Technique and results of secondary alveolar bone grafting in 221 cleft lip patients

Secondary alveolar bone grafting has become an essential step in the total management of patients with cleft lip. The aims of secondary alveolar bone grafting are to unite cleft alveolar segments and to ensure bony space, not only for canine eruption but also for alignment of malpositioned, inclined, rotated central incisors. In 1996, we introduced secondary alveolar bone grafting in the overall management of cleft lip patients. Since that time, 268 alveolar bone grafts have been performed in 221 patients up to December 31, 2006. The indication for alveolar bone grafting is determined by orthodontists who assess the alveolar bone using CT, dental casts, oral pictures and dental X-rays. As a result, not only the patients with complete alveolar cleft, but also 75 % of the patients with alveolar ridge notching in the edentulous stage required the procedure. Of 221 patients, 90 % were subjected to bone grafting at the stage of mixed dentition prior to the canine eruption. Our technique is based on the method using the mucoperiosteum of the inner wall of the alveolar cleft to close the nasal floor and the palate. The cancellous bone was harvested from the iliac crest. We have improved the details of the procedure through discussion with our orthodontists over 11 years. The results of the bone grafting have been assessed by the orthodontists, and they have diagnosed 89.6 % out of 268 procedures as achieving satisfactory results.