Abstract
An important aim of secondary alveolar bone grafting is alignment of teeth into the bone bridge during orthodontic treatment. When the maxillary lateral incisors are missing, unerupted canines situated at the posterior of alveolar clefts may spontaneously move into the grafted area after bone grafting. On the other hand, erupted canines may migrate into the bone bridge with orthodontic treatment. In both cases, dental rehabilitation does not use any prostheses. However, relapse of the dental arch may be observed long after orthodontic treatment.
We report a 36-year-old patient with unilateral cleft lip and palate who maintained an ideal dental arch without prostheses for about 10 years after orthodontic treatment, but her occlusion gradually developed into anterior cross bite. Thus, she underwent additional orthodontic treatment in order to improve anterior cross bite and reserve space for lateral incisors on the bone bridge. After improvement of anterior cross bite, she was treated with an implant prosthesis, and her dental rehabilitation was satisfactory.
She had undergone alveolar bone grafting at age 7 years and 4 months, and orthodontic treatment had finished at age 21 years. During her dental rehabilitation, because of congenital missing left lateral incisor, the left canine was aligned at the left central incisor. Although periodic follow-up continued, anterior cross bite developed gradually. She therefore underwent additional orthodontic treatment at age 32 years. The width of the opened bone bridge was 5–7 mm from the buccal side to the palatal side, and showed a vertical height of 11 mm on X-ray computed tomography. After implantation of the fixture, her prosthetic dental rehabilitation was satisfactory at age 35 years.
Based on this case, dental rehabilitation with specific treatment goals may infrequently result in unplanned long-term changes. Thus, the bone bridge, which maintains stable dentition, comprises rich bone tissues and is subsequently capable of supporting orthodontic treatment with an implant prosthesis. Our experience suggests that patients with cleft lip/palate should be followed for long periods of time whenever possible.
