Alveolar Bone Grafting and Cleft Lip and Palate: A Review

Alveolar bone grafting in the mixed dentition stage is an accepted step in the management of cleft alveoli, providing maxillary arch support for dentition and mastication. Points of contention regarding best practices remain, including specific timing, perioperative orthodontic management, bone harvest and substitutes, pain management, and outcomes evaluations. SCO-PUS and MEDLINE were searched for articles about alveolar bone grafting, which were read independently by two authors and selected for inclusion on the basis of relevance and merit. Articles on which recommendations were based were rated using the methodological index for non-randomized studies criteria. Three hundred thirty-three distinct articles were found, of which 64 were found to be suitable and relevant for inclusion. The average methodological index for non-randomized studies score was 10.39, with an interrater weighted kappa of 0.7301. Prospective comparative studies about alveolar bone grafting are rare, but available evidence suggests grafting before canine eruption with targeted preoperative orthopedic interventions, the continued use of iliac crest corticocancellous autologous graft, and adjunctive pain control methods. Greater consensus must be reached about valuable outcome measures for research, including use of imaging and indications for regrafting following graft failure.