{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T03:01:33Z","timestamp":1790218893137,"version":"4.1.0"},"reference-count":20,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Cleft Palate Craniofacial Journal"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Despite the critical role of prosthodontic care in cleft rehabilitation, access remains inconsistent, and the institutional barriers to its integration are uncharacterized. This study evaluates institutional and socioeconomic barriers to prosthodontic care for patients with cleft conditions and identifies strategies to improve service delivery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional survey of 35 American Cleft Palate-Craniofacial Association\u2013approved cleft-craniofacial teams across academic medical centers, public institutions, and private practices in the United States and Canada. The survey assessed institutional characteristics, prosthodontic service availability, barriers to care, insurance coverage patterns, and improvement strategies. Descriptive statistics were used to analyze response patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty-five institutions participated (68% academic medical centers, 24% public institutions). Most teams (22\/31, 71%) lacked dedicated prosthodontic providers. Among 7 teams with on-staff prosthodontists, wait times were 3 months or less in 6 of 7 (86%) and 6 to 9 months in 1 of 7 (14%). The most common institutional barriers were insufficient funding and limited prosthodontist availability (each 10\/18, 56%). Insurance denials for lack of prosthodontic coverage were reported by 75% of respondents (3\/4 teams). Among 14 respondents (40%) reporting socioeconomic effects on access, financial barriers were most frequently cited (11\/14, 79%), followed by transportation (7\/14, 50%) and work\/family obligations (6\/14, 43%). Among teams without an on-staff prosthodontist, 12 of 22 (55%) had access to an external prosthodontist. Proposed solutions included increased insurance coverage (20\/23, 87%) and legislative advocacy (17\/23, 74%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Access to prosthodontic care for patients with cleft conditions is limited by workforce shortages, inadequate funding, and insurance denials. Expanded insurance coverage, legislative advocacy, and strategic prosthodontist recruitment are needed to improve access.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10556656261489480","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T13:27:53Z","timestamp":1789997273000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prosthodontic Services in Cleft Care: Institutional Barriers and Pathways to Equity"],"prefix":"10.1177","author":[{"given":"Michael","family":"Hernandez","sequence":"first","affiliation":[{"name":"Division of Pediatric Plastic Surgery, UPMC Children's Hospital of Pittsburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobi J.","family":"Somorin","sequence":"additional","affiliation":[{"name":"Division of Pediatric Plastic Surgery, UPMC Children's Hospital of Pittsburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6718-0746","authenticated-orcid":false,"given":"Ethan","family":"Richlak","sequence":"additional","affiliation":[{"name":"Division of Pediatric Plastic Surgery, UPMC Children's Hospital of Pittsburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Bish","sequence":"additional","affiliation":[{"name":"Division of Pediatric Plastic Surgery, UPMC Children's Hospital of Pittsburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffany","family":"Jeong","sequence":"additional","affiliation":[{"name":"Division of Pediatric Plastic Surgery, UPMC Children's Hospital of Pittsburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8923-4781","authenticated-orcid":false,"given":"Alzbeta","family":"Novotna","sequence":"additional","affiliation":[{"name":"Division of Pediatric Plastic Surgery, UPMC Children's Hospital of Pittsburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1293-6167","authenticated-orcid":false,"given":"David L.","family":"Kornmehl","sequence":"additional","affiliation":[{"name":"Division of Pediatric Plastic Surgery, UPMC Children's Hospital of Pittsburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noor","family":"Allanqawi","sequence":"additional","affiliation":[{"name":"Division of Pediatric Plastic Surgery, UPMC Children's Hospital of Pittsburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelby","family":"Nathan","sequence":"additional","affiliation":[{"name":"Division of Pediatric Plastic Surgery, UPMC Children's Hospital of Pittsburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5242-3844","authenticated-orcid":false,"given":"Jesse A.","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Division of Pediatric Plastic Surgery, UPMC Children's Hospital of Pittsburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4985-8625","authenticated-orcid":false,"given":"Jessica","family":"Canallatos","sequence":"additional","affiliation":[{"name":"Kaleida Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4603-6177","authenticated-orcid":false,"given":"Lindsay A.","family":"Schuster","sequence":"additional","affiliation":[{"name":"Division of Pediatric Plastic Surgery, UPMC Children's Hospital of Pittsburgh"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)02321-3"},{"issue":"4","key":"e_1_3_2_3_2","first-page":"440","article-title":"Prevalence of congenitally missing permanent teeth in patients with cleft lip and\/or palate: a meta-analysis","volume":"54","author":"Suzuki A","year":"2017","unstructured":"Suzuki A, Takahama Y, Mukai Y, Hoshi K. Prevalence of congenitally missing permanent teeth in patients with cleft lip and\/or palate: a meta-analysis. Cleft Palate Craniofac J. 2017;54(4):440-450.","journal-title":"Cleft Palate Craniofac J"},{"issue":"1","key":"e_1_3_2_4_2","first-page":"39","article-title":"Long-term quality of life and patient satisfaction with prosthodontic rehabilitation in patients with cleft lip and palate","volume":"40","author":"Landes CA","year":"2012","unstructured":"Landes CA, Goral WA, Wiedeck H, By R. Long-term quality of life and patient satisfaction with prosthodontic rehabilitation in patients with cleft lip and palate. J Craniomaxillofac Surg. 2012;40(1):39-45.","journal-title":"J Craniomaxillofac Surg"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/jopr.13353"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00784-024-05574-w"},{"issue":"5","key":"e_1_3_2_7_2","first-page":"1165","article-title":"Disparities in cleft care: a review of insurance coverage and access to treatment","volume":"149","author":"Rochlin DH","year":"2022","unstructured":"Rochlin DH, Nagarajan N, Davis CR, Roth R. Disparities in cleft care: a review of insurance coverage and access to treatment. Plast Reconstr Surg. 2022;149(5):1165-1173.","journal-title":"Plast Reconstr Surg"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otc.2014.06.010"},{"issue":"1","key":"e_1_3_2_9_2","first-page":"112","article-title":"Financial barriers to comprehensive cleft care: an institutional perspective","volume":"155","author":"Ibrahim AM","year":"2025","unstructured":"Ibrahim AM, Roth JS, Patel NK. Financial barriers to comprehensive cleft care: an institutional perspective. Plast Reconstr Surg. 2025;155(1):112-120.","journal-title":"Plast Reconstr Surg"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000011410"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656241259883"},{"issue":"2","key":"e_1_3_2_12_2","first-page":"33","article-title":"Workforce analysis of prosthodontics in the United states: current trends and future needs","volume":"30","author":"Peck CC","year":"2021","unstructured":"Peck CC, Crow HC, Lee DJ, Hedger JE. Workforce analysis of prosthodontics in the United states: current trends and future needs. J Prosthodont. 2021;30(S2):33-40.","journal-title":"J Prosthodont"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1597\/1545-1569_2000_037_0534_dapcfp_2.0.co_2"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-849X.2010.00647.x"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.13244"},{"issue":"5","key":"e_1_3_2_16_2","first-page":"567","article-title":"State-mandated insurance coverage for craniofacial conditions: a 50-state analysis","volume":"60","author":"Azizollahi S","year":"2023","unstructured":"Azizollahi S, Khosla RK, Patel AJ, Koudstaal MJ. State-mandated insurance coverage for craniofacial conditions: a 50-state analysis. Cleft Palate Craniofac J. 2023;60(5):567-574.","journal-title":"Cleft Palate Craniofac J"},{"issue":"7","key":"e_1_3_2_17_2","first-page":"1023","article-title":"Insurance coverage mandates for cleft lip and palate: a state-by-state analysis","volume":"55","author":"Pfiefauf KJ","year":"2018","unstructured":"Pfiefauf KJ, Leonard MS, Schuster LA. Insurance coverage mandates for cleft lip and palate: a state-by-state analysis. Cleft Palate Craniofac J. 2018;55(7):1023-1029.","journal-title":"Cleft Palate Craniofac J"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000011379"},{"key":"e_1_3_2_19_2","unstructured":"Ensuring Lasting Smiles Act of 2025 S 1677 119th Cong (2025). Accessed July 2025. https:\/\/www.congress.gov\/bill\/119th-congress\/senate-bill\/1677"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/10556656221078488"},{"issue":"4","key":"e_1_3_2_21_2","article-title":"Socioeconomic status and access to dental care among children with orofacial clefts","volume":"120","author":"Liu JL","year":"2007","unstructured":"Liu JL, Howell SK, Jones DB. Socioeconomic status and access to dental care among children with orofacial clefts. Pediatrics. 2007;120(Suppl 4):S164-S171.","journal-title":"Pediatrics"}],"container-title":["The Cleft Palate Craniofacial Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10556656261489480","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10556656261489480","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10556656261489480","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T02:47:36Z","timestamp":1790218056000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10556656261489480"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,21]]},"references-count":20,"alternative-id":["10.1177\/10556656261489480"],"URL":"https:\/\/doi.org\/10.1177\/10556656261489480","relation":{},"ISSN":["1055-6656","1545-1569"],"issn-type":[{"value":"1055-6656","type":"print"},{"value":"1545-1569","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,21]]},"article-number":"10556656261489480"}}