Cleft Skeletal Iii: Assisted Molar Eruption And Non-Conventional Extractions

Introduction: Cleft lip/palate patients often present with maxillary constriction and dental anomalies. Impacted mandibular second molars may compromise occlusal function, requiring multidisciplinary intervention. This case combines soft tissue fenestration for vertically impacted second molar eruption with non-conventional extractions in a skeletal Class III hyperdivergent cleft patient. Case description: A 15-year-old male with repaired cleft lip/palate exhibited a severely narrow maxillary arch, anterior crossbite, lingual displacement of teeth 12/22, multiple open bites, and vertical impaction of tooth 47 with a dentigerous cyst (Angle Class II, skeletal Class III, hyperdivergent ). Treatment included: Phase 1: Surgical removal of soft tissue and cyst overlying tooth 47, followed by maxillary expansion. After 15 months, tooth 47 erupted into the arch. Phase 2: Extractions of teeth 12, 22, 34, and 44 to relieve crowding, coordinate the dental arches and retract the lower incisors to correct the overjet. Discussion: Soft tissue fenestration preserved alveolar bone by avoiding osteotomy while eliminating eruption resistance via cyst enucleation. Non-conventional extractions addressed anterior crowding (12/22) and coordinated arch width (34/44), compensating for skeletal Class III discrepancy. Conclusion/clinical significance: Rational utilization of soft tissue fenestration and non-conventional extractions facilitates assisted eruption of vertically impacted mandibular second molars and improves overbite/overjet in cleft lip/palate patients with dental arch discrepancies. This approach provides a therapeutic strategy for skeletal Class III hyperdivergent cleft cases, avoiding orthognathic surgery while achieving functional and aesthetic outcomes.