Early Secondary Alveolar Bone Grafting
The aim of the reconstruction of clefting of the maxilla and alveolus is to close the residual nasoalveolar fistula, reconstruct the bony cleft defect involving the alveolar ridge, maxilla, and piriform aperture. The cleft of the alveolar process is mainly reconstructed by secondary grafting using the autogenous cancellous bone and marrow. This stabilizes the maxillary arch and adjacent teeth, thereby facilitating eruption of elements adjusted to the alveolar cleft and enabling orthodontic and restorative treatment. Furthermore, it leads to an improvement of facial morphology by elevation of the alar base [1–5]. In case of bilateral cleft lip and palate, an added benefit of bone graft reconstruction is stabilization of an often mobile premaxillary segment. The author prefers to perform an early secondary bone grafting (ESBG) between the age of 5 and 6, even if the lateral incisor is not present. In these cases, the central incisor is often bordering the cleft, and ESBG will provide adequate periodontal support to this area. The other advantage of ESBG is to provide enough support for the often-seen supernumerary tooth adjusted to the cleft border of the lesser maxillary segment, which could replace the missing lateral incisor.
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