Ensuring success in alveolar bone grafting: a three-dimensional approach

Alveolar bone grafting is an integral part of correcting dental arch interruption in those with cleft lip and palate. Often included within a combination of treatment modalities, alveolar grafting must be conducted in a technically effective manner and at the appropriate stage of development in order to maximize outcome and avoid morbidity. Although much regarding this procedure remains unclear, continued research and experience has provided several key insights. Bone grafting appears optimal between maxillary growth completion and maxillary canine eruption (usually between 8 and 10 years of age). Coordination of efforts and planning between surgeon and orthodontist is imperative. Correction of the alveolar defect helps not only restores dental arch continuity, but also supports the nasal base, stabilizes the maxilla, and restores volume to the lip. Appreciation of the 3-dimensional nature of the defect helps to reliably correct the defect in an anatomically correct fashion. Optimization of soft tissue, bony, and, periodontal conditions adjacent to the cleft help maximize the likelihood of success. Staging of the procedure is often necessary to maximize outcome and avoid unnecessary procedures. Here, we review several variables of alveolar bone grating based on current literature as well as our own experience.