Abstract
We describe a case whose permanent canine underwent surgical exposure and was aligned into grafted bone actively with orthodontic treatment after bone grafting, and the occlusion has been stable for a long period of time. A male patient had a complete unilateral cleft lip/palate, and fresh autogenous cancellous bone and marrow harvested from iliac bone were grafted to the alveolar cleft at 8 years 2 months of age.
The width of the cleft was 7 mm on the alveolar side, and 17mm on the wide nasal side at the point of the bone grafting operation.
Although the exchange of erupting permanent teeth had been observed after bone grafting, the canine in the left maxilla was found to be perpendicular to the root of the adjacent central incisor on panoramic radiographs. Problems with canine eruption were suspected. So surgical exposure of the impacting canine was prformed two years and eight months after bone grafting.
We considered that this surgical exposure was done on the following grounds: the dislocation of canine-tooth germ had taken place because of wide cleft on the nasal side, and the direction of the canine root formation depended on the existence of maxillary bone, so the root axis was decided. From the literature, as the root axis did not change after bone grafting, the direction of canine eruption might be limited. In this case the canine was guided into grafted bone at the alveolar cleft with orthodontic treatment after surgical exposure. Permanent occlusion was completed at 15 years 6 months of age.
More than 18 years after the bone grafting, the occlusion remains stable. The axis of the canine remains controlled without relapse.
Our experience with this case suggested that alveolar bone grafts provide places where cleftadjacent canines erupt and align, and thus help to acquire stable occlusion.
