Evaluation of Secondary Alveolar Cleft Reconstruction With Labial and Palatal Lateral Ramus Cortical Grafts: A Case-Series Study

Abstract

Objective

The study aims to evaluate a lateral ramus cortical graft technique for secondary alveolar bone grafting (SABG) in alveolar clefts.

Design

This study is a prospective case series.

Settings

From October 2024 to October 2025.

Patients/Participants

Seven patients of both sexes with unilateral alveolar clefts with an age range of 11 to 15 years old.

Main Outcome Measure(s)

The radiographic 3-dimensional volumetric calculation of graft fill, bone-bridge formation, and graft resorption rates.

Intervention

The cleft defects were reconstructed by the harvest of the mandibular lateral ramus cortical plate, which was cut and adapted to frame the labial and palatal cleft boundaries, while obliterating the intercancellous space with a mixture of cancellous particulates and allogenic demineralized bone matrix (DBM), covered by a collagen membrane.

Results

All grafts were consolidated with acceptable volume. The calculation of the generated models counted: 3.94 ± 0.30 cm³ for volume cleft, 4.41 ± 0.38 cm³ for volume graft, and 3.77 ± 0.36 cm³ for volume bone bridge, with a graft fill rate of 1.12, bone bridge formation rate of 95.6%, and graft resorption rate of 14.51%.

Conclusion

The lateral ramus plate enabled a nearby intramembranous graft to achieve structural integrity and minimal morbidity, with favorable graft fill, bone bridge formation, and resorption rates. Mixing cancellous particulates with allogenic DBM and collagen membrane coverage compensated for the limited cancellous abundance at the donor site and enhanced the graft's osteogenic potential.