Elimination of the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment.

A combined surgical/orthodontic procedure to eliminate the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment is described. The operations have been carried out on 378 patients: 240 males and 138 females. Seventy-two patients had bilateral clefts, making a total of 450 grafted clefts. The optimal age for this secondary bone grafting has been found to be 9 to 11 years. In 292 of the cases, the canine had reached its final position in the arch, which allowed a four-group semiquantitative assessment of the newly obtained interdental septum on dental radiographs. The best results have been achieved in cases where the bone graft was carried out prior to the eruption of the canine. In this group, a normal (category I) interdental septal height was achieved in 64 percent and a slightly lower (category II) interdental septum in 32 percent. Interdental septa classified as type I and II are considered to be acceptable. The cleft space was closed in 90 percent of the cases. No significant difference between unilateral and bilateral cases was found. When the same procedure was carried out after eruption of the canine, the results were less favorable.