Orthodontic assisted periodontium generation in cleft alveolus and functional rehabilitation

Abstract

A 16-year-old girl reported with the complaint of missing upper left front teeth and large alveolar cleft defect. The patient was an operated case of cleft lip and palate, managed with primary surgical treatment protocol at age 5 and 11 months and secondary alveolar grafting at 11 years. However, the grafting failed to achieve desired result leaving large residual defect (20 mm). The orthodontic treatment aimed at reduction of alveolar cleft defect, followed by grafting. This was a reverse, innovative plan as usually grafting precedes controlled tooth eruption. A moving tooth carries along its periodontium, and this physiological phenomenon was used to reduce the size of the cleft. Nine months of orthodontics resulted in the eruption of canine through the cleft defect, reducing defect by 12 mm, and the tertiary alveolar grafting obliterated the residual 8 mm defect. Thereafter, orthodontic treatment was completed, and fixed prosthesis provided for missing left lateral incisor for optimal function and esthetics.