Secondary bonegrafting in unilateral cleft lip palate patients: indications and treatment procedure

A consecutive series of 62 complete unilateral cleft lip and palate patients were investigated with respect to indication for a secondary bone grafting. 2 major indications for secondary bone grafting were established. One was a symptomatic oro-nasal fistula, the other one being a bony defect in the alveolar process, which could impair orthodontic treatment and prosthodontic rehabilitation in the cleft area. The average age for bonegrafting was 12 years. After surgery, fistula-related discomfort was eliminated and speech disorders were drastically reduced. Orthodontic uprighting of teeth and correction of mid-line deviations indicated in 50% of the patients were facilitated. In 10% of the cases with extensive defects in the alveolar process, the graft enhanced the possibility for later prosthodontic treatment. Secondarily, periodontal conditions improved. When bonegrafting was performed before canine eruption, total dental rehabilitation by orthodontic treatment was often sufficient, thus decreasing the need for later prosthodontic restoration of the cleft area. Patients who had surgery after eruption of the cleft side canine exhibited more complications. The optimal treatment sequence therefore appears to be transversal expansion of the maxilla in the late mixed dentition, followed by bone grafting. Maxillary expansion must be retained until final orthodontic and prosthodontic treatment is carried out.