Alveolar cleft repair: A 30-year follow-up

Secondary alveolar bone grafting (SABG) is a key surgical procedure in the management of patients with cleft lip and palate, aiming to restore maxillary continuity and support dental development. However, long-term outcomes beyond the first decade remain poorly documented. This study presents a 30-year longitudinal evaluation of SABG outcomes in patients with complete unilateral non-syndromic CLP, focusing on clinical, radiological, and patient-reported outcomes, and identifying predictive factors of surgical success. A retrospective cohort of 32 patients who underwent SABG between 1990 and 1994 was analyzed. Clinical assessment included dental and periodontal evaluation (DMFT index), while radiological success was assessed using Cone Beam CT scan and the Suomalainen Index. Patient-reported outcomes were evaluated using the validated CLEFT-Q questionnaire. Predictors of outcome were explored through uni- and multivariate regression analyses. After 30 years, 56.3% of patients achieved satisfactory radiological outcomes (Suomalainen Index ≥12). Autologous grafting, good oral health (lower DMFT), and compliance with orthodontic treatment were significantly associated with favorable outcomes. In multivariate analysis, only oral health and orthodontic treatment remained independent predictors. Patients with successful grafts reported significantly better quality of life across all CLEFT-Q domains. SABG can provide durable clinical and radiological benefits over three decades, especially when combined with proper orthodontic management and maintained oral health. Integration of PROMs reveals that long-term graft success correlates with improved patient satisfaction and psychosocial well-being.