Cleft Lip and Palate Program

Orthodontic preparation for alveolar cleft repairs (bone grafting)

At The Children’s Hospital of Philadelphia, we typically repair alveolar clefts between 6 and 8 years of age, when your child’s permanent teeth are beginning to erupt. An alveolar cleft is the cleft in the gum line that runs through the arch where the teeth are aligned.

Alveolar cleft repair often requires orthodontic preparation to bring the alveolar (gum) segments into good alignment and create space for permanent teeth to erupt. Your orthodontist will work closely with your child’s plastic surgeon to prepare for any necessary bone grafting, a procedure in which the surgeon takes bone from the hip and packs it into any area of the alveolus where the bone is deficient.

Orthodontic preparation at this stage typically includes palatal expansion. Using an orthodontic appliance that is fixed to the upper teeth, our specialists will expand and align the alveolar segments to prepare an optimal bone graft site.

After expansion is complete, the expansion appliance is removed, and a surgical splint is fabricated for patients before they have their surgery. The splint is a removable retainer that fits on the upper teeth, and it is to be worn full time after surgery. This provides stability, like a cast, to allow the newly packed bone to heal and solidify into the new expanded dental arch.

Updated January 2014

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