A 10 year old patient reported to department with BCLP (bilateral cleft lip & palate); the maxillary transverse width was normal, lateral incisor was congenitally missing with impacted canine. What will be the treatment approach?
(A) SABG only (B) SABG followed by expansion (C) Expansion followed by SABG (D) Only expansion
(A) Timing of SABG surgery:
Secondary alveolar bone grafting (SABG) is done at an age when the growth inhibition effects of the surgery on maxilla are minimised, and it can help the maxillary canine or lateral incisor to erupt normally through the cancellous bone. After the age of 9 years, maxillary growth is minimal. Secondary bone grafting is done during the mixed dentition stage after the eruption of permanent incisors, but before the eruption of permanent canines. The timing of bone graft is based on the root formation and eruption pattern of the maxillary lateral incisor and maxillary canine. In case, insufficient bone is available in the cleft area for the lateral incisors to erupt, bone graft can be done around 7 years of age.
Note: In this patient, since the transverse width is normal, there is no need for expansion.
Orthodontics: Diagnosis and Management of Malocclusion and Dentofacial Deformities 3rd ed Om P. Kharbanda pdf no 3709