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 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 5  |  Issue : 1  |  Page : 53-56

A novel feeding appliance made up of soft silicone-based denture liner for cleft palate patient


1 Department of Prosthodontics, S C B Dental College and Hospital, Cuttack, Odisha, India
2 Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
3 Department of Oral and Maxillofacial Surgery, S C B Dental College and Hospital, Cuttack, Odisha, India
4 Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Date of Web Publication7-Dec-2015

Correspondence Address:
Akhilesh Kumar Singh
Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-6027.171156

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  Abstract 

Cleft palate is a common congenital maxillofacial disorder leading to feeding problems in a newborn baby. Due to the malformed palate, infants are unable to apply adequate negative pressure to squeeze the nipple for the release of milk. This disability leads to malnutrition, middle ear infection, and even death if not treated early. To obtain better nutritional intake prior to surgical correction, a feeding appliance is recommended. In the present report, we present a case of a 1-month-old baby with cleft palate, treated with a novel feeding appliance made up of soft silicone-based denture liner.

Keywords: Cleft palate, feeding appliance, silicone, soft denture liners


How to cite this article:
Kar R, Singh AK, Mishra N, Singh S. A novel feeding appliance made up of soft silicone-based denture liner for cleft palate patient. Int J Oral Health Sci 2015;5:53-6

How to cite this URL:
Kar R, Singh AK, Mishra N, Singh S. A novel feeding appliance made up of soft silicone-based denture liner for cleft palate patient. Int J Oral Health Sci [serial online] 2015 [cited 2019 Sep 20];5:53-6. Available from: http://www.ijohsjournal.org/text.asp?2015/5/1/53/171156


  Introduction Top


Cleft palate is a common congenital maxillofacial defect that has a significant effect on the nutritional intake of the newborn. When a child is born with a cleft, maintenance of adequate nutrition, which is necessary for growth, development, and the infant's preparation for surgery, is a priority.[1] The oro-nasal communication diminishes the ability to create negative pressure for sucking. Other associated problems are a nasal regurgitation of food, excessive air intake, choking, and prolonged feeding time.[2],[3] Prolonged feeding interferes with the parent's ability to attend other matters and increases familial stress. Although the definitive treatment for these problems is the surgical correction of the defect but the timing of appropriate surgery is 12–18 months. Till that time a feeding obturator is indicated to maintain the oral functions of the infant.

The feeding appliance is a prosthetic aid which obturates the cleft and restores the continuity of the palate. It creates a rigid platform toward which the baby can press the nipple and extract milk.[4] It blocks the oro-nasal communication which facilitates feeding, reduces nasal regurgitation, reduces the incidence of choking, and shortens the length of time required for feeding.[4],[5] The appliance also prevents the tongue from entering the defect which interferes with the growth of palatal shelves toward the midline.[6] Various researches have been done regarding the choice of material for the fabrication of the obturator. So far acrylic was the choice of material due to its easy availability, manipulation and its strength. Not only being rigid and less resilient, but it also exerts more pressure on the underlying mucosa which may lead to pain and ulceration, thus compromising with its functional importance. Its rough surface attracts food debris thereby compromising the oral hygiene as well. Thus, the acrylic feeding appliance is doing more harm than good. Hence a new revolution in search for a better material arises which not only should provide a better functional environment but should also be friendlier to the infant. Our search ended with the introduction of silicone denture liner as a better material for the fabrication of feeding appliance.


  Case Report Top


A 1-month-old infant reported to our department with a chief complaint of difficulty in feeding. On clinical examination, a midline cleft of the soft palate and posterior part of the hard palate was detected [Figure 1]. A nasogastric tube for feeding was placed by his physician. The clinical condition was discussed with the parents and a feeding appliance was advised till definitive surgery. A preliminary impression was made with rubber base impression material (addition silicone, Flexceed, GC Dental Products Corp., Japan). A cast was poured with plaster of Paris (type I dental stone) on the preliminary impression obtained. A custom tray was then fabricated using self-cure acrylic resin. With the help of the custom tray, a secondary impression was made using rubber base impression material (addition silicone, Flexceed, GC Dental Products Corp., Japan). Final cast was poured with die stone (type IV dental stone, Kalrock, Kalabhai Karson Pvt. Ltd, Mumbai, India).
Figure 1: Photograph of the child showing midline cleft of the hard and soft palate. The nasogastric tube present for feeding

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A feeding appliance with soft silicone-based denture liner (Molloplast B, Detax Germany) was then made on the final cast by compression molding technique [Figure 2]. An orthodontic wire (19 gauge) was attached to the anterior aspect of easy placement and retrieval of the appliance. The feeding appliance was inserted into the infant's mouth and assessed for any extensions in the hard and soft palate regions; any necessary adjustments were made [Figure 3]. The trial feeding was done using the bottle with long nipple. The child was able to suck properly with the help of the appliance [Figure 4]. The parents were educated about the insertion, removal, and maintenance of the appliance. The infant was followed-up weekly and necessary adjustments were made.
Figure 2: Feeding appliance made with soft silicone-based denture liner with attached orthodontic wire in the anterior aspect

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Figure 3: Feeding appliance in place

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Figure 4: Infant fed with the bottle containing milk with the help of feeding appliance

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  Discussion Top


Infants with cleft lip, cleft palate, or both as their sole health problem swallow normally but suck abnormally. Sucking is achieved through the combined tasks of generating intraoral negative pressure and making effective intraoral muscular movements. Negative intraoral pressure is accomplished by sealing the lips and velopharynx and expanding the intraoral cavity, either through contraction of the tongue or by the movement of the mandible.[7] In cleft palate condition, the nipple gets pushed into the gap between the palatal shelves thus tongue is unable to squeeze it. To overcome this situation, a nasopharyngeal obturator or feeding obturator appliance is required.

Ideal orthodontic appliances should have a polished surface, retain less organic debris and offer less risk of microbiological imbalance, less risk of oral stomatitis or candidiasis, and favor oral hygiene.[8] Feeding appliances are commonly fabricated with acrylic resins (polymethyl methacrylates). Introduced in the 1930s, these resins are easy to handle, have reduced cost, and allow satisfactory clinical outcomes.[9] However, several factors may yield porosities during the manufacturing process of these appliances. As possible causes, the literature mentions mistaken proportions of polymer and monomer, inadequate agglutination of powder particles to the liquid, application of resin at an improper stage of the reaction, and lack of application of a long-enough curing cycle.[10]

Silicone represents a group of polymer products derived from silicon metal which after oxygen is the most abundant element on the surface of the earth. In fact, silicon can be found in over 27% of the earth's crust by mass. Chemically a silicone based denture liner is αω-dihydroxy end-blocked poly dimethyl siloxane. The properties of silicone rubber are high tear strength, extreme resilient, elastic at both high (+300°C) and low (−80°C) temperatures, hydrophobic in nature, and resistant to ageing. Hence, it is an ideal material for the fabrication of feeding appliances. Silicone rubbers may be chemically activated or heat activated. Heat activated silicones are one component system. These materials are applied and contoured using compression moulding techniques. The soft silicone rubbers are not dependent upon leachable plasticizers; therefore they retain their elastic properties for prolonged periods.[11]

While fabricating the feeding appliance, the most important step is a proper registration of tissue details. The impression making is very tedious work because of small oral opening and noncooperation by the infant. Various impression materials have been advocated in the past literature such as alginate, beeswax, periphery wax, Adaptol (Jelenco Dental Products, Armonk, NY), Citricon (Kerr USA, Romulus, Mich), polysulfide impression material, and addition silicone (Vinyl polysiloxane) impression material.[3],[4],[5],[6],[11],[12],[13],[14] The putty type addition silicone is the material of choice because its high viscosity reduces the danger of aspiration or swallowing, and its relatively good detail registration property.[15] Thus, we performed both the preliminary and final impression with putty type addition silicone impression material.

After delivering the feeding appliance, in the 1st week the patient should be examined every alternate day for possible tissue irritation. Mechanical cleaning of the appliance may lead to damage, such debridement is often necessary. If mechanical cleaning is undertaken, a soft brush should be used in conjunction with a mild detergent solution or nonabrasive dentrifrices. Antimycotic agents (Nystatin, clotrimazole) have been incorporated into soft liners.[16] The feeding appliance should be adjusted every 2–3 weeks and replaced every 2–3 months. To avoid interfering with the growth of the dental arch, the border of the obturator must be trimmed regularly, until the retention becomes insufficient.[1]


  Conclusion Top


The feeding appliance is not the definitive management, but it is indicated to provide better nutrition till final repair of the cleft palate. Regular follow-up for proper care of the oral tissue and the feeding appliance is necessary.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Karayazgan B, Gunay Y, Gurbuzer B, Erkan M, Atay A. A preoperative appliance for a newborn with cleft palate. Cleft Palate Craniofac J 2009;46:53-7.  Back to cited text no. 1
    
2.
Choi BH, Kleinheinz J, Joos U, Komposch G. Sucking efficiency of early orthopaedic plate and teats in infants with cleft lip and palate. Int J Oral Maxillofac Surg 1991;20:167-9.  Back to cited text no. 2
    
3.
Jones JE, Henderson L, Avery DR. Use of a feeding obturator for infants with severe cleft lip and palate. Spec Care Dentist 1982;2:116-20.  Back to cited text no. 3
[PUBMED]    
4.
Osuji OO. Preparation of feeding obturators for infants with cleft lip and palate. J Clin Pediatr Dent 1995;19:211-4.  Back to cited text no. 4
    
5.
Goldberg WB, Ferguson FS, Miles RJ. Successful use of a feeding obturator for an infant with a cleft palate. Spec Care Dentist 1988;8:86-9.  Back to cited text no. 5
[PUBMED]    
6.
Oliver HT. Construction of orthodontic appliances for the treatment of newborn infants with clefts of the lip and palate. Am J Orthod 1969;56:468-73.  Back to cited text no. 6
[PUBMED]    
7.
Clarren SK, Anderson B, Wolf LS. Feeding infants with cleft lip, cleft palate, or cleft lip and palate. Cleft Palate J 1987;24:244-9.  Back to cited text no. 7
    
8.
Boersma JG, van der Veen MH, Lagerweij MD, Bokhout B, Prahl-Andersen B. Caries prevalence measured with QLF after treatment with fixed orthodontic appliances: Influencing factors. Caries Res 2005;39:41-7.  Back to cited text no. 8
    
9.
Tylman S, Peyton F. Acrylics and Other Synthetic Resins Used in Dentistry. Philadelphia, PA: Lippincott; 1946. p. 259.  Back to cited text no. 9
    
10.
Skinner E, Philips R. Denture Base Resins: Technical Considerations in Science of Dental Materials. Philadelphia, PA: Saunders; 1973. p. 178-96.  Back to cited text no. 10
    
11.
Phoenix RD, Anusavice KJ. Denture base resins. Philips Science of Dental Materials. 12th ed. St. Louis, Missouri: Elsevier, Saunders; 2013. p. 493-4.  Back to cited text no. 11
    
12.
Samant A. A one-visit obturator technique for infants with cleft palate. Oral Maxillofac Surg 1989;47:539-40.  Back to cited text no. 12
    
13.
Finger IM, Guerra LR. Provisional restorations in maxillofacial prosthetics. Dent Clin North Am 1989;33:435-55.  Back to cited text no. 13
    
14.
Saunders ID, Geary L, Fleming P, Gregg TA. A simplified feeding appliance for the infant with a cleft lip and palate. Quintessence Int 1989;20:907-10.  Back to cited text no. 14
[PUBMED]    
15.
Taylor TD. Clinical Maxillofacial Prosthetics. Chicago: Quintessence; 2000. p. 65-6.  Back to cited text no. 15
    
16.
Chow CK, Matear DW, Lawrence HP. Efficacy of antifungal agents in tissue conditioners in treating candidiasis. Gerodontology 1999;16:110-8.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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