Sequential Fixed Extraction Correction For Cleft Lip And Palate

This case report described an adult patient with unilateral cleft lip and palate combined with alveolar cleft treated with fixed tooth extraction correction. Permanent dentition with postoperative status of repaired left unilateral cleft lip and palate combined with alveolar cleft, absence of the left upper lateral incisor, 5mm crowding in both upper and lower arches, midline discrepancy between the upper and lower arches, anterior crossbite, and bilateral neutral molar relationships; chronic periodontitis.Prior to treatment, periodontal therapy and surgical extraction of teeth 15, 35, and 45. A standard edgewise appliance with Xinya base was used to align and level the dentition,the remaining spaces were closed, and the occlusal relationship was finely adjusted. A transparent vacuum-formed retainer was used to maintain. The total treatment duration was 29 months. The main challenge in this case is the alveolar cleft in the maxilla. During treatment, there is a significant risk of gingival recession and bone dehiscence around teeth 21 and 23. Additionally, incomplete space closure may occur by the end of treatment.To address these issues, the orthodontic process is combined with surgical alveolar bone grafting to improve the integrity of the dental arch. The direction of root movement is also crucial during treatment. Multidisciplinary collaborative treatment is crucial in the sequential management of cleft lip and palate. Close interdisciplinary coordination throughout the treatment process is essential to achieve satisfactory corrective outcomes.