We appreciate the great attention of Drs Soumya Narayani Thirumoorthy and Saumiya Gopal to our case. Before orthodontic treatment, the panoramic radiograph showed a maxillary alveolar cleft. During the orthodontic treatment, the maxillary arch needed to be expanded, so we advised the patient to consult an oral surgeon for alveolar bone grafting. The oral surgeon asked the patient to have a computed tomography scan for following reasons: (1) the patient and his parents were worried about the risk and success rate of the surgery, (2) the oral surgeon could better evaluate the space of the maxillary alveolar cleft with a computed tomography scan from 3 dimensions, (3) the maxilla could be fully observed during expansion because of the wide alveolar cleft, and (4) there was no cone-beam computed tomography in the hospital at that time.

Before taking a computed tomography scan, the patient was informed about the high radiation dose, and he agreed to have the scan. He and his family didn’t want to go to other places for cone-beam computed tomography as well. During the computed tomography scan, we took as many precautions as possible.