Canine eruption into grafted bone in maxillary alveolar cleft defects

Forty-six patients with clefts of the alveolus who had received alveolar bone grafts (secondary osteoplasties) at ages 7-14 years, were studied. A total of 64 affected canines from 18 bilateral and 28 unilateral alveolar cleft patients was available. Follow up orthopantomographs were examined to determine the state of root development and spontaneous canine movement through the grafted site. The postoperative observation period ranged from 2-8 years (mean 4.3 +/- 1.5). All test canines erupted through the graft. Spontaneous eruption occurred for 27% of test canines, 17% required surgical uncovering (either bony or soft tissue), and 56% required surgical uncovering and orthodontic assistance to accomplish eruption. All patients required orthodontic treatment to accomplish arch alignment. The prognosis for canine eruption through a graft site is most favorable if the graft is performed at 1/4-1/2 canine root formation and when the patient is aged 9-12 years. The post graft observation period is very important and requires complete cooperation between the orthodontist and the surgeon.