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Case Report

A novel feeding appliance made up of soft silicone‑based

denture liner for cleft palate patient
Rosalin Kar, Akhilesh Kumar Singh1, Niranjan Mishra2, Shreya Singh3

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

Address for correspondence: Dr. Akhilesh Kumar Singh, Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute
of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India. E‑mail: georgianaks@gmail.com

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.
Key words: Cleft palate, feeding appliance, silicone, soft denture liners

INTRODUCTION timing of appropriate surgery is 12–18 months. Till that

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
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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
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DOI: How to cite this article: Kar R, Singh AK, Mishra N, Singh S. A novel
10.4103/2231-6027.171156 feeding appliance made up of soft silicone-based denture liner for
cleft palate patient. Int J Oral Health Sci 2015;5:53-6.

© 2015 International Journal of Oral Health Sciences | Published by Wolters Kluwer - Medknow 53
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Kar, et al.: Soft silicone liner as feeding appliance in cleft palate patients
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
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
Figure 1: Photograph of the child showing midline cleft of the
hard and soft palate. The nasogastric tube present for feeding
54
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).
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.
DISCUSSION
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
Figure 2: Feeding appliance made with soft silicone‑based denture
liner with attached orthodontic wire in the anterior aspect
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Kar, et al.: Soft silicone liner as feeding appliance in cleft palate patients
Figure 3: Feeding appliance in place
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]
International Journal of Oral Health Sciences | Jan-Jun 2015 | Vol 5 | Issue 1
Figure 4: Infant fed with the bottle containing milk with the help
of feeding appliance
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.[3‑6,11‑14] 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
The feeding appliance is not the definitive management,
but it is indicated to provide better nutrition till final repair
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Kar, et al.: Soft silicone liner as feeding appliance in cleft palate patients
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.
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