Radiographic determination of the position of the maxillary lateral incisor in the cleft alveolus and parameters for assessing its habilitation prospects

Objective: Develop patient selection criteria and guidelines for the diagno stic work-up for early secondary alveolar bone graft designed to accommodat e a lateral incisor in the cleft. Design: A literature review with clinical examples, Interventions: For the majority of cleft lip and palate (CLP) patients, the timing of the secondary alveolar bone graft procedure is devised to accomm odate the eruption of the maxillary canine, However, when the lateral incis or is present in the cleft area, a decision may be made to perform early gr afting in order to salvage an additional tooth. Appropriate case selection for this intervention is the key for successful dental habilitation in the cleft area. Results and Conclusions: Attempts to maintain the lateral incisor are recom mended only if the tooth contributes to the comprehensive orthodontic and r estorative patient care and when the presence of a lateral incisor with ade quate size, shape, and proper position may be demonstrated. For optimal dec ision making, the position, form, and periodontal ligament support of the l ateral incisor should be assessed, Evaluation of these parameters is based chiefly on radiographic imaging. Occlusal projections and traditional tomog raphy may augment the information available from periapical and panoramic r adiographs. However, each of these has benefits and drawbacks that require consideration.