The art of secondary alveolus bone grafting

Secondary alveolar bone grafting has become an essential step in the total management of cleft lip patients. 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 a malpositioned, inclined, and rotated central incisor. We have refined the details of the procedure in consultation with our orthodontists. Our technique is based on use of the mucoperiosteum of the inner wall of the alveolar cleft to close the nasal floor and palate. This enables bone grafting behind the premaxilla. In addition, the timing of grafting is important to achieve success. The results of bone grafting were assessed by the orthodontists, who determined that 92.2 % of 564 procedures achieved satisfactory results. We herein discuss the timing of grafting, procedure technique, and the importance of collaboration with orthodontists.