Customized Maxillary Expansion in a Child with Unilateral Cleft Lip and Palate and Multiple Anchorage Teeth Loss

Patients with cleft lip and palate (CLP) often require pre-surgical maxillary expansion to prepare for alveolar bone grafting and proper arch alignment. However, early loss of primary teeth can preclude the use of traditional tooth-borne orthodontic appliances. This case report describes the treatment of a male patient with a unilateral complete CLP who initially presented at age 7 with compromised dental anchorage due to extensive caries, and subsequently underwent maxillary expansion at age 8. A conventional tooth-borne expander could not be utilized prior to secondary alveolar bone grafting. To address this, a fan-shaped expander supported solely by palatal miniscrews was designed. A custom thermoformed stent incorporating a radiopaque gutta-percha grid was fabricated to precisely guide miniscrew placement into the limited available palatal bone. This guided approach successfully reapproximated the maxillary segments, facilitating subsequent bone graft integration. This report demonstrates a practical, radiographically guided technique for miniscrew-assisted expansion in pediatric CLP patients lacking adequate dental anchorage.