction of
premaxilla with alveolar distraction osteogenesis in a
patient with complete cleft lip and palate: a case report.
Cleft Palate Craniofac J. 2019;56(4):534-7. http://dx.doi.
org/10.1177/1055665618785789. PMid:30001495.
11. Lira AD, Araújo IR. Analysis of orthopedic treatment of skeletal
class III malocclusion with rapid palatal expansion and face
mask therapy. Braz Dent Sci. 2019;22(4):467-74. http://dx.doi.
org/10.14295/bds.2019.v22i4.1794.
12. Balkaya MC, Sultan H, Erdem S, Mutlu D. Prosthetic rehabilitation
of a patient with a unilateral cleft palate: a clinical report. J
Prosthet Dent. 2014;111(4):269-72. http://dx.doi.org/10.1016/j.
prosdent.2013.06.024. PMid:24388721.
13. Bidra AS. Esthetic and functional rehabilitation of a bilateral cleft
palate patient with fixed prosthodontic therapy. J Esthet Restor
Dent. 2012;24(4):236-44. http://dx.doi.org/10.1111/j.1708-
8240.2011.00485.x. PMid:22863127.
14. Scotti CK, Bastos NA, Velo MM, Zabeu GS, Bueno LS, Bombonatti
JF, et al. Understanding the interaction of resin composite
with light for predictable aesthetic results in anterior teeth:
a case report. Braz Dent Sci. 2018;21(2):257-65. http://dx.doi.
org/10.14295/bds.2018.v21i2.1547.
15. Esper LA, Sbrana MC, Cunha MJS, Moreira GS, Almeida ALPF.
Esthetic composition of smile in individuals with cleft lip,
alveolus, and palate: visibility of the periodontium and the
esthetics of smile. Plast Surg Int. 2012;2012:563734. http://
dx.doi.org/10.1155/2012/563734. PMid:23227326.
16. Silva G, Normandes AC, Barros E Jr, Gatti J, Maranhão
K, Reis AC, et al. Ceramic laminate veneers for
reestablishment of esthetics in case of lateral incisor
agenesis. Case Rep Dent. 2018;2018(1):4764575. http://dx.doi.
org/10.1155/2018/4764575. PMid:29992059.
17. Meirelles LCF, Pierre FZ, Tribst JPM, Pagani C, Bresciani E, Borges
ALS. Influence of preparation design, restorative material and
load direction on the stress distribution of ceramic veneer in
upper central incisor. Braz Dent Sci. 2021;24(3):e2494. http://
dx.doi.org/10.14295/bds.2021.v24i3.2494.
18. Cunha LF, Gaião U, Silva RC, Gonzaga CC, Correr GM. Cosmetic
remodeling of the smile: combining composite resin and ceramics
over teeth and implants. Case Rep Dent. 2017;2017:8698010.
http://dx.doi.org/10.1155/2017/8698010. PMid:28840044.
19. Coachman C, Calamita M. Digital smile design: a tool for
treatment planning and communication in esthetic dentistry.
Quintessence Dent Technol. 2012;35:103-11.
20. Paolucci B, Calamita M, Coachman C, Gürel G, Shayder A, Hallawell
P. Visagism: the art of dental composition. Quintessene Dent
Technol [Internet]. 2018 [cited 2023 Mar 27]; 41(1):19-28. Available
from: https://digitalsmiledesign.com/files/Old-Website-
Assets/Media/Paolucci_Visagism_QDT.pdf%0Ahttps://www.
academia.edu/39252468/Visagism%0Ahttps://d1wqtxts1xzle7.
cloudfront.net/59385004/Visagism20190524-5415-11lsej9-
with-cover-page-v2.pdf?Expires=1628276032&S
João Mauricio Ferraz
(Corresponding address)
Universidade Estadual Paulista - UNESP, Instituto de Ciência e Tecnologia,
Departamento de Materiais Dentais e Prótese, São José dos Campos, SP, Brazil.
Email: joao.mauricio@unesp.br
Date submitted: 2023 Feb 07
Accept submission: 2023 Mar 27