We read the article titled “Interdisciplinary treatment for an adult with a unilateral cleft lip and palate” (Ma QL, Conley RS, Wu T, Li H. Am J Orthod Dentofacial Orthop 2014;146:238-48) with great interest, and really appreciate the combined efforts of the team that produced a good esthetic result for the cleft patient. But we are very curious to know the indication for taking a computed tomography scan. The periapical and panoramic radiographs clearly demonstrate the difference in the cleft size from pretreatment to posttreatment. Considering its high radiation dose, a computed tomography scan would be justified only if diagnostically warranted.

Furthermore, the authors mentioned that the “panoramic radiograph… showed a wide alveolar cleft between the maxillary left central incisor and the canine” but failed to address this issue by secondary bone grafting. Therefore, neither cleft surgery nor implant placement necessitated a computed tomography scan; as a cleft lip and palate patient, the patient would have already undergone multiple radiographic exposures from childhood, so why add to his exposure burden?