Not many people know what a prosthodontist is, so I wanted to take the time to explain what exactly my specialty is all about and why it is important for the cleft patient to see a prosthodontist .

Really, this specialty in dentistry can all come down to one word: PLANNING.

As prosthodontists, we have had extensive training in treatment planning, which is actually my favorite part of treatment, besides seeing my patients’ smiles when we are finished .

My definition:

A prosthodontist is a specialist in dentistry who is responsible for putting anything that is fake, or man-made, and putting it into the mouth.

This general definition can apply to things like dental implants, crowns, and dentures. You’re probably thinking: But wait, can’t a general dentist do that?

And the answer is: YES , but wait .

The difference is that prosthodontists have had training in how to visualize the dentition as a whole, and we have a better understanding of cause and effect when it comes to restoring the mouth.

How this relates to a cleft patient:

This is where you come in! 

Maxillofacial Prosthetics:

For a cleft palate patient, before closure of the palatal defect, there is a communication between the roof of the mouth and the nose.

In order for the patient to be able to eat without food escaping through the nose , and also for the patient to be able to speak, especially for an older patient, that defect needs to be blocked with something that would resemble a palate. This is called an obturator.

Also, if the palate has been repaired, but the patient still experiences speech problems , the patient can sound nasally due to missing tissue in the soft palate. A speech bulb helps to close this tissue deficiency or lift the soft palate in the back of the throat.

A maxillofacial prosthodontist is like a super prosthodontist because there is a one year fellowship these doctors go through after the completion of a prosthodontic residency. (This is what my husband is going for right now).

We will have a whole post dedicated to this topic at a later time, but for now, this gives you the basics.

When to see a maxillofacial prosthodontist: Prior to closure of the cleft palate, whether as an infant, as early as 3 months old, or as an adult who has not had cleft palate surgery for any reason.

Treatment Planning:

Most cleft patients are missing either 1 or more front teeth due to the cleft and lack of bone. If there is no bone, there can be no teeth ! When the patient is undergoing orthodontic treatment with braces, it can be an important time for the orthodontist to consult with the prosthodontist to help set the patient up for replacement of the missing teeth in the future.

There will be a time in the cleft patient’s early childhood, before braces, when the patient will not have any false teeth in place. This is the perfect time to become acquainted with a prosthodontist, who will begin to direct treatment. (See Flipper section below)

The prosthodontist can help evaluate the space available and let the orthodontist know if certain teeth should be moved into certain areas or if we need a larger space for the possibility of implant placement in the future.

The prosthodontist can also advise the oral surgeon about any teeth that need to be taken out in order to plan for the final treatment in the future.

Lastly, the prosthodontist will oversee the patient’s treatment to make sure all dental specialists are on the same page because the prosthodontist will have an end goal in mind .

Flipper:

During orthodontic treatment with braces, the orthodontist can put false teeth on the brackets so when the patient smiles, there are teeth there to maintain the space and also for social reasons .

When orthodontic treatment with braces has ended, the patient will most likely have an orthodontic retainer with false teeth attached to it. These retainers can be bulky with a wire that runs across the front of the teeth. A prosthodontist can make what is called a flipper until the patient is ready for definitive and final treatment to replace the missing teeth.

A flipper is meant to be temporary, and it is a partial denture that is weaker than a final partial denture. It replaces the missing teeth and is very esthetic. Socially, this can change a cleft patient’s life. I know it definitely boosted my confidence !

Final treatment options for missing teeth:

The prosthodontist will go through all treatment options when the patient is at the end of cleft repair treatment in order to replace the missing teeth. Below are the options, but we will dive into these in more detail in a later post.

Removable partial denture: As the name gives away, this is a removable option to replace the missing teeth. It has a base of metal with clasps around the teeth, and then the teeth are made of acrylic, along with the pink acrylic to resemble the gums.

Fixed partial denture: This is what is commonly known as a bridge. In this situation, the teeth on either side of the missing teeth can be drilled down in order to fit a crown over it, and a fake tooth will be connected to those crowns on either side.

Dental implants: After evaluating the bone in the cleft site from bone grafting, dental implants may be placed to replace the missing teeth. The dental implants act like the root of a tooth, and a crown will be attached to the dental implant.

My personal treatment:

Early:

I had an obturator made by a maxillofacial prosthodontist at a cancer hospital, called Roswell Park Cancer Institute. Many maxillofacial prosthodontists work at a cancer hospital because many of the head and neck cancers can cause defects, requiring a prosthesis.

Middle:

I had no idea what a prosthodontist was when I was young and neither did my parents. For this reason, I went from age 6-14 without two of my front teeth. I absolutely despised smiling or laughing, and I felt so insecure. It was such a relief when I had braces and they told me they could put false teeth on my brackets. It pains me to know I could have had something like a flipper during this time .

End:

After my braces were off, I wore a bulky retainer for about 3 years until my general dentist asked me if I had any plans for replacing my missing teeth. She then encouraged me to go see a prosthodontist after I told her I did not know what my next step was going to be. I had the most amazing experience with my prosthodontist. He fabricated a flipper for me, which I wore for 4 years. When it was time, my prosthodontist presented 3 treatment plans to my mom and me. We decided to go with dental implants. My prosthodontist planned my implants, and my oral surgeon placed them according to where the prosthodontist wanted them. After about 5 months of healing, my prosthodontist made an impression and restored my implants with crowns. I FINALLY HAD TEETH!!!

This was the most rewarding experience of my life, which is why I wanted to become a prosthodontist. You can see though how my life could have been drastically different if I had known something like a flipper was possible for me during ages 6-14.

I wrote this in the hopes that it can help you see a prosthodontist, and now you know what one does as well!