Alveolar bone grafting: past, present, and new horizons

Abstract

Alveolar bone grafting is an important part of the reconstructive journey for many cleft lip and palate patients. The reconstruction of the alveolar cleft can provide both aesthetic and functional benefits to the patient. To be able to effectively treat alveolar clefts, it is essential to possess an understanding of several aspects of the problem. Acquiring this knowledge will allow the provider to treat the different variants of the cleft alveolus. In this article, the author will discuss anatomy, history, techniques, controversies, and new technologies to provide the reader with new insight into treating this challenging condition.

Keywords: alveolar cleft; bone graft sources; bone morphogenic protein; cleft lip; cleft palate; primary alveolar cleft grafting; secondary alveolar bone grafting.

Figures

Fig. 1

Dental x-ray that shows unerupted permanent teeth above an unoperated cleft.

Fig. 2

Dental x-ray of teeth erupting into an unoperated cleft.

Fig. 3

(A–C) The alveolar and hard palate cleft should be viewed as a three-dimensional defect resembling a triangle or pyramid. (Reprinted with permission from Craven C, Cole P, Hollier L Jr, Stal S. Ensuring success in alveolar bone grafting: a three-dimensional approach. J Craniofac Surg 2007;18(4):855–859)

Fig. 4

(A) The alveolar cleft after packing with cortical and cancellous bone. (B,C) Cortical bone reinforcing the roof of the cleft (nasal floor) and the anterior wall of the alveolus. (Reprinted with permission from Craven C, Cole P, Hollier L Jr, Stal S. Ensuring success in alveolar bone grafting: a three-dimensional approach. J Craniofac Surg 2007;18(4):855–859)