**6. Postgraft orthodontics**

If the graft is done at proper time, before eruption of the cleft-related permanent canine, observation of the permanent dentition is generally all that is necessary. The status of cleft side unerupted teeth does need careful monitoring [5]. Physiologic eruption of the adjacent canine will provide enough stimulation for the alveolar graft. Sometimes orthodontic traction might be needed if the position of the canine is not appropriate for spontaneous eruption. High degrees of canine inclination indicate risk for altered eruption and impaction [5, 32].

If graft is done at age 7–8, correction of incisor irregularities provides also favorable stimulation to the graft.

Orthodontic movement of the cleft-adjacent teeth in the direction of the grafted bone can be instituted at an average of 3 months after the bone grafting, if needed. Combined interceptive bone grafting and orthodontic treatment at an early age avoid more extensive prolonged treatment later in the patient's life [5, 13, 19, 34].

It has been recommended not to delay orthodontic treatment more than 6 months after grafting, in cases in which an a-p crossbite or a residual transverse posterior crossbite exists. Oneto two year delay in stimulation of the ABG of the premaxilla (by orthodontic treatment) can lead to serious postoperative problems. Where there is no stimulation of the graft, there tends to be "locking" or lingual collapse of the maxillary central incisors and collapse of the premaxillary arch [19].

> into the newly formed bone and increases its vertical height. Maintaining the alveolar bone height in the cleft area is important to prevent long-term complications, such as gingival

> **Figure 6.** Space closure with canine substitution in patient with successful ABG. (a-d) intraoral occlusal views of the case. a. pre-graft, b. post-graft, c. after eruption of the canine, d. levelling of the upper dentition. (e-h) panoramic radiographs

Orthodontics in Relation with Alveolar Bone Grafting in CLP Patients

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of the case. a. pre-graft, b. post-graft, c. eruption of the canine, h. levelling of the upper arch.

Moreover, the natural dentition has the best prognosis for long-term health of the dentition. Thus, space closure with the canine substitution should be the first treatment choice for patients with CLP [5, 32, 33] (**Figure 6**). The functional stress imposed by orthodontic treatment influences the volume and prevents resorption of the grafted bone. Higher grafting success was found in the case of space closure than in the case of space openings [5, 33].

retractions and periodontitis [32, 33].
