In those children who have had a complete cleft of the lip and palate repaired, there is one area that is not touched. This is the gum (or alveolus). Early surgery to repair this is also thought to stop normal growth of the upper jaw. This aspect of the reconstruction is normally done just before the permanent eye teeth (canine teeth) erupt –usually between nine and twelve years of age. Just before these teeth erupt a small bone graft from somewhere like the hip bone is used to fill the gap. Now the eye tooth can erupt or be guided into this bone grafted area giving a complete arch of teeth without gaps.
There is some orthodontic work prior to the bone graft surgery to prepare the bone graft site. This involves putting a small spring (quad helix) in between the teeth on either side of the cleft. Over a period of about 6 months this slowly makes the gap big enough to take the new bone.