Abstract
We reported a case of bilateral cleft lip and palate treated by surgical rotation of tooth germ of the lateral incisor adjacent to the alveolar cleft along with bone graft. The patient was a 7-year, 4-month-old boy at the time of the operation. The alveolar cleft existed only on the right side. The image findings revealed that the upper right lateral incisor was conical, infraversed and inclined mesialy at about 90 degrees. The degree of completion of root formation described by Moorrees was Ri to R1/4. The right upper second premolar was also absent. During the operation, the tooth germ of the lateral incisor was exposed on the cleft margin of the minor segment. After extraction of the upper right deciduous canine and removal of the dental sac of the crown of the lateral incisor, the lateral incisor was inclined toward the socket of the deciduous canine in order not to move the location of the root apex. Finally, particulate cancellous bone and marrow from the iliac crest were grafted and the wound was completely closed. The lateral incisor erupted at 8 months and the root formation was completed by 2 years after the operation. There has been no evidence of root resorption, curved root or pulpa canal obliteration in the 7 years since the operation.
In order to achieve successful results of surgical rotation of tooth germ, it is important to operate at the initial root formation stage, with less surgical damage, and not to move the location of the root apex. It is also recommended that the degree of root rotation should not exceed 90 degrees. If these conditions are satisfied, the surgical repositioning of the tooth becomes a treatment option for occlusal formation of the alveolar cleft region where misdirection and dislocation of teeth occur frequently.
