Abida Ijaz.
Orthodontic management and tertiary graft in unilateral cleft lip and palate.
J Pak Dent Assoc Jan ;15(1):49-54.

Bone grafting to repair an alveolar cleft is an integral part of the treatment in unilateral and bilateral clefts of the lip and palate. The graft may be primary secondary or tertiary. Tertiary graft is placed to provide a firm anatomic base for prosthodontic rehabilitation, to improve stability and health of periodontium and to assist in the closure of persistent bucconasal fistulae. Presented here is a case of a female patient with right unilateral alveolar cleft and repaired lip and anterior palate on the right side. Orthodontic and surgical management of this anomaly is described. After about over a year of orthodontic alignment leveling and cuspid retraction (on the right side), tertiary bone grafting was performed. An autogenous corticocancellous particulate bone graft was harvested from the anterior iliac crest using the standard lateral approach. The graft was held in position for six months with stabilizing heavy rectangular arch. Later on minor dental adjustments were followed by Hawley`s retainers and the patient was referred for fixed prosthesis. The treatment outcome was an acceptable occlusal relationship, a successful closure of the alveolar cleft as well as improved periodontal conditions of the teeth adjacent to the cleft area.

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