Children with cleft lip and palate have special problems related to their teeth and jaws. An orthodontist is a specialist in tooth movement and the orthopedic movement of jaws. Orthodontic treatment does not begin before the eruption of permanent teeth i.e. at age of 6-7 years. The goal of treatment is function (a bite which works well), aesthetics (to achieve a good smile) and stability of the arches. When the teeth have been orthodontically moved to their proper place, the defect in the alveolar arch at the site of the cleft is filled surgically by bone graft. This filling facilitates the eruption of permanent canine teeth. The purpose of the orthodontic treatment is, where possible, to align all the teeth and close all residual spaces without the use of bridges or dentures.

Around 6-7 years of age, some children only need simple orthodontic treatment involving braces to straighten the teeth and no further treatment is necessary. In most cases, however, expansion of the maxilla and bone grafting of the alveolus (tooth bearing portion of the upper jaw) is necessary, with the expansion beginning at about 6 to 7 years of age. The purpose of the expansion is to bring the child's teeth into correct relationship to each other. When this has been done successfully, the bone graft (from the top of the hip bone) is placed to replace the missing bony tissue. The expanded position of the dental arch is maintained for 6 to 12 months by which time the graft should have taken successfully. The procedure should be completed by the age of 10 to 11 years. Full orthodontic alignment can start with the use of fixed braces when all the permanent teeth have erupted (usually by the age of 13 years).