Combining orthodontic tooth movement with distraction osteogenesis to close cleft spaces and improve maxillary arch form in cleft lip and palate patients

Orthodontic tooth movement occurs when dental roots move through alveolar bone. This article describes a different biological process, the movement of blocks of bone containing teeth along an orthodontic archwire to reposition a segment and create additional bone by distraction osteogenesis. The distraction of a bony segment, also termed bony transport, is particularly useful for treating children with severe cleft lip and palate deformities who have inadequate maxillary arch forms, large cleft spaces, vertically canted segments, or restricted skeletal development. The following cases are presented to illustrate how orthodontic tooth movement can be combined with distraction osteogenesis to solve some unusual orthodontic problems in cleft lip and palate care. They represent unusually severe skeletal deformities that were inadequately treated with palatal closure surgeries. The first 3 cases illustrate the use of bony transport to close large alveolar clefts or palatal fistulae. The last 3 cases illustrate the use of bony transport to reposition maxillary segments to improve the dental arch form. Once an alveolar segment has been surgically