Clefts of the lip and/or palate (CLP) are oral-facial defects that affect health and overall quality of life. CLP patients often need multidisciplinary treatment to restore oral function and esthetics. This paper describes the oral rehabilitation of a CLP adult patient who had maxillary bone and tooth loss, resulting in decreased occlusal vertical dimension. Functional and cosmetic rehabilitation was achieved using a maxillary removable partial denture (RPD) attached to telescopic crowns. Attachment-retained RPDs may be a cost-effective alternative for oral rehabilitation in challenging cases with substantial loss of oral tissues, especially when treatment with fixed dental prostheses and/or dental implants is not possible.

Purpose: This in vitro study assessed the amount of debris extruded apically after preparation with different techniques.Methods: Sixty healthy, extracted, human mandibular incisors were randomly divided into 3 groups: Group A -hand crown-down technique; Group B -crown-down technique with enginedriven rotary reciprocating instruments; Group C -Protaper: engine-driven continuous rotary instrumentation. The roots were immersed in 2.3 mL of distilled water. After preparation, the water in each tube was filtered to collect solid material extruded, and the filters were weighed using a precision scale. Data were analyzed by Kolmogorov-Smirnov and Kruskal-Wallis tests at the 0.05 level of significance.Results: The statistical analysis showed that group C had significantly higher values of debris than groups A and B.Conclusion: The instrumentation using a continuous rotary technique, Protaper, produced greater apical extrusion than the hand and engine-driven crown-down techniques. The direction of instrumentation, whether cervical-apical or apical-cervical, seems to be a more important factor influencing apical extrusion than whether the instrumentation was performed by hand or was engine-driven.Key words: Root canal preparation; crown-down technique; periapical tissue; Protaper ResumoObjetivo: Este estudo, in vitro, avaliou a quantidade de extrusão apical de "debris", após o preparo químico-mecânico do canal radicular, utilizando diferentes técnicas.Metodologia: Sessenta incisivos inferiores humanos hígidos foram aleatoriamente divididos em três grupos: Grupo A: técnica coroa-ápice manual; Grupo B: técnica coroa-ápice mecanizada com sistema de rotação oscilatória; Grupo C: Protaper, técnica mecanizada com sistema de rotação contínua. As raízes foram imersas em 2,3 mL de água destilada. Após os preparos, a água destilada de cada amostra foi filtrada, e o filtro de papel, contendo o material sólido extruído, foi pesado em uma balança analítica de precisão. Os dados foram analisados estatisticamente pelos testes Kolmogorov-Smirnov e Kruskal-Wallis ao nível de significância de 0,05.Resultados: A análise estatística demonstrou que o grupo C apresentou valores superiores de "debris" do que os grupos A e B.Conclusão: A técnica rotatória contínua com Pro-taper produziu maior quantidade de extrusão apical do que as técnicas coroa-ápice manual e mecanizada com sistema de rotação oscilatória. A direção da instrumentação, se cérvico-apical ou ápico-cervical, parece ser o fator mais determinante na extrusão de "debris" independente desta ser realizada manual ou mecanizada.

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