REVIEW ARTICLE
The contemporary approaches to alveolar bone defect management in children with cleft lip and palate. A review
1
Department of Surgical Dentistry and Clinical Subjects, Uzhhorod National University, Uzhhorod, Ukraine
2
Department of Paediatrics, Obstetrics, and Gynaecology, Educational and Scientific Centre “Institute of Biology and Medicine”, Taras Shevchenko Kyiv National University, Kyiv, Ukraine
Submission date: 2025-07-16
Final revision date: 2025-08-06
Acceptance date: 2025-08-06
Online publication date: 2026-09-18
Corresponding author
KEYWORDS
TOPICS
ABSTRACT
The cleft lip and palate belong to the triad of the most common defects in humans. Secondary maxilla bone plasty, as a stage of complex rehabilitation, was first described in the 1970s. Its principle was to restore the dentition and connect the jaw fragments, and move and stabilise the existing teeth in a new position by bone grafting of the alveolar process and implantation of bone tissue (or bone substitute material) into the defect. The approaches to congenital defects of the alveolar process plasty of the upper jaw with congenital facial defects differ significantly in different countries and clinics in terms of timing, type, and processing of bone substitute material, as well as the level of filling of the alveolar defect. Comprehensive rehabilitation of such patients includes alveolar process osteoplasty, which is a promising direction in the development of maxillofacial surgery and surgical dentistry, and it contains some poorly understood and unexplored aspects.
REFERENCES (72)
1.
Kharkov LV, Yakovenko LM. Congenital clefts of the upper lip and palate. Methodological manual for dentists, pediatricians, ENT specialists, psychologists, speech therapists. Knyga Plus, Kyiv 2004; 84 p. [In Ukrainian].
2.
Larsen PE. Reconstruction of the Alveolar Cleft. In: Peterson’s Principles of oral and maxillofacial Surgery. Miloro M, Ghali GE, Larsen PE, Waite P (eds.). Springer Nature 2004; 859-870.
3.
Dixon MJ, Marazita ML, Beaty TH, Murray JC. Cleft lip and palate: understanding genetic and environmental influences. Nat Rev Genet. 2011; 12(3): 167-178.
4.
Lee TJ, Kim ST. A survey of cleft lip and palate management taught in training programs in Korea. Cleft Palate Craniofac J. 2003; 40(1): 80-83.
5.
Heliövaara A, Leikola J. Guideline 00158. Cleft lip and palate. Helsinki: DUODECIM Medical Publications, Ltd. 2018. 7 p. URL: https://guidelines.moz.gov.ua/....
6.
Batra P, Sybil D, Izhar A, Batra P, Thiruvenkatachari B. Standard of care for patients with cleft lip and palate in India-a questionnaire-based study. Cleft Palate Craniofac J. 2023; 60(5): 536-543.
7.
Bagheri SC, Bell RB, Khan HA. Cleft lip and palate: timing and approaches to reconstruction. Curr Ther Oral Maxillofac Surg. 2011; 1: 726-749.
8.
Bajaj AK, Wongworawat AA, Punjabi A. Management of alveolar clefts. J Craniofac Surg. 2003; 14(6): 840-846.
9.
Abyholm FE, Bergland O, Semb G. Secondary bone grafting of alveolar clefts. A surgical/orthodontic treatment enabling a non-prosthodontic rehabilitation in cleft lip and palate patients. Scand J Plast Recontr Surg. 1981; 15(2): 127-140.
10.
Szyszka-Sommerfeld L, Woźniak K, Matthews-Brzozowska T, Kawala B, Mikulewicz M. Electromyographic analysis of superior orbicularis oris muscle function in children surgically treated for unilateral complete cleft lip and palate. J Craniomaxillofac Surg. 2017; 45(9): 1547-1551.
11.
Szyszka-Sommerfeld L, Machoy ME, Wilczyński S, Lip- ski M, Woźniak K. Superior orbicularis oris muscle activity in children surgically treated for bilateral complete cleft lip and palate. J Clin Med. 2021; 10(8): 1720.
12.
Turri de Castro Ribeiro T, Aliaga-Del Castillo R, Oza- wa TO, Ramalho-Ferreira G, Aliaga-Del Castillo A, Janson G. Late alveolar bone grafting in complete unilateral cleft lip and palate (UCLP): Biomechanical considerations for the success of orthodontic finishing. J Orthod. 2022; 49(4): 457-462.
13.
Kane G, Good S. A national survey of current practice in pre-alveolar bone graft orthodontics in the United Kingdom. J Orthod. 2025; 52(2): 177-182.
14.
Anver TD, Mirzai L, Li P, Powell KK, Waite PD. Long-term postoperative cone-beam computed tomography analysis of secondary bone grafting in 79 patients with unrepaired alveolar clefts. J Oral Maxillofac Surg. 2020; 78(7): 1164-1170.
15.
Bergland O, Semb G, Abyholm FE. Elimination of the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment. Cleft Palate J. 1986; 23(3): 175-205.
16.
Crockett DJ, Goudy SL. Cleft lip and palate. Facial Plast Surg Clin North Am. 2014; 22(4): 573-586.
17.
Ennemark H, Sindet-Pedersen S, Bundgaard M. Long-term results after secondary bone grafting of alveolar clefts. J Oral Maxillofac Surg. 1987; 4(11): 913-919.
18.
Berkowitz S. A comparison of treatment results in complete bilateral cleft lip and palate using a conservative approach versus Millard-Latham PSOT procedure. Semin Orthod. 1996; 2: 169-184.
19.
Rosenthal AH, Buchman SR. Volume maintenance of inlay bone grafts in the craniofacial skeleton. Plast Reconstr Surg. 2003; 112(3): 802-811.
20.
Trindade IK, Mazzottini R, Silva Filho OG, Trindade IEK, Deboni MCZ. Long-term radiographic assessment of secondary alveolar bone grafting outcomes in patients with alveolar clefts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 100(3): 271-277.
21.
Feichtinger M, Mossböck R, Kärcher H. Assessment of bone resorption after secondary alveolar bone grafting using three-dimensional computed tomography: a three-year study. Cleft Palate Craniofac J. 2007; 44(2): 142-148.
22.
Honma K, Kobayashi T, Nakajima T, Hayasi T. Computed tomographic evaluation of bone formation after secondary bone grafting of alveolar clefts. J Oral Maxillofac Surg. 1999; 57(10): 1209-1213.
23.
Han K, Jeong W, Yeo H, Choi J, Kim J, Son D, Oh S, Kim C. Longterm results of secondary alveolar bone grafting using a technique to harvest pure calvarial cancellous bone: evaluation based on plain radiography and computed tomography. J Plast Reconstr Aesth Surg. 2017; 70(3): 352-359.
24.
Kindelan J, Roberts-Harry D. A 5-year post-operative review of secondary alveolar bone grafting in the Yorkshire region. Br J Orthod. 1999; 26(3): 211-217.
25.
Hynes PJ, Earley MJ. Assessment of secondary alveolar bone grafting using a modification of the Bergland grading system. Br J Plast Surg. 2003; 56(7): 630-636.
26.
Long RE Jr, Paterno M, Vinson B. Effect of cuspid positioning in the cleft at the time of secondary alveolar bone grafting on eventual graft success. Cleft Palate Craniofac J. 1996; 33(3): 225-230.
27.
Nightingale C, Witherow H, Reid FD, Edler R. Comparative reproducibility of three methods of radiographic assessment of alveolar bone grafting. Eur J Orthod. 2003; 25(1): 35-41.
28.
Witherow H, Cox S, Jones E, Carr R, Waterhouse N. A new scale to assess radiographic success of secondary alveolar bone grafts. Cleft Palate Craniofac J. 2002; 39(3): 255-260.
29.
Boyne PJ, Sands NR. Secondary bone grafting of residual alveolar and palatal clefts. J Oral Surg. 1972; 30(2): 87-92.
30.
Nordin KE, Johnason B. Frei knochentransplantation bei defektem in alveolar kamm nach kiefer-orthopadischen einstellung der maxilla bei lippengaumenspalten. Fortschritten der Kiefer und Gesichts-Kirurspalten 1955; 1: 121-126.
31.
Chhajlani R, Chhajlani P, Bonanthaya K, Mahajan RK. Alveolar bone grafting and gingivoperiosteoplasty in bilateral cleft lip and palate. Curr Opin Otolaryngol Head Neck Surg. 2021; 29(4): 327-332.
32.
Jabbari F, Hakelius MM, Thor ALI, Reiser EA, Skoog VT, Nowinski DJ. Skoog primary periosteoplasty versus secondary alveolar bone grafting in unilateral cleft lip and alveolus: long-term effects on alveolar bone formation and maxillary growth. Plast Reconstr Surg. 2017; 139(1): 137-148.
33.
Brudnicki A, Petrova T, Dubovska I, Kuijpers-Jagtman AM, Ren Y, Fudalej PS. Alveolar bone grafting in unilateral cleft lip and palate: impact of timing on palatal shape. J Clin Med. 2023; 12(24): 7519.
34.
Bushong EE, Patmon D, Pfershy H, Huffman C, Carlson A, Girotto J. Timing of alveolar bone graft and barriers to care. Cleft Palate Craniofac J. 2025; 62(7): 1190-1194.
35.
Benitez BK, Weibel SK, Halbeisen FS, Lill Y, Nalabothu P, Tache A, Mueller AA. Craniofacial growth at age 6-11 years after one-stage cleft lip and palate repair: a retrospective comparative study with historical controls. Children (Basel). 2022; 9(8): 1228.
36.
Millard DR Jr, Latham RA. Improved primary surgical and dental treatment of clefts. Plast Reconstr Surg. 1990; 86(5): 856-871.
37.
Ma L, Yali H, Guijun L, Dong F. Effectiveness of corticocancellous bone graft in cleft lip and palate patients: a systematic review. J Stomatol Oral Maxillofac Surg. 2021; 122(1): 33-38.
38.
Friede H, Johanson B. Adolescent facial morphology of early bone-grafted cleft lip and palate patients. Scand J Plast Reconstr Surg. 1982; 16(1): 41-53.
39.
Ross RB. Treatment variables affecting facial growth in complete unilateral cleft lip and palate. Cleft Palate J. 1987; 24(1): 75-77.
40.
Grayson BH, Santiago PE, Brecht LE, Cutting CB. Presurgical nasoalveolar molding in infants with cleft lip and palate. Cleft Palate Craniofac J. 1999; 36(6): 486-498.
41.
Pinholt EM, Solheim E, Talsnes O, Larsen TB, Bang G, Kirkeby OJ. Revascularization of calvarial, mandibular, tibial, and iliac bone grafts in rats. Ann Plast Surg. 1994; 33(2): 193-197.
42.
Kerwin SC, Lewis DD, Elkins AD, Oliver J, Pechman R, McCarthy RJ, Hosgood G. Deep-frozen allogenic cancellous bone grafts in 10 dogs: a case series. Vet Surg. 1996; 25(1): 18-28.
43.
Sadove AM, Nelson CL, Eppley BL, Nguyen B. An evaluation of calvarial and iliac donor sites in alveolar cleft grafting. Cleft Palate J. 1990; 27(3): 225-229.
44.
Varidel A, Ambrose M, DiTullio N, Fritschy T, Padwa BL, Resnick CM. Can alveolar bone grafting using posterior iliac crest be a day surgery procedure? Cleft Palate Craniofac J. 2025; 62(7): 1151-1155.
45.
O’Keeffe RM Jr, Riemer BL, Butterfield SL. Harvesting of autogenous cancellous bone graft from the proximal tibial metaphysis. A review of 230 cases. J Orthop Trauma. 1991; 5(4): 46-74.
46.
Catone GA, Reimer BL, McNeir D, Ray R. Tibial autogenous cancellous bone as an alternative donor site in maxillofacial surgery: a preliminary report. J Oral Maxillofac Surg. 1992; 50(12): 1258-1263.
47.
Besly W, Ward Booth P. Technique for harvesting tibial cancellous bone modified for use in children. Br J Oral Maxillofac Surg. 1999; 37(2): 129-133.
48.
Ilankovan V, Stronczek M, Telfer M, Peterson LJ, Stas- sen LF, Ward-Booth P. A prospective study of trephined bone grafts of the tibial shaft and iliac crest. Br J Oral Maxillofac Surg. 1998; 36(6): 434-439.
49.
Chen YC, Chen CH, Chen PL, Huang IY, Shen YS, Chen CM. Donor site morbidity after harvesting of proximal tibia bone. Head Neck. 2006; 28(6): 496-500.
50.
Van Damme PA, Merkx MA. A modification of the tibial bone-graft harvesting technique. Int J Oral Maxillofac Surg. 1996; 25(5): 346-348.
51.
Kortebein MJ, Nelson CL, Sadove AM. Retrospective analysis of 135 secondary alveolar cleft grafts using iliac or calvarial bone. J Oral maxillofac Surg. 1991; 4(5): 493-498.
52.
La Rossa D, Buchman S, Rothkopf DM, Mayro R, Randall P. A comparison of iliac and cranial bone in secondary grafting of alveolar clefts. Plast Reconstr Surg. 1995; 9(4): 789-797.
53.
Wolfe SA, Berkowitz S. The use of cranial bone grafts in the closure of alveolar and anterior palatal clefts. Plast Reconstr Surg. 1983; 72(5): 659-761.
54.
Denny AD, Talisman R, Bonawitz SC. Secondary alveolar bone grafting using milled cranial bone graft: a retrospective study of a consecutive series of 100 patients. Cleft Palate Craniofac J. 1999; 36(2): 144-153.
55.
Tessier P, Kawamoto H, Posnick J, Raulo Y, Tulasne JF, Wolfe SA. Complications of harvesting autogenous bone grafts: a group experience of 20,000 cases. Plast Reconstr Surg. 2005; 116 (5 suppl): 72-73.
56.
Jackson IT, Helden G, Marx R. Skull bone grafts in maxillofacial and craniofacial surgery. J Oral Maxillofac Surg. 1986; 44(12): 949-955.
57.
Kline RM Jr, Wolfe SA. Complications associated with the harvesting of cranial bone grafts. Plast Reconstr Surg. 1995; 95(1): 5-20.
58.
Fearon JA. A magnetic resonance imaging investigation of potential subclinical complications after in situ cranial bone graft harvest. Plast Reconstr Surg. 2000; 105(6): 1935-1939.
59.
Borstlap WA, Heidbuchel KL, Freihofer HP, Kuijpers-Jagtman AM. Early secondary bone grafting of alveolar cleft defects. A comparison between chin and rib grafts. J Craniomaxillofac Surg. 1990; 18(5): 201-205.
60.
Koole R. Ectomesenchymal mandibular symphysis bone graft: an improvement in alveolar cleft grafting? Cleft Palate Craniofac J. 1994; 31(3): 217-223.
61.
Booij A, Raghoebar GM, Jansma J, Kalk WWI, Vissink A. Morbidity of chin bone transplants used for reconstructing alveolar defects in cleft patients. Cleft Palate Craniofac J. 2005; 42(5): 533-538.
62.
Freihofer HP, Borstlap WA, Kuijpers-Jagtman AM, Voorsmit RA, van Damme PA, Heidbüchel KL, Borstlap- Engels VM. Timing and transplant materials for closure of alveolar clefts. A clinical comparison of 296 cases. J Craniomaxillofac Surg. 1993; 21(4): 143-148.
63.
Park YW, Lee JH. Use of mandibular chine bone for alveolar bone grafting in cleft patients. Maxillofac Plast Reconstr Surg. 2016; 38(1): 45.
64.
Bahr W, Coulon JP. Limits of the mandibular symphysis as a donor site for bone grafts in early secondary cleft palate osteoplasty. Int J Oral Maxillofac Surg. 1996; 25(5): 389-393.
65.
Weijs WL, Siebers TJ, Kuijpers-Jagtman AM, Bergé SJ, Meijer GJ, Borstlap WA. Early secondary closure of alveolar clefts with mandibular symphyseal bone graft and beta-tri calcium phosphate (beta-TCP). Int J Oral Maxillofac Surg. 2010; 39(5): 424-429.
66.
Shirzadeh A, Rahpeyma A, Khajehahmadi S. A prospective study of chin bone graft harvesting for unilateral maxillary alveolar cleft during mixed dentition. J Oral Maxillofac Surg. 2018; 76(1): 180-188.
67.
Eppley BL, Sadove AM. Management of alveolar cleft bone grafting state of the art. Cleft Palate Craniofac J. 2000; 37(3): 229-233.
68.
Horswell BB, Henderson JM. Secondary osteoplasty of the alveolar cleft defect. J Oral Maxillofac Surg. 2003; 61(9): 1082-1090.
69.
Ochs MW. Alveolar cleft bone grafting (Part II): Secondary bone grafting. J Oral Maxillofac Surg. 1996; 54(1): 83-88.
70.
Lee KC, Costandi JJ, Carrao V, Eisig SB, Perrino MA. Autogenous iliac crest versus rhBMP-2 for alveolar cleft grafting: a 14-year single-institution experience. J Oral Maxillofac Surg. 2021; 79(2): 431-440.
71.
Marquez JL, Sudduth J, DeMay H, Kuo K, Battistini A, Yamashiro DK, Siddiqi FA, Gociman B. Early results on the efficacy of demineralized bone matrix, bone morphogenic protein, and freeze-dried bone chips in alveolar cleft repair. Plast Reconstr Surg Glob Open. 2024; 12(2): e5600.
72.
Zielinski E, Santiago CN, Santiago GS, Zelko I, Hlavin R, Choudhary A, Purnell CA. Differences in practice in alveolar bone grafting among american cleft palate-craniofacial association members. Cleft Palate Craniofac J. 2023; 60(11): 1404-1410.
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