Interdental Distraction Osteogenesis in Unilateral Cleft Lip and Palate Patient with Wide Alveolar Cleft

Abstract

Alveolar bone grafting is routinely performed in repair of alveolar clefts. When the alveolar cleft is wider than 11 mm, however, the survival rate of the bone graft and prognosis are poor. Here, we describe successful orthodontic treatment using interdental distraction osteogenesis (IDO) with a tooth-tooth type distractor to reduce the width of the alveolar cleft in a patient with unilateral cleft lip and palate. The patient was a 12-yearold girl with unilateral cleft lip and palate, maxillary dentition midline deviation, congenitally missing maxillary lateral incisors, a palatally-displaced right upper first premolar, a wide alveolar cleft (20 mm), and mandibular prognathism due to maxillary hypoplasia. Treatment comprised a combination of orthodontic treatment and IDO. After treatment, appropriate occlusion, space closure in the maxillary arch, coincidence of the maxillary and facial midlines, and incorporation of the right maxillary first premolar into the arch were obtained. These results suggest that IDO is effective in treating cleft lip and palate patients with a wide alveolar cleft.

Outcomes of Bifocal Transport Distraction Osteogenesis for Repairing Complicated Unilateral Alveolar Cleft

“…Bone-borne devices were used in this study because previous research found that tooth-borne devices result in more dental movements than bony movements. A bone-borne distractor placed above the transport segment may also help to reduce superior tilting 4,5 . There was no relapse in this study's follow-up period (which lasted 6–18 months).…”

“…During mixed dentition, alveolar cleft closure in conjunction with orthodontic treatment has become a widely accepted treatment choice 1,2 . Secondary grafting provides adequate bone support for teeth adjacent to the cleft area, a bony environment for teeth eruption in the cleft site, a bony continuity in the maxillary alveolar ridge, and a satisfactory alveolar bone contour, arch width support to prevent maxillary arch collapse, elimination of oronasal fistulas, improved facial symmetry, and improved oral hygiene status 3–6 …”