Abstract
A patient with incomplete cleft lip and alveolus (classified (3,0,0) by Kamiya) in a growth period just before the maximum pubertal growth spurt underwent secondary bone grafting using particulate marrow and cancellous bone at the age of five years and seven months. The implications of bone grafting before eruption of the upper central incisor are discussed herein. The antero-posterior bony defect pattern of the alveolar cleft in this patient was type A (classified by Kita et al. ), that is, the mesiodistal width of the alveolar cleft was nearly constant as shown by computed tomography, and the mesiodistal width of the alveolar cleft on the nasal floor was larger than that on the alveolar crest. The tooth bud of the cleft-sided upper central incisor was observed to be displaced to the noncleft side from the median line by CT. The average width of the alveolar cleft was 9 mm and 2.5 g of bone chips were transplanted in the alveolar cleft region. The cleft-sided central incisor erupted one year after bone grafting, earlier than the noncleft-sided tooth. Roentgenography revealed that the mesial rotation of the upper cleft-sided central incisor was reduced and the lingual change of its axial inclination became less than that of the opposite one after bone grafting. The orthodontic labial movement and alignment of the upper cleft-sided central incisor began one year eight months after surgery. The growth direction of the maxilla did not change before and after bone grafting. The findings indicated that secondary bone grafting, performed before eruption of upper central incisor, improved the axial inclination of the malpositioned cleft-sided central incisor and simplified the orthodontic therapy.
