Bone grafting and orthodontic treatment for patients with alveolar clefts

Most of cleft lip and palate patients have malocclusions accompanied with alveolar defects and/or depressions, retardation of maxillary growth, tooth malposition, depression of nasal alar base and so on. For the orthodontic and the prosthetic treatments, there are severe restrictions due to the discontinuity of alveolar bone. This article is to report our treatment system which combines the bone grafting with the orthodontic treatment for patients with alveolar clefts and clinical results. Autogenous iliac cancellous bone was mostly used and has shown viable in high percentage for the unilateral cleft cases. When the grafted bone was viable sufficiently in the cleft site, the alveolar contour was well improved and the eruption or the movement of tooth into the grafted bone was achieved. Furthermore, the fixation of floating premaxilla or the stabilization of advanced maxilla was done by the grafted bone. The ages from 8 to 10 years are adequate for the bone grafting especially in cases of the guidance of tooth eruption, the tooth movement and the fixation of floating premaxilla. But in cases of the maxillary advancement surgery, the ages from 15 to 17 years are adequate, because the growih of jaw bone has stopped by these ages. Although the further technical improvements would be recommended, the bone grafting combined with the orthodontic treatment will be one of the essential treatment procedures for the patients with alveolar clefts