In some cases supernumerary teeth can be used to hold appliances used for expanding palatal segments. Though in some those teeth may naturally rotate themselves into a more normal position after eruption, they may also remain severely rotated and need the help of an orthodontist to straighten them. In bilateral clefts both central incisors may be poorly developed and there may be insufficient supporting alveolar bone. This is especially true when the clefts are wide and the premaxilla is extremely mobile. Nevertheless, these teeth should be retained and rotated into a normal position after the clefts are grafted.
Early rotation can damage the roots and jeopardize the longevity of the teeth.
Naturally, we are anxious to see our children's teeth straightened as soon as possible, but timing is crucial and we must be patient. Teeth that are not solidly anchored in bone can be lost in minor childhood accidents such as bumps or falls. This is usually nothing to be alarmed about, but the orthodontist or dentist should be notified promptly and his recommendations followed. They may be placed in the palate and completely blocked out of the dental arch. Some decisions must be made about the disposition of these teeth as well.