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ORIGINAL ARTICLE
Year : 2015  |  Volume : 5  |  Issue : 6  |  Page : 482-487
Oral health related quality of life in cleft lip and palate patients rehabilitated with conventional prostheses or dental implants


Department of Oral and Maxillofacial Sciences, "Sapienza" University of Rome, Rome, Italy

Date of Web Publication26-Nov-2015

Correspondence Address:
Piero Papi
Department of Oral and Maxillofacial Sciences, "Sapienza" University of Rome, Via Caserta 6, Rome - 00161
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-0762.168645

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   Abstract 

Objectives: Cleft lip and/or palate (CLP) is the most common congenital craniofacial abnormality, with a prevalence of 9.92 per 10,000 live births. In treating patients with CLP, oral rehabilitation is definitely a very important phase of the treatment in order to improve the patient's oral health related quality of life (OH-QoL). The aim of this retrospective study is to assess the OH-QoL in patients rehabilitated with different prosthetic options, thus comparing the conventional treatments, which include removable partial dentures and fixed partial dentures, with the implant-supported prostheses. Materials and Methods: Sixty-three patients were enrolled in this retrospective survey [44 females (69.84%) and 19 males (30.16%)] with a mean age of 34.93 ± 7.04 years (age range 21–53 years). They were all treated for CLP and rehabilitated with a conventional prosthesis or an implant-supported denture. Two different questionnaires were used in the present study to evaluate patients' OH-QoL: The Italian version of the 49-item Oral Health Impact Profile (OHIP-49) and the Italian version of the Cleft Evaluation Profile (CEP). Statistical analysis was performed using analysis of variance (ANOVA) test, with a significant P < 0,05. Results: Data analysis revealed that patients rehabilitated with implant-supported dentures and fixed partial dentures showed a good level of satisfaction with their prostheses, scoring low values in the OHIP-49 and high values in the CEP, while subjects with removable partial dentures scored the highest values in the OHIP-49 and the lowest values in the CEP, which means an unsatisfactory feeling (P < 0.05). Conclusions: OH-QoL is a challenging demand for all prosthodontists. Our results show, clearly, that patients rehabilitated with implant-supported dentures are more satisfied compared to subjects with fixed partial dentures and removable partial dentures.


Keywords: Cleft lip and palate, congenital malformation, dental implants, prosthetic rehabilitation, quality of life


How to cite this article:
Papi P, Giardino R, Sassano P, Amodeo G, Pompa G, Cascone P. Oral health related quality of life in cleft lip and palate patients rehabilitated with conventional prostheses or dental implants. J Int Soc Prevent Communit Dent 2015;5:482-7

How to cite this URL:
Papi P, Giardino R, Sassano P, Amodeo G, Pompa G, Cascone P. Oral health related quality of life in cleft lip and palate patients rehabilitated with conventional prostheses or dental implants. J Int Soc Prevent Communit Dent [serial online] 2015 [cited 2019 Jul 20];5:482-7. Available from: http://www.jispcd.org/text.asp?2015/5/6/482/168645



   Introduction Top


Cleft lip and/or palate (CLP) is the most common congenital craniofacial abnormality, with a prevalence of 9.92 per 10,000 live births.[1],[2]

Treatment of CLP requires a multidisciplinary approach: Maxillofacial surgeons, orthodontists, oral surgeons, prosthodontists, otorhinolaryngologists, speech-language pathologists, neurologists, and psychologists are all involved.[2],[3]

Oral rehabilitation is an important phase of the treatment, it involves re-establishing esthetics, phonetics, and function, the primary goals of prosthetic rehabilitation, which are directly related to the dysfunctions and alterations determined by malformations.[2],[3],[4]

Prosthetic rehabilitation options include either conventional prostheses, such as removable partial dentures (RPDs) and fixed partial dentures (FPDs), or implant-supported prostheses.[4],[5],[6]

In recent years, the oral health related quality of life (OH-QoL) of CLP patients has been evaluated using different methods, which include semi-structured interviews and self-administered questionnaires.[7],[8],[9],[10]

Patient's satisfaction following CLP treatment, has been investigated extensively, however only few studies focused on oral rehabilitation.[8],[10]

The aim of this study is to assess OH-QoL in patients rehabilitated with different prosthetic options, thus comparing the conventional treatments, which include the RPDs and the FPDs, with implant-supported prostheses.


   Materials and Methods Top


This retrospective study was conducted at the Department of Oral and Maxillofacial Sciences of the "Sapienza" University of Rome, and approved by the institution review board (ref. no. 3552).

The study was open to all patients who met specific inclusion and exclusion criteria and provided signed informed consent according to the World Medical Association's Declaration of Helsinki.

Sixty-three patients were enrolled in this retrospective survey [44 females (69.84%) and 19 males (30.16%)] with a mean age of 34.93 ± 7.04 years (age range 21–53 years). They were all treated for CLP and rehabilitated with a conventional prosthesis or an implant-supported denture.

Fifty-three (84.12%) subjects were diagnosed with unilateral CLP, while 10 (15.88%) patients had a bilateral cleft lip.

Out of all the patients enrolled in this study, 38 received conventional prosthetic rehabilitation. Of these, 10 had RPDs and the remaining 28 patients received FPDs with dental bridges.

Dental implants were placed in 25 patients: Alveolar bone grafts in the cleft area were performed prior to the implant placement. These grafts were taken from donor sites, which were the iliac crest for 16 subjects and the mandibular ramus and symphysis for the remaining 9 people (7 and 2, respectively).

A total of 29 dental implants were inserted in 25 patients after a mean period of 5 months (range 4–6 months) from the bone graft procedure. Each subject received one implant in the upper lateral incisor area, except in two cases of bilateral cleft where two dental implants were placed for the patient, one in the left and one in the right upper lateral incisor area.

Implant-supported single crowns were realized in a mean time of 4 months after surgery.

After a mean follow-up of 24.25 ± 9.84 months (range 12–56 months), patients were invited to participate in this survey.

Two different questionnaires were used in the present study to evaluate patients' OH-QoL: The Italian version of the 49-item Oral Health Impact Profile (OHIP-49)[11] and the Italian version of the Cleft Evaluation Profile (CEP) proposed by the Royal College of Surgeons Cleft Lip and Palate Audit Group.[12]

Subjects completed the OHIP-49, which focuses on seven impact dimensions (functional limitation, pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap), with its standard ordinal format ('never', 'hardly ever', 'occasionally', 'often', 'very often') as a self-administered questionnaire.

The answers were recorded using the Likert scale (values from 0 to 4, with 0 representing the best outcome possible and 4 representing the worst).

The OHIP-49 was analyzed through the 'additive method' (OHIP-ADD) by summing the item values for the 49 questions (range 0–196). High OHIP scores indicated poor OH-QoL, while low OHIP scores showed satisfactory and adequate OH-QoL.

Patients completed the CEP also, which consists of an eight-item list (speech, hearing, lip, nose, teeth, bite, breathing, and profile) as a self-administered questionnaire.

For each item in the CEP, subjects were asked to rate their satisfaction on a 7-point Likert scale ranging from very satisfactory (a rank of 1) to very unsatisfactory (a rank of 7), and the mean scores for each answer were recorded.

Statistical analysis

Patients were divided into groups based on their rehabilitation: RPDs (Group 1), FPD (Group 2), and implant-supported dentures (Group 3).

Analysis of variance (ANOVA) test was performed. Primary null hypothesis were verified, finding a proper limit value for each subgroup of the two questionnaires, in order to determine satisfaction with prosthetic rehabilitation [Table 1] and [Table 2].
Table 1: OHIP-49 null hypothesis tested

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Table 2: Cleft Evaluation Profile null hypothesis tested

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A P < 0.05 was considered significant. A specific statistical software (IBM SPSS V10 Statistics, IBM, Armonk, NY, USA) was used for data analysis.


   Results and Discussion Top


Descriptive analysis was used to summarize the data of the two questionnaires. For each macro area and for each subset, the mean and the median values were calculated and illustrated on graphs using charts [Table 3] and [Table 4], [Figure 1] and [Figure 2].
Table 3: Descriptive analysis of OHIP-49

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Table 4: Descriptive analysis of Cleft Evaluation Profile

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Figure 1: OHIP-49 scores for patient population

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Figure 2: Cleft Evaluation Profile scores for patient population

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In the OHIP-49 questionnaire, four subgroups were considered particularly to evaluate overall satisfaction with prosthetic rehabilitation: FL = Functional limitation, P1 = Physical pain, P2 = Psychological discomfort, and D1 = Physical disability.

In the CEP questionnaire, the scores of four questions were analyzed: Speech, appearance of teeth, appearance of lip, and bite.

Data analysis revealed that patients rehabilitated with implant-supported dentures and FPDs showed a good satisfaction with their prostheses, scoring low values in the OHIP-49 and high values in the CEP, while subjects with RPDs scored lower values in the OHIP-49 and higher values in the C, which means an unsatisfactory feeling [Figure 1] and [Figure 2].

Data were analyzed by ANOVA test. They were statistically significant for a P < 0.05.

Statistical analysis suggested that quality of life in patients rehabilitated with RPDs is lower than in subjects who received FPDs or implant-supported dentures.

The prosthetic rehabilitation of CLP patients is directly related to the dysfunctions and alterations determined by the malformation: Thus re-establishing function, phonetics, and esthetics are the primary goals of oral rehabilitation.[7],[8]

CLP patients undergo multiple surgical treatments overlapping along a timeline ranging from birth to late teenage years.[13],[14]

RPDs are not completely accepted by these patients and should be avoided, and considered as a secondary choice for obtaining a proper restoration that is capable of ensuring esthetic and psychological results.[14]

However, RPDs are recommended in patients presenting tissue deficiency, soft palate dysfunction, numerous palatal fistulas, and high risk of hypernasal speech.

They could bealso used as temporary prostheses prior to implant placement in young patients, who need to complete their surgical treatment or finish their dental and skeletal growth first.[14],[15]

According to the authors, their use should be as limited as possible.

FPDs are considered a good option for prosthetic rehabilitation, particularly when alveolar bone grafts fail and implant placement is not possible. A three-unit/six-unit dental bridge is made, preparing the central incisor and the canine as abutments; in case of dental anomalies of teeth, adjacent to the cleft, extension of the bridge may be necessary involving other teeth to ensure a proper relationship between root and crown.[15],[16],[17]

However, nowadays, implant-supported prostheses have become the gold standard for prosthetic rehabilitation of CLP patients.[18],[19],[20]

According to a systematic review [18] authored by Wermker et al., mean dental implant survival rate after 5 years is 88.6% in these subjects and can be compared to a control population.

Dental implant placement is generally recommended after a mean period of 4–6 months from the alveolar bone graft.[18],[19],[20],[21] According to our experience, donor sites from the iliac crest, mandibular ramus, and symphysis can be used with some compliance.

Dental implant insertion achieves good esthetic and functional results, restoring the dental arch and the continuity of bone alveolar defects; patients generally accept implant-supported prostheses very well.[21],[22],[23]

Subjects showed a good satisfaction, scoring the highest values in CEP and the lowest in OHIP-49: Functional limitation, physical and psychological disability values were very low, and speech, appearance of teeth/lip, and bite were very high.


   Conclusions Top


OH-QoL is a challenging demand for prosthodontists to achieve functional and esthetic results as a way to improve psychological comfort for CLP patients.

The retrospective nature of this study and its relatively small sample may have affected our results. The risk of selection bias is higher and the quality of the data is lower compared to prospective studies.

However, this study is, to the best of the authors' knowledge, and aesthetics results is a way to improve psychological comfort for CLP patients. Our results clearly show that patients rehabilitated with implant-supported dentures are more satisfied, compared to subjects with FPDs and RPDs.

According to the authors, dental implant placement should be considered as the gold standard in prosthetic rehabilitation of CLP patients, in order to ensure achieving the best esthetic and functional results and therefore maximize patient satisfaction with their oral rehabilitation.

Financial support and sponsorship

There was no financial support for this work that could have influenced its outcome.

Conflicts of interest

There are no known conflicts of interest associated with this publication.

 
   References Top

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Freitas JA, Almeida AL, Soares S, Neves LT, Garib DG, Trindade-Suedam IK, et al. Rehabilitative treatment of cleft lip and palate: Experience of the hospital for rehabilitation of craniofacial anomalies/USP (HRAC/USP) - Part 4: Oral rehabilitation. J Appl Oral Sci 2013;21:284-92.  Back to cited text no. 14
    
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Pena WA, Vargervik K, Sharma A, Oberoi S. The role of endosseous implants in the management of alveolar clefts. Pediatr Dent 2009;31:329-33.  Back to cited text no. 19
    
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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]

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