Combined bone grafting and delayed closure of the hard palate in patients with unilateral cleft lip and palate: Facilitation of lateral incisor eruption and evaluation of indicators for timing of the procedure

Objective: To compare outcomes of bone grafting performed before eruption o f the lateral incisor to outcomes of grafting performed before eruption of the canine and to evaluate the long-term results of bone grafting combined with delayed closure of the hard palate during mixed dentition. Design: Seventy consecutive patients (52 men and 18 women) with complete un ilateral cleft lip and palate were studied. All patients underwent bone gra fting with simultaneous closure of the cleft in the hard palate at the stag e of mixed dentition. The velum had been repaired in infancy. Mean age for the bone grafting procedure was 8.4 years. Bone grafting was performed to f acilitate eruption of the lateral incisor in 43 (61%) of the patients and t o facilitate eruption of the canine in the remaining 27 (39%) patients. Int raoral radiographs were used to evaluate the morphologic characteristics of the cleft and the stage of eruption of the permanent lateral incisor and c anine before bone grafting. Mean followup time was 4.0 years (range, 1-10.1 years). Results: The mean time for the surgery, which included bone grafting and re pair of the residual cleft in the hard palate, was 109 minutes, and the mea n amount of bleeding was 121 mi. The rate of dehiscence in the flap coverin g the alveolar bone graft was 14%, and the rate of total failure of bone gr afting was 3%. An oronasal fistula developed in the hard palate of 13% of p atients, but the fistula was of sufficient size to serve as an indication f or reoperation in only 6%. The postoperative alveolar bony height in the cl eft area was more than 75% of the normal height in 94% of patients. Closure of the cleft space in the dental arch was performed or planned to be achie ved orthodontically in 91% of patients. When bone grafting was performed to facilitate eruption of the lateral incisor, the cleft space was closed ort hodontically in 100% of patients. The optimal indicator for timing of the b one grafting procedure from an orthodontic point of view was when the perma nent lateral incisor or the canine close to the cleft was covered by a thin shell of bone (i.e., 7-9 years of age).