Clinical Orthodontic Outcomes Following Secondary Alveolar Bone Grafting in Patients With Cleft Lip and Palate: A Systematic Review

Abstract

Objectives

To examine and synthesize orthodontic outcomes, including treatment feasibility, spontaneous or orthodontically assisted eruption of maxillary canines, and periodontal or alveolar bone-related outcomes, following secondary alveolar bone grafting (SABG) in patients with cleft lip and palate (CLP).

Materials and Methods

A comprehensive PubMed, Scopus, EBSCOhost (MEDLINE), and Cochrane Library search was conducted until February 9, 2025. Randomized controlled trials and observational clinical studies of non-syndromic unilateral or bilateral cleft lip and palate patients who had SABG were eligible. The GRADE framework rated evidence certainty, whereas the Cochrane RoB 2 tool assessed bias in randomized trials and the ROBINS-I instrument in non-randomized research. Narrative synthesis was used due to study design and orthodontic protocol heterogeneity.

Results

From 528 records, 6 studies (1 randomized controlled trial and 5 observational cohorts) with 167 patients met the inclusion criteria. The synthesized results showed that thorough orthodontic mechanics and spontaneous and directed canine eruption into the grafted region were possible after graft integration. Cone-beam computed CT showed excellent short- to mid-term periodontal architecture, including alveolar crest height and no prominent bone dehiscences.

Conclusion

SABG provides a clinically effective foundation for CLP patients’ orthodontic rehabilitation. Directed orthodontic tooth movement and maxillary canine eruption are feasible; however, the low certainty of the evidence means that current data should inform clinical judgment and therapy planning rather than treatment efficacy.

Keywords

cleft lip and palate orthodontic tooth movement secondary alveolar bone grafting orthodontics tooth eruption

Get full access to this article

View all access options for this article.

References

Vandersluis

Fisher

Stevens

Tompson

Lou

Suri

. Comparison of dental outcomes in patients with nonsyndromic complete unilateral cleft lip and palate who receive secondary alveolar bone grafting before or after emergence of the permanent maxillary canine. Am J Orthod Dentofacial Orthop. 2020;157(5):668–679. doi: 10.1016/j.ajodo.2019.11.012

Pinheiro

FHSL

Drummond

Frota

Bartzela

Dos Santos

. Comparison of early and conventional autogenous secondary alveolar bone graft in children with cleft lip and palate: A systematic review. Orthod Craniofac Res. 2020;23(4):385–397. doi: 10.1111/ocr.12394

Jahanbin

Kamyabnezhad

Raisolsadat

Farzanegan

Bardideh

. Long-term stability of alveolar bone graft in cleft lip and palate patients: A systematic review and meta-analysis. J Craniofac Surg. 2022;33(2):e194–e200. doi: 10.1097/SCS.0000000000008254

Pinheiro

FHSL

Drummond

Frota

Bartzela

Dos Santos

Seike

Hashimoto

Matsumoto

Tanaka

Nakanishi

. Early postoperative evaluation of secondary bone grafting into the alveolar cleft and its effects on subsequent orthodontic treatment. J Med Invest. 2012;59(1-2):152–165. doi: 10.2152/jmi.59.152

Chang CS, Wallace CG, Hsiao YC, Chiu YT, Pai BC, Chen IJ, Liao YF, Liou EJ, Chen PK, Chen JP, et al. Difference in the surgical outcome of unilateral cleft lip and palate patients with and without pre-alveolar bone graft orthodontic treatment. Sci Rep. 2016;6:23597. doi: 10.1038/srep23597

Yatabe

Ozawa

Janson

Faco

RAS

Garib

. Are there bone dehiscences in maxillary canines orthodontically moved into the grafted alveolar cleft? Am J Orthod Dentofacial Orthop. 2015;147(2):205–213. doi:10.1016/j.ajodo.2014.10.027

Peled

Aizenbud

Horwitz

Machtei

. Treatment of osseous cleft palate defects: A preliminary evaluation of novel treatment modalities. Cleft Palate Craniofac J. 2005;42(4):344–348. doi: 10.1597/03-141.1

Thuaksuban

Nuntanaranont

Pripatnanont

. A comparison of autogenous bone graft combined with deproteinized bovine bone and autogenous bone graft alone for treatment of alveolar cleft. Int J Oral Maxillofac Surg. 2010;39(12):1175–1180. doi: 10.1016/j.ijom.2010.07.008

10.

Sakio

Sakamoto

Ogata

Sakamoto

Ishii

Kishi

. Effect of platelet-rich plasma on bone grafting of alveolar clefts. J Craniofac Surg. 2017;28(2):486–488. doi: 10.1097/SCS.0000000000003345

11.

Vellone

Cirignaco

Cavarretta

Cascone

. Canine eruption after secondary alveolar bone graft in unilateral cleft lip and palate patients. J Craniofac Surg. 2017;28(5):1206–1210. doi: 10.1097/SCS.0000000000003659

12.

Stonehouse-Smith

Beale

Bellardie

. Radiographic outcome of secondary alveolar bone grafting in patients with alveolar clefts. Orthod Craniofac Res. 2022;25(1):128–133. doi: 10.1111/ocr.12508

13.

Garcia

Yatabe

Fuzer

Calvo

Trindade-Suedam

. Ideal versus late secondary alveolar bone graft surgery: A bone-thickness cone-beam computed tomographic assessment. Cleft Palate Craniofac J. 2018;55(3):369–374. doi: 10.1177/1055665617738401

14.

Garib

Massaro

Yatabe

Janson

Lauris

JRP

. Mesial and distal alveolar bone morphology in maxillary canines moved into the grafted alveolar cleft: Computed tomography evaluation. Am J Orthod Dentofacial Orthop. 2017;151(5):869–877. doi: 10.1016/j.ajodo.2016.11.019

15.

Datana

Chattopadhyay

Kadu

. Bony bridge resorption after secondary alveolar grafting and correlation with success of orthodontic treatment: A prospective volumetric CBCT study. Med J Armed Forces India. 2019;75(4):375–382. doi: 10.1016/j.mjafi.2018.02.005

16.

Stasiak

Wojtaszek-Słomińska

Racka-Pilszak

. Current methods for secondary alveolar bone grafting assessment in cleft’lip and palate patients: A systematic review. J Craniomaxillofac Surg. 2019;47(4):578–585. doi: 10.1016/j.jcms.2019.01.013

17.

Allareddy

Bruun

MacLaine

Markiewicz

Ruiz

Miller

. Orthodontic preparation for secondary alveolar bone grafting in patients with complete cleft lip and palate. Oral Maxillofac Surg Clin North Am. 2020;32(2):205–217. doi: 10.1016/j.coms.2020.01.003

18.

De Mulder

Cadenas de Llano-Pérula

Jacobs

Verdonck

Willems

. Three-dimensional radiological evaluation of secondary alveolar bone grafting in cleft lip and palate patients: A systematic review. Dentomaxillofac Radiol. 2019;48(1):20180047. doi: 10.1259/dmfr.20180047

19.

Minamidate T, Haruyama N, Inoue A, Nomura S, Noguchi K, Yoshizaki K, Takahashi I. Quality of life in preadolescent orthodontic patients before and after secondary alveolar bone grafting. Am J Orthod Dentofacial Orthop. 2022;162(5):e267–e276. doi: 10.1016/j.ajodo.2022.08.012

20.

Fowler

Al-Ani

Thompson

JMD

. Bone fill following secondary alveolar bone grafting for children with cleft of the alveolus in New Zealand. Orthod Craniofac Res. 2019;22(3):153–158. doi: 10.1111/ocr.12305

21.

Caceres Manfio

Suri

Dupuis

Stevens

. Eruption path of permanent maxillary canines after secondary alveolar bone graft in patients with nonsyndromic complete unilateral cleft lip and palate. Am J Orthod Dentofacial Orthop. 2022;161(5):e416–e428. doi: 10.1016/j.ajodo.2021.06.019

22.

Lowry CH, Long RE, Russell K, Giltner JQ, Weaver L, Mercado AM, Beals S, Beals P, Daskalogiannakis J, Hathaway RR, et al. The effect of earlier bone grafting, prior to orthodontic treatment, on SWAG ratings of graft outcomes. Cleft Palate Craniofac J. 2021;58(2):208–214. doi:10.1177/1055665620949433

23.

Bittermann

GKP

de Ruiter

Bittermann

van Es

RJJ

Koole

Rosenberg

AJWP

. Midfacial growth and dental arch relationships in bilateral cleft palate following secondary alveolar bone grafting and orthodontic intervention. J Craniomaxillofac Surg. 2018;46(10):1764–1771. doi: 10.1016/j.jcms.2018.07.014

24.

Preston

Chen

Brennan

Sheller

. Orthodontic treatment protocols in patients with alveolar clefting: A survey of ACPA-approved cleft teams in the United States. Angle Orthod. 2023;93(1):88–94. doi: 10.2319/051522-357.1

25.

Alalola

Asiri

Binmoghaiseeb

Baharoon

Alrassi

Alanizy

Alsayari

. Impact of bone-grafting materials on the rate of orthodontic tooth movement: A systematic review. Cureus. 2023;15(9):e44535. doi: 10.7759/cureus.44535

26.

Saka

Nishizawa

Matsushita

Michigami

Tanaka

Isomura

Kogo

Miyagawa

. Association between the timing of secondary alveolar bone grafting and maxillary permanent central incisor development in unilateral cleft lip and palate. J Craniomaxillofac Surg. 2025;53(10):1795–1803. doi: 10.1016/j.jcms.2025.07.021.

27.

Chinchilla

Tiwari

Alvarado

Flores-Mir

Hirschhaut

. Orthodontic tooth movement for CLP alveolar ridge reconstruction after a homologous lyophilized bone graft combined with platelet-rich plasma. Semin Orthod. 2025;31(5):646–674. doi: 10.1053/j.sodo.2025.02.002

28.

Bartzela

Hoffmann

Kluge

Jäger

Schmechel

Opitz

. Timing matters: Dental development and outcomes on secondary alveolar bone grafting in cleft lip and palate patients. Clin Oral Investig. 2025;29(11):545. doi: 10.1007/s00784-025-06594-w

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.02 MB

0.00 MB