Between the ages of 8 and 10, the remaining gap in the hard palate and the cleft jaw can usually be closed. The gap in the hard palate has usually gotten smaller on its own during this time. Bone harvested by scraping the outside of the skull under the hair is placed in the jaw cleft.
Closing the jaw cleft is important because the orthodontist can then move the small incisor to its proper location. However, it is not uncommon for it to be a better idea to remove the small incisor (lateral incisor) altogether because the tooth is malformed and/or damaged. At the age of 17-18, when the patient is fully grown, a root implant can be placed. Sometimes it is necessary to scrape and transplant more bone onto the too narrow jaw bone in order to give the implant something to bite into. This procedure may be combined with any eventual nose correction and/or secondary lip correction. Until that time, the patient can wear a temporary bridge. After closure of the jaw cleft, the orthodontist can begin his or her work.
