Alveolar bone grafting is an essential procedure for the formation of permanent occlusion of patients with cleft lip and palate. However, surprisingly, less than half a century has passed since alveolar bone grafting was first performed in Japan, on March 17, 1982, by the late Professor Teiichi Teshima, Professor and Chair of the Second Department of Oral and Maxillofacial Surgery at Tohoku University School of Dentistry. The formation of permanent occlusion following alveolar bone grafting has undergone numerous transformations and has become the treatment model for patients with cleft lip and palate in Japan today, thanks to the contributions of the late Dr. Shoko Koichi, former Editor-in-Chief of the Japanese Cleft Palate Association, and other pioneering researchers.
　This paper introduces the early-stage treatment system for permanent occlusal formation using alveolar bone grafting, which has been conducted at the Department of Oral and Maxillofacial Functional Rehabilitation and Oral and Maxillofacial Surgery, Tohoku University School of Dentistry, since the 1980s.

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Alveolar bone grafting is an integral component of surgical interventions for cleft lip and palate. The standard method of bone grafting involves harvesting bone from the ilium, however, postoperative difficulty in walking and delayed ambulation due to sustained pain at the iliac site remain major concerns. Pain control at the harvested site of the iliac is critical for patient satisfaction and improving quality of life post-surgery. We have been using ropivacaine hydrochloride, a long-acting local anesthetic, in the iliac bone grafting area for alveolar bone grafts since 2013, and report its efficacy in the present study.
　Alveolar bone grafting was performed on 101 patients, comprising 60 boys and 41 girls, aged between 7 and 13 years, with 111 alveolar clefts, at the Department of Dentistry, Oral and Maxillofacial Surgery, Jichi Medical University Hospital between April 2006 and March 2019. Bone graft harvesting was performed on the anterior iliac crest. The 87 patients who received ropivacaine hydrochloride local injection post iliac crest harvesting were designated as the R group, and the remaining 24 patients, who did not receive ropivacaine hydrochloride, were designated as the NR group. Postoperative analgesic use, time to resumption of walking, and postoperative hospital stay were compared between the two groups.
　The mean initial postoperative analgesic administration time was 8.3 hours in the NR group and 8.2 hours in the R group. A total of 70.8 % of patients in the NR group and 56.3 % in the R group needed analgesics before initiation of regular analgesic administration. The mean time to resumption of walking was 42.9 hours in the NR group and 23.5 hours in the R group, with the R group being able to walk significantly earlier. The postoperative hospital stay was 5.5 days in the NR group and 2.9 days in the R group, with the R group having a significantly shorter hospital stay. Multiple regression analysis revealed that the use of ropivacaine hydrochloride significantly influenced postoperative hospital stay.
　Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are routinely used as postoperative analgesics in children. However, the systemic administration of analgesics alone does not provide sufficient pain relief during physical activity, resulting in delayed early ambulation. We report that the use of ropivacaine hydrochloride post iliac crest harvesting results in early postoperative ambulation and shorter hospital stay. Ropivacaine hydrochloride is thus a highly effective pain relief treatment due to its sustained analgesic effects.

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A statistical investigation was carried out on 839 patients with congenital disorders who visited the Division of Orthodontics at the National Center for Child Health and Development between April 2010 and March 2020. In addition, a comparison was conducted between disorders covered by public insurance for concomitant orthodontic treatment and disorders covered by the Medical Aid Program for Chronic Pediatric Diseases of Specified Categories (specific pediatric chronic diseases). The results were as follows.
　1.　 A total of 84 disorders were observed. The five most frequently observed disorders were, in order of frequency, non-syndromic cleft lip and/or palate, Goldenhar syndrome (including branchial arch abnormalities), Down syndrome, Beckwith-Wiedemann syndrome, and craniosynostosis (including Crouzon syndrome and acanthosyndactyly).
　2.　 All of the disorders with six or more patients were covered by public insurance for concomitant orthodontic treatment.
　3.　 The classification of 313 patients with non-syndromic cleft lip and/or palate were cleft lip (23 patients), cleft lip and alveolus (56 patients), cleft lip and palate (156 patients), and cleft palate (78 patients).
　4.　 Goldenhar syndrome (including branchial arch abnormalities), Pierre Robin syndrome, and Russell-Silver syndrome, which are frequently treated in orthodontic treatment, were covered by public insurance for their orthodontic treatment, but not included in specific pediatric chronic diseases.
　5.　 Disorders covered by public insurance for orthodontic treatment belonged to 11 out of 16 disease groups of specific pediatric chronic diseases and corresponded to 66 diseases (7.8 %) of 845 specific pediatric chronic diseases.
　The above results show that many patients with congenital disorders that are widely recognized to have malocclusions visit our hospital and public insurance support is adequately provided to improve concomitant malocclusion. Specific pediatric chronic diseases include many disorders that are rarely encountered in dental care settings and are not covered by public insurance for their orthodontic treatment. This finding indicates the importance of encouraging understanding of these disorders from a dental perspective and disseminating information to further expand the insurance coverage for orthodontic treatment.

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