Secondary bone grafting in cleft lip and palate patients is performed preferably before the eruption of permanent canine in order to provide adequate periodontal support for eruption and preservation of the teeth adjacent to the cleft. Presented here with is a case of unilateral cleft lip and palate, which was followed up from birth to 15 years of age. The role of an orthodontist in the team approach for management of such anomalies is described. Also discussed in detail is the entire range of treatment procedures the child underwent, especially the role of secondary bone grafting.