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PubMed This is a summary of 28 peer-reviewed journal articles Updated
Orthodontics · Hypodontia in Cleft Palate

How Are Missing Teeth Treated in Cleft Palate Patients?

At a Glance

Missing adult teeth at the cleft site are treated through a multi-year plan. The process typically involves using expanders to make room, performing an alveolar bone graft to build bone, and either closing the gap with braces or placing a permanent dental implant once the jaw stops growing.

Missing adult teeth—particularly the upper lateral incisors (the teeth right next to the two front teeth)—are the most common dental anomaly in children with cleft lip and palate [1][2][3]. Because the cleft occurs exactly where these teeth usually develop, the tooth buds may be missing entirely (a condition called hypodontia) [4].

While this is a frequent source of worry for parents and kids, orthodontists and oral surgeons have a well-established, multi-year, staged plan to address it. This long-term roadmap typically involves making room for teeth, building new bone in the cleft site, maintaining space during adolescence, and eventually replacing the tooth.

Making Room: Early Orthodontics and Expanders

In children with a cleft palate, the upper jaw is often narrower than the lower jaw. To address this and create adequate space for all adult teeth, orthodontists often use rapid maxillary expanders (RME) or similar devices [5][6]. This phase usually happens during childhood (around ages 7 to 9). Expanding the palate not only corrects the bite but also ensures there will be enough physical room in the dental arch for a future replacement tooth if that route is chosen [5][6].

Building the Foundation: Alveolar Bone Grafting

A crucial step in managing a missing tooth at the cleft site is preparing the area to support teeth. Since there is naturally a gap in the gum and bone due to the cleft, a procedure called an alveolar bone graft (ABG) is performed to fill this gap [7][8].

  • Where the bone comes from: The bone used for this graft is most commonly taken from the patient’s own hip (the iliac crest). This is considered the “gold standard” because it provides the best quality and amount of bone for long-term success [9][10][11].
  • When it happens: This surgery is usually timed just before the adult canine (eyetooth) erupts, typically between ages 8 and 11 [12][13].
  • Why it matters: The newly placed bone provides essential support for the neighboring teeth to erupt properly and creates a solid foundation for a future dental implant or bridge [7][14]. Without a successful bone graft, there would not be enough bone volume to support a dental implant later on [15][16].

Deciding the Next Steps: Maintaining the Space vs. Closing the Gap

After the bone graft and early orthodontic expansion, your care team will decide on the best strategy for the missing tooth space. There are two main approaches:

  1. Closing the Space (Canine Substitution): The orthodontist moves the adjacent teeth together using braces to close the gap entirely. This avoids the need for an implant later and relies on the child’s natural teeth.
  2. Maintaining the Space: The orthodontist holds the gap open to replace the missing lateral incisor later [17][18].

Both are common, valid options. The best choice depends on your child’s bite, facial profile, and the quality of the bone graft. If the plan is to keep the space open, permanent replacements like implants cannot be placed until the jaw stops growing. Instead, the orthodontist will hold the space open using braces or a retainer [19].

Often, a pontic (a fake, cosmetic tooth) is attached to the braces or retainer to fill the gap so your child can smile confidently during their teenage years. It is extremely important to maintain rigorous oral hygiene around the pontic, braces, and retainers to prevent decay on the adjacent teeth.

Permanent Tooth Replacement

Once your child’s jaw has stopped growing (usually in late adolescence, around age 17 to 21), a permanent tooth replacement can be planned if the space was kept open. The multidisciplinary care team will evaluate the bone graft and the position of the teeth to determine the best option:

  • Dental Implants: An implant is a small titanium post placed into the grafted bone, topped with a lifelike artificial tooth. Placing an implant into grafted cleft bone is technically demanding and requires a highly skilled team. However, when successful, implants offer a highly reliable and aesthetically pleasing option [20][21][22]. Many patients report higher psychological comfort and better function with implants [23][24].
  • Bridges: A bridge involves placing crowns on the teeth adjacent to the gap and suspending a false tooth between them. Sometimes, a fixed partial denture (bridge) is used if an implant isn’t suitable, as it can help stabilize the final orthodontic result [25].

Because clefts can sometimes affect how the upper jaw grows [26], the team will also ensure the jaws are properly aligned—sometimes requiring jaw surgery—before placing the final permanent tooth [27][28].

Common questions in this guide

Why are adult teeth often missing in children with cleft palate?
The cleft naturally occurs exactly where the upper lateral incisors usually develop. Because of this gap in the bone and tissue, the tooth buds may not form at all, leading to missing adult teeth at the cleft site.
What is an alveolar bone graft and why is it needed?
An alveolar bone graft is a surgery that takes bone, usually from the patient's hip, and places it into the gap in the upper jaw caused by the cleft. This creates a solid foundation for adult teeth to erupt and provides the necessary bone volume to support future dental implants.
Should we close the tooth gap with braces or leave it open for an implant?
Both closing the space with braces and leaving it open for a future implant are valid options. The best choice depends on your child's bite, facial profile, and the quality of their bone graft. Your orthodontist will help determine the safest and most effective approach.
How will my child's missing tooth be hidden during their teenage years?
If the plan is to keep the space open for a future implant, orthodontists will hold the gap open using braces or a retainer. A temporary, fake cosmetic tooth called a pontic is often attached to the dental hardware so your child can smile confidently while waiting for their jaw to finish growing.
When can a permanent dental implant be placed in the cleft site?
Permanent tooth replacements like dental implants cannot be placed until the jaw completely stops growing. This typically occurs in late adolescence, around age 17 to 21, at which point the cleft care team will evaluate the bone graft and plan the permanent implant.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Has a panoramic X-ray or 3D scan been performed to confirm exactly which adult teeth are missing?
  2. 2.Is my child a better candidate for closing the gap with braces (canine substitution) or keeping it open for a future implant?
  3. 3.When do you anticipate my child will need an alveolar bone graft, and where will the donor bone come from?
  4. 4.What is the plan for a temporary cosmetic tooth (pontic) during their teenage years, and how do we handle it if the retainer breaks or is lost?
  5. 5.Does my child show any signs of upper jaw growth deficiency that might require jaw surgery before we place a permanent tooth?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

Related questions

Why Use Arm Restraints After Cleft Palate Surgery?Why Choose an ACPA-Accredited Cleft Team?What Is the Best Age for Cleft Palate Surgery?What Are the Best Bottles for Cleft Palate Feeding?Why Do Babies With Cleft Palate Get Ear Infections?Will My Child Always Have a Nasal Voice After Cleft Repair?How to Choose a Cleft Palate Surgeon for Your BabyIs a Cleft Palate Hereditary? Recurrence RisksDoes My Teen Need Jaw Surgery for a Cleft Palate?Why is Milk Coming Out of My Baby's Nose with Cleft Palate?How Pierre Robin Sequence Affects Cleft Palate TreatmentWhat Are the Signs of a Palatal Fistula After Cleft Repair?What Are the Symptoms of a Submucous Cleft Palate?What Causes a Cleft Palate During Pregnancy?

References

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This page provides general information about dental treatments for missing teeth in cleft palate patients for educational purposes. Always consult your child's cleft care team and orthodontist for a personalized, multi-year treatment plan.

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