Three-dimensional reconstruction of large secondary alveolar cleft by two-stage distraction

Our aim is to demonstrate a method for reconstruction of a wide alveolar cleft before implant placement.

An adult patient with a unilateral cleft palate and a wide alveolar and maxillary bone defect underwent transport distraction osteogenesis to medialize the left segment and reduce the alveolar cleft to a minimum. Removal of the transport distraction device was accompanied by autogenous bone grafting to the remaining alveolar defect in the medial cleft, attaining an osseous closure with adequate soft-tissue coverage. Three months later, vertical alveolar distraction of the newly reconstructed bone was performed. Implants were placed after the removal of the distraction device.

Alveolar bone was transported forward 20 mm followed by 15 mm vertical distraction. The large cleft palate defect was reconstructed in three dimensions by the two-stage distraction osteogenesis, and the soft tissues were expanded to achieve functional correction. After removal of the distraction device, dental implants were osteointegrated in the newly reconstructed bone for fixed dental rehabilitation.

The two-stage distraction allowed gradual closure of a large defect three dimensionally. This method can be safely performed not only in patients undergoing initial treatment for large alveolar clefts but also after failed bone grafting.