**8. Summary**

**7.2. Patients with moderate to severe skeletal discrepancy**

**7.3. Summary of treatment sequencing for mixed dentition stage**

a day for 6–12 months. MP can be started 4–6 weeks after SABG.

through oral appliances such as an arch wire and/or lingual arch.

for the orthodontist.

168 Current Approaches in Orthodontics

options can be considered if needed [5].

**7.4. Unfavorable conditions**

cleft, (c) 3D image of the case.

alveolar graft–maxillary protraction if needed.

Early determination of the eventual need for maxillary osteotomy is a very important decision

Extracting lower premolar to correct anterior crossbite and trying to camouflage skeletal discrepancy are not appropriate in growing children. In that case, leveling only the upper arch, finishing with crossbite, and monitoring the growth are the best options. Early surgical

Evaluation CBCT–maxillary expansion and/or ortho-tooth movement–fistula closure and

Maxillary protraction protocol: 350–450 gram per side protraction force is adequate 14–15 hours

Part of this force should be transmitted as intermittent force to the maxillary anterior teeth

If maxillary deficiency accompanies with a wide alveolar cleft and/or fistula, it will be more challenging for both orthodontist and surgeon to treat growing patients [54] (**Figure 9**).

Late bone grafting or prolonged orthodontic treatment prior to bone grafting leads to loss of orthodontic control, marked instability of the premaxilla, and difficulty in maintaining

**Figure 9.** Wide alveolar cleft limits both orthodontic treatment and maxillary osteotomy. (a, b) intraoral views of a wide

The success of the orthodontic treatment and SABG is strongly interrelated. Carefully coordinated orthodontic and surgical involvement is critical for the well-being of the patients with CLP.
