Orthodontic treatment for a patient with a unilateral cleft lip and palate and congenitally missing maxillary lateral incisors and left second premolar

Treatment of a patient with a cleft lip and palate can be challenging. A woman, aged 26 years 8 months, was referred for orthodontic evaluation of her anterior crossbite. She was unhappy with the unesthetic appearance of her maxillary anterior teeth, which were behind her mandibular anterior teeth. She had a unilateral cleft lip and palate and had received primary lip repair and palatoplasty when she was younger, as well as rhinoplasty and a secondary lip repair when she was 15. At the pretreatement evaluation, she had a concave profile with an overjet of −9 mm, a Wits appraisal of −3.8 mm, and a transposed ectopic maxillary right canine. She was treated with orthodontic treatment alone, without orthognathic surgery. The posttreatment records 9 years later showed excellent results with good occlusion, facial balance and harmony, and long-term stability.