A 41-year-old man with cleft palate presented with a wide dehiscence and missing teeth. Six implants had been placed for fabrication of an overdenture, which was unsatisfactory. A bar was waxed and cast for connection to the implants; precision attachments were placed laterally for retention. A fixed partial denture was fabricated, and milled crowns were fabricated at the molar region to provide a guiding plane for insertion of a removable palatal obturator. Good swallowing and speech outcomes were achieved. This technique provided functional and esthetic benefits, enhanced oral hygiene, and improved the psychological condition of the patient.

A 43-year-old woman with a unilateral cleft lip and palate, presenting a totally edentulous maxilla and mandible with marked maxillomandibular discrepancy, attended the Prosthodontics section of the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo for treatment. She could not close her mouth and was dissatisfied with her complete dentures. Treatment planning comprised placement of six implants in the maxilla, four in the mandible followed by prostheses installation and orthognathic surgery. The mandibular full arch prosthesis guided the occlusion for orthognathic positioning of the maxilla. The maxillary complete prosthesis was designed to assist the orthognathic surgery with a provisional prosthesis (no metal framework), allowing reverse treatment planning. Maxillary and mandibular realignment was performed. Three months later, a relapse in the position of the maxilla was observed, which was offset with a new maxillary prosthesis. This isa complex interdisciplinary treatment and two-year follow-up is presented and discussed. It should be considered that this type of treatment could also be applied in non-cleft patients.

Dedicarórias À Deus, por me guiar nos caminhos da paz, me conceder uma vida e uma família maravilhosa, por me acolher e me proteger permitindo que eu sinta sua presença em todos os momentos de minha vida. Ao meu esposo e professor Fernando, que sempre foi zeloso, companheiro, me dando estímulo e amor. Uma pessoa muito especial, que doa todo seu conhecimento com prazer e dedicação, que me guiou para que eu me formasse uma profissional. Aos meus pais, Elizabeth e Waldemarin, que me protegeram e educaram me ensinando a caminhar respeitando meus semelhantes e a viver com honra e dignidade. Acolheram-me nos momentos de dificuldade com um amor incondicional, e, acima de tudo, pela dedicação e o esforço que fizeram para me educar e me formar cirurgiã-dentista. III Agradecimentos À Dra. Maria Lúcia Rubo de Rezende, orientadora deste trabalho, manifesto toda minha admiração e respeito pela renomada competência e reconhecida capacidade profissional, agradeço o companheirismo, dedicação e ensinamentos. Ao Dr. João Henrique Nogueira Pinto, diretor administrativo do HRAC, que ao longo destes anos me fez crescer como profissional, me espelhando em sua competência, honestidade, profissionalismo, inteligência, alegria e acima de tudo respeito com o próximo. Ao Dr. Alceu Sergio Trindade Júnior, por me ceder seus conhecimentos de forma tão solícita, me atendendo aos inúmeros chamados, agradeço a presença em cada etapa da concretização deste trabalho. Ao Centrinho, representado pelo Dr. José Alberto de Souza Freitas pelo ideal de criar um lugar mágico, onde a ciência se desenvolve reestruturando vidas. À Dra. Ana Claudia Martins Sampaio Teixeira, do setor de Fisiologia do HRAC, que me recebeu no setor de Fisiologia e orientou durante todos os exames de eletromiografia. Às Doutoras Inge Elly K. Trindade; Ana Paula Fukushiro e Renata Paciello Yamashita que fazem do setor de Fisiologia do HRAC, exemplo de organização, de apoio à ciência, agradeço muito a acolhida. Aos Doutores Luiz Gustavo Nascimento de Melo, Flávia Fontão, Giedre Berretin, e Marileda Tomé, pela ajuda inestimável no início e planejamento deste trabalho, e pelo exemplo de inteligência e humildade dentro do universo científico, pela essência em serem verdadeiros professores. Aos setores de Implantodontia Prótese e Radiologia, também envolvidos nesta pesquisa, agradeço a acolhida.

A 41-year-old man with cleft palate presented with a wide dehiscence and missing teeth. Six implants had been placed for fabrication of an overdenture, which was unsatisfactory. A bar was waxed and cast for connection to the implants; precision attachments were placed laterally for retention. A fixed partial denture was fabricated, and milled crowns were fabricated at the molar region to provide a guiding plane for insertion of a removable palatal obturator. Good swallowing and speech outcomes were achieved. This technique provided functional and esthetic benefits, enhanced oral hygiene, and improved the psychological condition of the patient.

Rehabilitation of cleft patients is a process that occurs from birth to adult life and involves a team of many professionals. Reconstructive plastic surgery, despite its functional and aesthetic benefits to the patient, can restrict the normal anterior displacement that occurs in the growth of the maxilla, which, in turn, can lead to a concave profile that requires correction. This study aimed to demonstrate an alternative rehabilitation treatment for cleft patients who have severe maxillomandibular discrepancy and choose not to undergo orthognathic surgery. A retrospective review and case reports of rehabilitation treatment of cleft patients were performed, with an emphasis on prosthetic rehabilitation without orthognathic surgical procedures. Prosthetic rehabilitation is a fast and reversible option for cleft patients that provides facial harmony and facilitates the reintegration of these patients into society.